Proctalgia fugax has many triggers
Proctalgia fugax or functional recurrent anorectal pain is part of a spectrum of functional gastrointestinal disorders defined by the Rome III diagnostic criteria as episodes of sharp fleeting pain that recur over weeks, are localized to the anus or lower rectum, and last from seconds to several minutes with no pain between episodes.1 There is no diurnal variation. There are numerous precipitants including sexual activity, stress, constipation, defecation and menstruation, although the condition can occur without a trigger. It should be differentiated from chronic proctalgia, a functional anorectal pain disorder with a vague, dull ache or pressure sensation high in the rectum, often worse when sitting than when standing or lying down, and lasts at least 20 minutes.1
Proctalgia fugax is common
The prevalence of proctalgia fugax in the general population may be as high as 8%–18%.2 Many patients present to primary health care physicians and often do not require further consultation because the symptoms are fleeting.3 This condition is more common among women than among men,3 and usually affects patients between 30 and 60 years of age.4
Anal sphincter spasm may cause the pain in proctalgia fugax
Although the cause of proctalgia fugax is unclear, spasm of the anal sphincter is commonly implicated.5 The condition may be more likely to occur after sclerotherapy for hemorrhoids and vaginal hysterectomy. There are also associations with other functional pathologies, such as irritable bowel syndrome and anxiety.5
Proctalgia fugax is a diagnosis of exclusion
Other causes of anorectal pain (e.g., hemorrhoids, cryptitis, ischemia, abscess, fissure, rectocele and malignant disease) must be excluded before the diagnosis can be made.6
Treatments relax the anal sphincter spasm
Most treatments for proctalgia fugax (e.g., oral diltiazem, topical glyceryl nitrate, nerve blocks) act by relaxing the anal sphincter spasm, but the effectiveness of these treatments are supported only by case reports or case series, with the exception of a single randomized controlled trial of salbutamol,7 making the value of most treatment options, including salbutamol, difficult to judge. See Appendix 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.101613/-/DC1) for a management pathway that may provide symptom relief.5 Reassurance of patients is paramount.
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Footnotes
Competing interests: None declared.
This article has been peer reviewed.
References
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