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 51% of patients (1)
    • usually occurs at night - occurs with intervals of weeks to many months
    • prevalence estimates range from 8 to 18% (1)
      • 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 (1)
  • diagnosis
    • based on symptoms alone
    • there are no physical examination findings or laboratory tests that support the diagnosis
  • treatment
    • reassurance and explantation is all that is required for most patientts because episodes of pain are so brief
      • however a small group of patients have proctalgia fugax on a frequent basis and may require active treatment - there is study evidence showing that inhalation of salbutamol (a beta adrenergic agonist) shortens the duration of episodes of proctalgia (3)

Reference:

1. Whitehead WE et al.Functional disorders of the anus and rectum. Gut. 1999 Sep;45 Suppl 2:II55-9.
2. Doctor (5/2/2005):27
3. Eckardt VF, Dodt O, Kanzler G, et al. Treatment of proctalgia fugax with salbutamol inhalation. Am J Gastroenterol 1996;91:686-689