Proctalgia fugax in adults
Proctalgia fugax is an episodic condition characterised by sudden short attacks of intense sharp, stabbing or cramping pain, in the region of the internal anal sphincter and the anorectal ring. Typically, the pain wakes the patient from sleep, but it can occur at any time.
Diagnosis of proctalgia fugax (based on the 2016 Rome IV criteria) is made if the patient fulfils all the following criteria:
- symptoms present for at least 3 months
- no anorectal pain between episodes
- other causes of rectal pain (eg inflammatory bowel disease, anal fissure) have been excluded
- episodes last from seconds to minutes with a maximum duration of 30 minutes
- episodes are recurrent, localised to the rectum and are unrelated to defecationRome Foundation Inc., 2016.
The aetiology of proctalgia fugax is unknown, but pain may be related to spasm of the pelvic floor and the rectosigmoid musculature. Proctalgia fugax occurs in up to 18% of people.
The mainstay of management is reassurance and explanation that the episodes are brief and self-limiting; for many patients this is all that is required. Other strategies include local warmth (eg warm bath), immediate ingestion of food or drink, and firm pressure to the perineum. For severe debilitating symptoms, anecdotal evidence suggests pain may be relieved by inhaled salbutamol, antispasmodic drugs, calcium channel blockers, clonidine or glyceryl trinitrate.