Digestive Health Irritable Bowel Syndrome How Proctalgia Fugax Is Diagnosed By Barbara Bolen, PhD twitter Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome. Learn about our editorial process Barbara Bolen, PhD Medically reviewed by Medically reviewed by Robert Burakoff, MD, MPH on October 20, 2020 linkedin Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York. Learn about our Medical Review Board Robert Burakoff, MD, MPH on October 20, 2020 Print Short attacks of pain in your rectal area may be caused by a condition known as proctalgia fugax. This is a common gastrointestinal (GI) disorder that affects adults and is more prevalent in women. If you're experiencing pain in your anus, it is something to discuss with your doctor. However, the symptoms of proctalgia fugax are well defined and it's typically not a condition to worry about. Portra Images / Taxi / Getty Images What Is Proctalgia Fugax? Proctalgia fugax means anal pain without an identifiable cause. When Rome III, a set of diagnostic guidelines for GI disorders, was replaced by Rome IV in 2016, the classification system for proctalgia disorders changed. Thus, the previous diagnosis of chronic proctalgia instead became categorized as three distinct conditions: proctalgia fugax, levator ani syndrome, or unspecified anorectal pain. Proctalgia fugax is a condition in which a person experiences episodes of sudden and severe rectal pain. The pain may last a few seconds or a few minutes before going away completely, and no longer than 30 minutes. Though it's not completely understood, the cause of the pain may be due to spasms of the muscles of the pelvic floor, rectum, or anal sphincter. There is also some indication that compression of the primary nerve in the anal and genital region — called the pudendal nerve — may cause such short and intermittent pains. For most people who have proctalgia fugax, these attacks are fairly infrequent and occur less than five times per year. Proctalgia fugax is estimated to affect anywhere from 4 to 18 percent of the population, depending on the study. Though it affects both men and women, it is somewhat more prevalent in women. It typically affects people between 30 and 60 years old. Symptoms The pain of proctalgia fugax is experienced in the anus or rectum. You may experience this pain as an ache or cramp and some people describe it as a gnawing or stabbing pain. The intensity of the pain can vary widely and typically does not radiate beyond the anorectal area. Causes Quite often, the pain occurs out of the blue and patients really cannot narrow down a trigger for it. However, at other times there may be identifiable triggers such as constipation or while you're having a normal bowel movement. It can also be experienced during or after sex or while you have your period. For some people, it occurs during times of high anxiety or stress. Proctalgia fugax may occur after having undergone sclerotherapy for hemorrhoid or a hysterectomy. People who have irritable bowel syndrome (IBS) also may be at higher risk of experiencing proctalgia fugax. Diagnosis As a functional gastrointestinal disorder (FGD), proctalgia fugax is diagnosed only after all other disease possibilities have been ruled out. Your doctor will do a physical examination. They may also recommend diagnostic tests that would be appropriate to make sure that there is not something more seriously wrong. It's possible that they may inquire about your psychological health as well. There are some indications that depression and anxiety may cause proctalgia fugax in some people. Rome IV Criteria Being an FGD, proctalgia fugax is diagnosed based on symptoms and criteria established by the Rome IV criteria. To meet these criteria:You must report symptoms for at least 12 weeks of repeating episodes of pain in your rectum. These do not necessarily have to be consecutive.The episodes must be of extremely short duration — no more than a few minutes.You must not experience any pain in that area in between episodes. Treatment Since the symptoms of proctalgia fugax are so fleeting, there is not much need for symptomatic treatment. Typically, doctors are encouraged to be supportive and explain the nature of the syndrome to put your mind at ease. Some of the treatments for relief they recommend may be warm baths to relax your muscles. The effectiveness of medications such as diltiazem (a common hypertension prescription) and topical glyceryl nitrate do not yet have sufficient evidence for proctalgia fugax. Was this page helpful? Thanks for your feedback! One of the most challenging aspects of having IBS is trying to figure out what's safe to eat. Our recipe guide makes it easier. Sign up and get yours now! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Jeyarajah S, Purkayastha S. Proctalgia fugax. Canadian Medical Association Journal. 2012;185(5):417-417. doi:10.1503/cmaj.101613 Jeyarajah S, Chow A, Ziprin P, Tilney H, Purkayastha S. Proctalgia fugax, an evidence-based management pathway. Int J Colorectal Dis. 2010;25(9):1037-1046. doi:10.1007/s00384-010-0984-8 Simren M, Palsson OS, Whitehead WE. Update on Rome IV criteria for colorectal disorders: Implications for clinical practice. Curr Gastroenterol Rep. 2017;19(4). doi:10.1007/s11894-017-0554-0 Rao SS, Bharucha AE, Chiarioni G, et al. Anorectal disorders. Gastroenterology. 2016;150(6):1430-1442.e4. doi:10.1053/j.gastro.2016.02.009 Takano M. Proctalgia fugax: Caused by pudendal neuropathy? Diseases of the Colon & Rectum. 2005;48(1):114-120. doi:10.1007/s10350-004-0736-3 Bharucha AE, Trabuco E. Functional and chronic anorectal and pelvic pain disorders. Gastroenterology clinics of North America. 2008;37(3):685-96, ix. doi:10.1016/j.gtc.2008.06.002 de Parades V, Etienney I, Bauer P, Taouk M, Atienza P. Proctalgia fugax: Demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients. Diseases of the Colon & Rectum. 2007;50(6):893-898. doi:10.1007/s10350-006-0754-4 Singh G. Proctalgia fugax with dysthymia. Indian J Psychiatry. 2006;48(2):126-. doi:10.4103/0019-5545.31606 Additional Reading Foxx-Orenstein AE, Umar SB, Crowell MD. Common anorectal disorders. Gastroenterology & Hepatology. 2014;10(5):294-301. Schmulson MJ, Drossman DA. What is new in Rome IV. Journal of Neurogastroenterology and Motility. 2017;23(2):151-163.