Proctalgia Fugax: Causes, Symptoms, And Treatments - Healthline

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Medically reviewed by Meredith Goodwin, MD, FAAFP — Written by Diana Wells — Updated on December 10, 2021

Symptoms
Causes
Diagnosis
Proctalgia fugax vs. levator syndrome
Management and treatment
Associated conditions
Outlook

Proctalgia fugax is anal pain with no specific cause. It occurs from intense muscle spasms in or around the canal of the anus. It can be severe enough to impact your day-to-day life.

Anyone can experience proctalgia fugax. But it doesn’t usually affect anyone prior to the start of puberty and seems to affect more women than men, according to one 2017 review.

Symptoms of proctalgia fugax

The symptoms of proctalgia fugax are:

muscle spasms in or around the lower rectum area or in or around the canal of the anus
pain that happens suddenly and usually without warning
pain that lasts for only a few seconds, although it can last up to 30 minutes in some cases

These episodes may be severe enough to keep you home from work. They may limit your other activities until the episode is over.

The pain will usually stop on its own. People with proctalgia fugax don’t have any anal pain between spasms. There can be long periods of time between spasms.

The pain or spasms that occur at night may be painful enough to wake you from sleep. They can also occur during the day.

Causes of proctalgia fugax

Proctalgia fugax isn’t known to have specific triggers. But a 2005 study suggested that it may be caused by an issue with the pudendal nerves. It often happens after an injection procedure for hemorrhoids called sclerotherapy or after a vaginal hysterectomy.

Other possible triggers may be:

sexual activity
menstruation
constipation
defecation
stress

Despite some evidence that there are some possible triggers like those listed above, it’s also common for proctalgia fugax to occur without anything triggering it.

How is proctalgia fugax diagnosed?

Proctalgia fugax is normally diagnosed after other possible causes of anal pain and spasms have been ruled out. In order to rule out other conditions that may be causing the pain, your doctor may:

conduct a physical exam
ask questions about the pain severity, duration, etc.
check for hemorrhoids, fissures, an abscess, and other diseases or conditions that might cause anal pain

Once other conditions have been ruled out as the cause of your pain, your doctor will be able to diagnose proctalgia fugax.

Proctalgia fugax vs. levator syndrome

Anal pain is classified according to three types. Each of the three types has unique characteristics.

Proctalgia fugax: As described above, this type is characterized by intermittent pains in the rectum that can last up to 30 minutes.

Levator ani syndrome: This type features pain or tenderness in the pelvic area and rectum that’s more lasting and may result in discomfort sitting for long periods. People with this condition experience pain in the rectum during a digital rectal exam.

Unspecified functional anorectal pain: This type features pain or tenderness in the pelvic area and rectum similar to levator ani syndrome, but no pain during a digital rectal exam.

Management and treatment of proctalgia fugax

There are several treatment options, but getting relief from the symptoms is different for each person. Since there isn’t a specific cause, treatment focuses on managing the symptoms. If a trigger has been identified, then that trigger should also be managed.

At-home treatments

Home treatments focus on relieving the pain from the spasms. Options include:

warm baths or sitz baths
relaxation techniques
over-the-counter pain medications
ointments prescribed by a doctor, like glyceryl trinitrate or topical diltiazem

Injections

If your spasms are severe, you may be a candidate for Botox injections in the area.

Electrical stimulation

This treatment works by the use of a probe inserted into the anus that carries electric stimulation. This can help to block the transmission of pain signals to the brain.

Biofeedback

This treatment uses attached electrodes to guide you in feeling what happens when the pelvic floor is tensed and relaxed. It can help you learn how to relax the pelvic floor muscles to relieve discomfort.

Associated conditions for proctalgia fugax

While proctalgia fugax doesn’t have a specific cause, there are some conditions that may be associated or that commonly occur at the same time. Some of these include menstruation and constipation.

Many times, an episode of these painful anal spasms can be associated with psychological issues like anxiety, depression, or stress.

Other conditions that may have an association with proctalgia fugax are anal fissures and abscesses, as well as rectal cancer.

Outlook

If you have anal pain of any kind, it’s important that you discuss it with a medical professional. This pain can be a symptom of a disease or condition that needs to be addressed.

But if no other condition or disease is found to be causing the pain, and you’re diagnosed with proctalgia fugax, there are treatments that can help manage the episodes.

If the pain and spasms seem to be related to times when you have an increase in stress or feel depressed, counseling or therapy may be recommended.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Anal pain (proctalgia). (2016).http://www.nhs.uk/conditions/anal-pain/Pages/Introduction.aspx
Anal pain. (n.d.).https://www.bowelresearchuk.org/about-bowels/other-bowel-disorders/anal-pain/
Bharucha AE, et al. (2016). Anorectal and pelvic pain.http://www.mayoclinicproceedings.org/article/S0025-6196(16)30503-1/fulltext#sec3
Carrington, EV et al. (2020). Proctalgia syndromes: Update in diagnosis and management.https://pubmed.ncbi.nlm.nih.gov/32519087/
Karlovsky, M et al. (2011). Pelvic floor dysfunction: A treatment update.https://www.practicalpainmanagement.com/pain/other/musculoskeletal/pelvic-floor-dysfunction-treatment-update
Simren, M et al. (2017). Update on Rome IV criteria for colorectal disorders: Implications for clinical practice.https://link.springer.com/article/10.1007%2Fs11894-017-0554-0
Takano, M. (2005). Proctalgia fugax: caused by pudendal neuropathy?https://pubmed.ncbi.nlm.nih.gov/15690667/

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Medically reviewed by Meredith Goodwin, MD, FAAFP — Written by Diana Wells — Updated on December 10, 2021

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