How Proctalgia Fugax Is Diagnosed

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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.

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:

  1. 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.
  2. The episodes must be of extremely short duration — no more than a few minutes.
  3. 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.

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