Proctalgia fugax: causes, treatment and what the pain is

Proctalgia means pain around the back passage, and fugax is a Latin word meaning fleeting. Proctalgia fugax is therefore a short-lasting pain in the rectum or anus. Patient.info explains that it is one of several conditions that cause anal or rectal pain, sometimes called ano-rectal pain, and that it is a type of levator ani syndrome.

The pain can be alarming because it is so sudden and severe, but it passes quickly. Patient.info says that up to one in five people may experience it at some point. It is thought to be quite common.

Often no treatment is needed. Patient.info says the episodes are infrequent and, if you know it is nothing to worry about, you know the pain will settle quickly on its own. In a few people it is more troublesome. There are no proven treatments, but for those people the options include a salbutamol inhaler (the same inhaler used in asthma, because it relaxes muscle), a cream that works on the blood vessels around the anus such as glyceryl trinitrate or diltiazem cream, or an injection into the nerve to make it less sensitive.

The NHS suggests general measures for anal pain, which may be sensible if constipation is a trigger: drink lots of fluid and eat more fibre to keep stools soft, exercise regularly, and avoid straining or ignoring the urge to go. Warm baths are suggested for easing pain, and a pharmacist can advise on laxatives or pain relief.

The cause is not exactly understood. Patient.info says it is believed to be due to spasms of the muscles of the anus, which are very strong muscles because they are the ones used to hold in stool and relax to let it out.

Often there is no reason, but in some cases the pain can be triggered by having sex, opening the bowels, being constipated, having a period or stress. In some people it starts after an operation, for example an injection for piles or a hysterectomy. It seems to be more common in people who have irritable bowel syndrome and in people who have anxiety symptoms.

According to Patient.info, pain occurs on several occasions over a few weeks, each time lasting only seconds or minutes. It is a sudden, cramping, severe pain. It may wake you in the night. You may get a cluster of attacks together, but in many people the attacks do not happen very often, and in between episodes there is no pain at all.

Importantly, it does not cause bleeding. That is one of the main features that separates it from conditions such as piles or anal fissures, which are described in the NHS information on anal pain as causing blood on the paper after wiping.

• A sudden, severe, cramping pain in the back passage.

• Each attack lasts only seconds or minutes.

• It may wake you in the night, and attacks sometimes come in clusters over a few weeks.

• No pain at all between episodes, and no bleeding.

The NHS says anal pain is common and has many different causes, and advises not to try to diagnose the cause of pain yourself. It sets out some of the common causes in a table, which is helpful for seeing how proctalgia fugax differs.

Patient.info explains the difference as mostly about how long the pain lasts. Proctalgia fugax is over within seconds or minutes, and you feel normal in between. Levator ani syndrome pain tends to be worse when sitting, lasts at least 20 minutes, is usually an aching pain high in the back passage, and is often there all the time or comes and goes persistently for months. It is also called chronic anal pain syndrome and affects around 6 in 100 people, according to the same leaflet.

The treatments differ. For levator ani syndrome, the leaflet lists biofeedback therapy, in which you learn to relax the pelvic floor muscles, as the option with the most encouraging evidence, with electrical stimulation, botulinum toxin and nerve stimulation as other options.

The NHS says to see a GP if your anal pain is severe, does not improve after a few days, or you have blood in your poo or bleeding from your bottom. It also advises asking for an urgent GP appointment or contacting NHS 111 if you have severe anal pain with a high temperature or feeling hot, cold or shivery, or if your poo is black or dark red. It says to go to A&E or call 999 if you are bleeding non-stop or there is a lot of blood.

Patient.info adds that if you have occasional fleeting pains, no bleeding and a normal examination, you are likely to have proctalgia fugax and will not need more tests, but that you should return to the doctor if anything changes, for example if you get bleeding or the pain becomes more persistent.

A doctor will ask how long the pain lasts, whether it is related to opening the bowels and whether there are other symptoms, in particular bleeding. They will examine the outside of the anus and may feel inside with a gloved finger, and may look with a short tube called a proctoscope.

If more investigation is needed, Patient.info says you may be referred to a gastroenterologist or colorectal surgeon, and tests might include a sigmoidoscopy, an ultrasound scan, an MRI scan or anorectal manometry, which measures the pressure of anal muscle contractions. Not everybody needs all of these.

On the NHS the first contact is usually a pharmacist or GP, who can examine you and exclude other causes. Persistent or unusual pain may lead to referral to a colorectal service for tests such as sigmoidoscopy or manometry. Private colorectal clinics can offer quicker access to examination and tests, though the approach to proctalgia fugax itself, reassurance and, rarely, a trial of treatment, is the same in either setting.