Proctalgia fugax

Overview
Proctalgia fugax is a severe, episodic, anal pain. It can be caused by cramp of the pubococcygeus or levator ani muscles.

Presentation
It most often occurs in the middle of the night and lasts approximately 20 minutes, occasionally 30 minutes or longer. Because pain threshold drops during sleep it intensifies as you go to sleep and wakes the sufferer up again. Most sufferers encounter it less than 6 times a year and can go for many months without an episode. Onset can be in childhood. One study showed that men were affected more commonly than women.

During an episode, the patient feels spasm-like pain in the anus, often misinterpreted as a need to defecate. Simultaneous stimulation of the local autonomic system can cause erection in males. It is a disorder of skeletal muscle, it is recurrent and there is also no known cure. It is not known to be linked to any disease process and data on the number of people afflicted varies, but is more prevalent than usually thought.

Like all ordinary muscle cramps it is a severe, deep rooted pain.

It has been reported to occur immediately following ejaculation.

Episodes happen almost always with an empty colon. Defaecation of any faeces present can to worsen the spasm, but may relieve it, or provide a measure of comfort. The pain might subside by itself as the spasm disappears on its own, or may persist or reoccur during the same night. At the time it can seem like 'it will never go away'.

In males there seems to be some indication that prolonged and tense sexual arousal may lead to an episode later that night.

Treatment and prevention
Traditional remedies have ranged from warm baths (if the pain lasts long enough to draw a bath), warm to hot enemas, relaxation techniques,gentle massage of the anus, and various medications. None of these is effective, however.

The use of botulinum toxin has been proposed, as has diazepam.

An episode may sometimes be avoided by making sure not to engage in sexual activity within a close time proximity to defecation. Those afflicted can usually tell after either sex or after defecation whether they would be in danger of an episode if they were to engage in the other activity, the potential onset of an episode being usually preceded by a very slight version of the pain that will eventually become much more intense.

Several people have expirienced relief by cold water enema. Also, moist heat, for example a warm wet towel has been reported to have more or less effect.