Proctalgia fugax

Proctalgia fugax

• • clinical features
    • a severe, cramp-like pain of the rectum
    • lasts several seconds or minutes to up to half an hour
    • pain then disappears completely
    • attacks are infrequent, occurring less than five times a year in half of patients
    • usually occurs at night - occurs with intervals of weeks to many months
    • prevalence estimates range from 8 to 18%
      • only 17-20% of those affected report the symptoms to their physicians
      • prevalence rates in men and women vary
  • pathophysiology and psychological factors
    • identification of physiological mechanisms is difficult because of the short duration and sporadic, infrequent nature of this disorder
    • there is study evidence to suggest that smooth muscle spasm may be the cause of proctalgia fugax
    • psychological testing has revealed that many patients are perfectionistic, anxious, and/or hypochondriacal
  • diagnosis
    • based on symptoms alone
    • there are no physical examination findings or laboratory tests that support the diagnosis
    • ideally, proctoscopy should be carried out (2)
  • treatment
    • reassurance and explanation is all that is required for most patients because episodes of pain are so brief
    • in patients who experience frequent, severe, prolonged attacks, inhaled salbutamol has been shown to reduce their duration (3)

Reference:

1. Simren M, Palsson OS, Whitehead WE; Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice. Curr Gastroenterol Rep. 2017 Apr;19(4):15.
2. Guidelines on Chronic Pelvic Pain; European Association of Urology (2020)
3. Bharucha AE, Trabuco E; Functional and chronic anorectal and pelvic pain disorders. Gastroenterol Clin North Am. 2008 Sep;37(3):685-96, ix.