- Amy Barto, MD
Amy Barto, MD
- Lahey Clinic Medical Center
- Burlington, MA
- Kristen M Robson, MD, MBA, FACG
Kristen M Robson, MD, MBA, FACG
- Assistant Professor
- Tufts University School of Medicine
Proctalgia fugax is a functional anorectal disorder characterized by severe, intermittent episodes of rectal pain that are self-limited. The diagnosis of proctalgia fugax requires exclusion of other causes of rectal or anal pain.
This topic will review the epidemiology, clinical manifestations, diagnosis, and management of proctalgia fugax. Other functional gastrointestinal disorders and disorders that affect the anus or rectum are discussed separately. (See "Clinical manifestations and diagnosis of irritable bowel syndrome in adults" and "Perianal abscess: Clinical manifestations, diagnosis, treatment" and "Anal fissure: Clinical manifestations, diagnosis, prevention" and "Hemorrhoids: Clinical manifestations and diagnosis" and "Perianal complications of Crohn disease" and "Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults" and "Clinical presentation, diagnosis, and staging of colorectal cancer" and "Clinical features, staging, and treatment of anal cancer".)
Proctalgia fugax is estimated to affect 4 to 18 percent of the general population [1-7]. However, only 17 to 20 percent of patients report their symptoms to their physicians. Although proctalgia has been reported in patients ranging from 10 to 87 years of age, it usually affects individuals between 46 and 58 years [1,8-13]. Proctalgia fugax has a higher prevalence in women as compared with men (58 to 84 percent) [1,5,6,9,10,12,14].
The sporadic and transient nature of proctalgia fugax has limited efforts to determine the underlying pathophysiologic basis, but spasm of the anal sphincter, pudendal nerve compression, neuropathy, and psychological factors have been implicated.
Muscle spasm/hypertrophy — Patients with proctalgia fugax have normal anorectal pressures when asymptomatic, but exhibit motor abnormalities of the anal smooth muscle during an acute attack [9,13,15,16]. In one study that included 18 patients with proctalgia fugax, anorectal manometry demonstrated slightly increased resting anal pressures, but no differences in squeeze pressure, sphincter relaxation, rectal compliance, or internal and external anal sphincter thickness . In two patients, anorectal manometry provoked symptoms of proctalgia fugax. Furthermore, increasing duration of pain was associated with an increase in anal resting tone and slow wave amplitude. An autosomal dominant inherited myopathy of the internal anal sphincter has also been associated with proctalgia fugax [17,18].
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- Muscle spasm/hypertrophy
- Nerve compression
- Psychologic factors
- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- Initial treatment
- - Topical antispasmodics
- Subsequent and alternative approaches
- - Inhaled beta agonists
- - Oral antihypertensives
- - Botulinum toxin and nerve blocks
- - Psychologic treatment
- - Other
- SUMMARY AND RECOMMENDATIONS