Digestive Health Irritable Bowel Syndrome What Is Proctalgia Fugax? A condition that causes fleeting rectal spasms and pain By Barbara Bolen, PhD 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 Updated on August 03, 2022 Medically reviewed by Chika Anekwe, MD Medically reviewed by Chika Anekwe, MD LinkedIn Chika Anekwe, MD, MPH, is a board-certified obesity medicine physician at Massachusetts General Hospital focusing on clinical nutrition and weight management. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Anorectal Pain Conditions Symptoms Causes Diagnosis Treatment Proctalgia fugax is a condition characterized by brief sudden spasms of rectal pain. These attacks can last up to 30 minutes before disappearing. It affects adults and is more prevalent in women. Its exact cause is not certain, but proctalgia fugax is believed to stem from activity of a muscle or nerve issue. Proctalgia fugax is diagnosed when identifiable causes of rectal pain have been excluded. This article provides an overview of proctalgia fugax, including its symptoms, when it tends to occur, possible reasons why, and how it's diagnosed and treated. Portra Images / Taxi / Getty Images Anorectal Pain Conditions Proctalgia fugax is one of three subtypes of functional anorectal pain that have this symptom but that do not have an identifiable cause. While proctalgia fugax and two other conditions were once lumped together under the name chronic proctalgia, each is now considered a unique condition: Proctalgia fugax: Anorectal pain that is occasional and temporary with no symptoms between episodes. Levator ani syndrome: Persistent, long-lasting, and often chronic anorectal pain. Unspecified anorectal pain: Cases that don't fit the other two categories. Chronic Proctalgia Replaced by Its Subtype Syndromes Symptoms of Proctalgia Fugax The pain of proctalgia fugax is solely experienced in the anus or rectum. People describe it as: AchingCrampingGnawingStabbing The pain is sudden and may last a few seconds or a few minutes before going away completely. The intensity of the pain can vary widely, and it is often severe. In most cases, these attacks are fairly infrequent and occur less than five times per year. What Causes Proctalgia Fugax? Proctalgia fugax pain may be due to spasms of the muscles of the pelvic floor, rectum, or anal sphincter. Compression of the primary nerve in the anal and genital region—called the pudendal nerve—may also cause these short and intermittent pains. In addition, there is some evidence to suggest that the nervous system's messages between the brain and digestive tract are altered in people who experience proctalgia fugax. Why these issues may occur is not well understood. Quite often, the pain occurs spontaneously and people really cannot narrow down a cause. Sometimes, there may be identifiable situations that precede proctalgia fugax episodes, including: Bowel movementsConstipationDuring/after sexDuring menstruationTimes of high anxiety or stress Proctalgia fugax may also occur after sclerotherapy for hemorrhoid treatment or after a hysterectomy. People who have irritable bowel syndrome (IBS) also may be at higher risk of experiencing this condition. Diagnosis As a functional gastrointestinal disorder (FGD), proctalgia fugax is diagnosed only after all other disease possibilities have been ruled out. Diagnoses that will be considered include: Hemorrhoids, a condition affecting veins in the rectum Rectal abscess, a pocket filled with pus in the rectum Anal fissure, a tear in the lining of the anus Rectocele, a weakening of the wall between the vagina and rectum A healthcare provider may also rule out a psychological or behavioral health condition as well, since some cases of proctalgia fugax may be linked to anxiety and depression. This will involve a physical examination, diagnostic tests, and potentially other evaluations. Being an FGD, proctalgia fugax is diagnosed based on a specific set of symptoms and 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 short duration.You must not experience any pain in that area in between episodes. Pelvic Pain During Pregnancy: Causes, Diagnosis, and Treatment How Proctalgia Fugax Is Treated An important part of treatment for proctalgia fugax is knowing that, although painful, the condition is not serious. Your healthcare provider is likely to be supportive and explain your symptoms. Some of the recommended treatments may include warm baths to relax your muscles. Medication Medication may be an option in more severe cases. Drugs including clonidine and diltiazem (which are typically used to treat hypertension) have been tried without any significant findings from study results. Salbutamol (albuterol), a bronchodilator used to treat asthma, appeared to limit the duration of pain when studied in an older drug trial. Topical therapy at the onset of rectal pain/spasm can be attempted using rectal nitroglycerin or diltiazem gel, although its benefit is not clear. Specialist-Driven Procedures Exercises and biofeedback also may be used to treat proctalgia fugax due to its likely association with pelvic floor muscle function. In some cases, dietary changes may help with pelvic floor dysfunction. Electrical stimulation, as well as treatments for functional anorectal pain using Botox, also are under investigation. Frequently Asked Questions Can proctalgia fugax cause fainting? Proctalgia fugax can cause severe pain that leads to fainting, but this is rare. If this happens to you, see your healthcare provider to get evaluated for other potential causes. Can autoimmune diseases cause rectal pain? Autoimmune diseases are not known to cause rectal pain, but certain types can cause abdominal symptoms. Who is affected by proctalgia fugax? Proctalgia fugax is estimated to affect between 8% to 18% of the population. Though it affects men too, it is more common in women. It typically affects people between the ages of 30 and 60. 10 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. Knowles CH, Cohen RC. Chronic anal pain: A review of causes, diagnosis, and treatment. Cleve Clin J Med. 2022 Jun 1;89(6):336-343. doi:10.3949/ccjm.89a.21102. 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 Zhang Q, Liu Y, Zhang Q, Zhang Y, Wu S, Jiang B, et al. Impaired Anorectal Afferents Is a Potential Pathophysiological Factor Associated to Functional Anorectal Pain. Front Neurol. 2020 Oct 9;11:577025. doi:10.3389/fneur.2020.577025. Jeyarajah S, Purkayastha S. Proctalgia fugax. CMAJ. 2013;185(5):417. doi:10.1503/cmaj.101613 Carrington EV, Popa SL, Chiarioni G. Proctalgia Syndromes: Update in Diagnosis and Management. Curr Gastroenterol Rep. 2020 Jun 9;22(7):35. doi:10.1007/s11894-020-00768-0. American Society of Colon and Rectal Surgeons. Pelvic Floor Dysfunction. Ooijevaar RE, Felt-Bersma RJF, Han-Geurts IJ, van Reijn D, Vollebregt PF, Molenaar CBH. Botox treatment in patients with chronic functional anorectal pain: experiences of a tertiary referral proctology clinic. Tech Coloproctol. 2019 Mar;23(3):239-244. doi:10.1007/s10151-019-01945-8. Medical University of South Carolina (MUSC). Proctalgia. Johns Hopkins Medicine. What Are Common Symptoms of Autoimmune Disease? 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. By Barbara Bolen, PhD Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit