Proctalgia fugax

Pathophysiology/treatment

Defined as episodic spasms of pain localized to the rectum and anus occurring at irregular intervals and without an identifiable cause, proctalgia fugax is highly prevalent, occurring in 14-19% of healthy subjects [36]. Episodes are normally brief (seconds to minutes) and infrequent (usually <6/year). Proctalgia fugax is not the same as chronic proctalgia, which is pain that is more continuous in nature and typically of lower intensity. Spasms of the sigmoid colon, levator ani, and/or pelvic floor musculature have been postulated as sources of the pain. Local anorectal pathology (fissures, abscesses) needs to be ruled out as alternative treatable sources of pain and spasm. Various activities may precipitate episodes such as bowel movements, sexual activity, stress, and temperature changes. As a consequence, avoidance behaviors may occur, with obvious consequences for quality of life.

No etiology or method of treating/preventing proctalgia fugax has been universally accepted. The brief nature of most episodes makes most reactive pharmacologic treatments inadequate since the episode resolves spontaneously prior to the onset of treatment effects. Inhaled salbutamol, clonidine, nitroglycerine, antispasmodics, botulinum A toxin, and calcium channel blockers have all been reported as effective in either reactive or preventive fashions, but none in controlled trials. Heat or pressure applied to the perineum, food/drink consumption, dilation of the anal sphincter, assumption of a knee-to-chest position, and assumption of other postures have also been anecdotally reported as beneficial.

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