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Proctalgia fugax

October 15, 2023

Proctalgia fugax, a variant of levator ani syndrome, is a severe, episodic pain in the regions of the rectum and anus.[1] It can be caused by cramping of the levator ani muscle, particularly in the pubococcygeal part.[2]

Proctalgia fugax
SpecialtyGeneral surgery

Signs and symptoms Edit

It most often occurs in the middle of the night[3] and lasts from seconds to minutes;[4] pain and aching lasting twenty minutes or longer would likely be diagnosed instead as levator ani syndrome. In a study published in 2007 involving 1809 patients, the attacks occurred in the daytime (33 percent) as well as at night (33 percent) and the average number of attacks was 13. Onset can be in childhood; however, in multiple studies the average age of onset was 45. Many studies showed that women are affected more commonly than men,[5] but this can be at least partly explained by men's reluctance to seek medical advice concerning rectal pain.[6] Data on the number of people affected vary, but prevalence may be as high as 8–18%.[4][7] It is thought that only 17–20% of patients consult a physician, so obtaining accurate data on occurrence presents a challenge.[4]

During an episode, the patient feels spasm-like, sometimes excruciating, pain in the rectum or anus, often misinterpreted as a need to defecate. To be diagnosed as proctalgia fugax, the pain must arise de novo (meaning the absence of clear cause). As such, pain associated with constipation (either chronic, or acute), penetrative anal intercourse, trauma (such as tears or fissures of the rectal sphincter or anal canal), side-effects of some medications (particularly opiates), or rectal foreign body insertion preclude this diagnosis. The pain episode subsides by itself as the spasm disappears on its own, but may reoccur.[4]

Because of the high incidence of internal anal sphincter thickening with the disorder, it is thought to be a disorder of that muscle or that it is a neuralgia of pudendal nerves. It is not known to be linked to any disease process.

Prevention Edit

High-voltage pulsed galvanic stimulation (HGVS) has been shown to be of prophylactic benefit, to reduce the incidence of attacks. The patient is usually placed in the left lateral decubitus position and a sterile probe is inserted into the anus. The negative electrode is used and the stimulator is set with a pulse frequency of 80 to 120 cycles per second. The voltage (intensity) is started at 0, progressively raised to a threshold of patient discomfort, and then is decreased to a level that the patient finds comfortable. As the patient's tolerance increases, the voltage can be gradually increased to 250 to 350 Volts. Each treatment session usually lasts between 15 and 60 minutes. Several studies have reported short-term success rates that ranged from 65 to 91%.[8][9][10][11]

A low dose of oral diazepam taken at night may be of benefit for frequent or disabling attacks.[12]

Treatment Edit

For milder cases, simple reassurance and topical treatment with a calcium channel blocker such as diltiazem, or nifedipine ointment, salbutamol inhalation and topical nitroglycerine. For persistent cases, local anesthetic blocks, clonidine or botulinum toxin injections can be considered.[13][14] Supportive treatments directed at aggravating factors include high-fiber diet, withdrawal of drugs which have gut effects (e.g., drugs that provoke or worsen constipation including narcotics and oral calcium channel blockers; drugs that provoke or worsen diarrhea including quinidine, theophylline, and antibiotics), warm baths, rectal massage, perineal strengthening exercises, anticholinergic agents, non-narcotic analgesics, sedatives or muscle relaxants such as diazepam. In patients who have frequent, severe, prolonged attacks, inhaled salbutamol has been shown in some studies to reduce their duration.[15]

Traditional remedies have ranged from cannabis suppositories, warm baths (if the pain lasts long enough), warm to hot enemas,[16] and relaxation techniques.[17]

References Edit

  1. ^ Alberts, Daniel (2012). Dorland's illustrated medical dictionary (32nd ed.). Philadelphia, PA: Saunders/Elsevier. p. 1521. ISBN 978-1-4160-6257-8.
  2. ^ Olden, Kevin W. (1996). Handbook of functional gastrointestinal disorders. New York: M. Dekker. p. 369. ISBN 0-8247-9409-5.
  3. ^ Takano M (2005). "Proctalgia fugax: caused by pudendal neuropathy?". Dis. Colon Rectum. 48 (1): 114–20. doi:10.1007/s10350-004-0736-3. PMID 15690667. S2CID 792567.
  4. ^ a b c d Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS (September 1999). "Functional disorders of the anus and rectum". Gut. 45 (Suppl 2): II55–9. doi:10.1136/gut.45.2008.ii55. PMC 1766682. PMID 10457046.
  5. ^ de Parades V, Etienney I, Bauer P, Taouk M, Atienza P (2007). "Proctalgia fugax: demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients". Dis. Colon Rectum. 50 (6): 893–8. doi:10.1007/s10350-006-0754-4. PMID 17164968. S2CID 11697730.
  6. ^ Brannon, Linda; Feist, Jess (2009-03-19). Health Psychology: An Introduction to Behavior and Health. Cengage Learning. p. 54. ISBN 978-0495601326.
  7. ^ Jeyarajah, Santhini; Purkayastha, Sanjay (2013-03-19). "Proctalgia fugax". Canadian Medical Association Journal. 185 (5): 417. doi:10.1503/cmaj.101613. ISSN 1488-2329. PMC 3602260. PMID 23184844.
  8. ^ Sohn N, Weinstein MA, Robbins RD. The levator syndrome and its treatment with high-voltage electrogalvanic stimulation. Am J Surg. 1982;144(5):580-582.
  9. ^ Oliver GC, Rubin RJ, Salvati EP, Eisenstat TE. Electrogalvanic stimulation in the treatment of levator syndrome. Dis Colon Rectum. 1985;28(9):662-663.
  10. ^ Nicosia JF, Abcarian H. Levator syndrome: A treatment that works. Dis Colon Rectum. 1985;28(6):406-408.
  11. ^ Morris L, Newton RA. Use of high voltage pulsed galvanic stimulation for patients with levator ani syndrome. Phys Ther. 1987;67(10):1522-1525
  12. ^ Pfenninger JL, Zainea GG (2001). "Common anorectal conditions: Part I. Symptoms and complaints". Am Fam Physician. 63 (12): 2391–8. PMID 11430454.
  13. ^ Jeyarajah S, Chow A, Ziprin P, Tilney H, Purkayastha S (September 2010). "Proctalgia fugax, an evidence-based management pathway". Int J Colorectal Dis. 25 (9): 1037–46. doi:10.1007/s00384-010-0984-8. PMID 20556402. S2CID 8635926.
  14. ^ Wollina U, Konrad H, Petersen S (2005). "Botulinum toxin in dermatology - beyond wrinkles and sweat". Journal of Cosmetic Dermatology. 4 (4): 223–7. doi:10.1111/j.1473-2165.2005.00195.x. PMID 17168867. S2CID 11333698.
  15. ^ Eckardt VF, Dodt O, Kanzler G, Bernhard G (1996). "Treatment of proctalgia fugax with salbutamol inhalation". Am. J. Gastroenterol. 91 (4): 686–9. PMID 8677929.
  16. ^ Olsen B (2007). "Proctalgia fugax - a nightmare drowned in enema". Colorectal Disease. 10 (5): 522–3. doi:10.1111/j.1463-1318.2007.01399.x. PMID 17949444. S2CID 45958437.
  17. ^ Carrington EV, Popa SL, Chiarioni G (June 2020). "Proctalgia Syndromes: Update in Diagnosis and Management". Curr Gastroenterol Rep. 22 (7): 35. doi:10.1007/s11894-020-00768-0. PMID 32519087.

External links Edit

  • PatientPlus

October 15, 2023
proctalgia, fugax, variant, levator, syndrome, severe, episodic, pain, regions, rectum, anus, caused, cramping, levator, muscle, particularly, pubococcygeal, part, specialtygeneral, surgery, contents, signs, symptoms, prevention, treatment, references, externa. Proctalgia fugax a variant of levator ani syndrome is a severe episodic pain in the regions of the rectum and anus 1 It can be caused by cramping of the levator ani muscle particularly in the pubococcygeal part 2 Proctalgia fugaxSpecialtyGeneral surgery Contents 1 Signs and symptoms 2 Prevention 3 Treatment 4 References 5 External linksSigns and symptoms EditIt most often occurs in the middle of the night 3 and lasts from seconds to minutes 4 pain and aching lasting twenty minutes or longer would likely be diagnosed instead as levator ani syndrome In a study published in 2007 involving 1809 patients the attacks occurred in the daytime 33 percent as well as at night 33 percent and the average number of attacks was 13 Onset can be in childhood however in multiple studies the average age of onset was 45 Many studies showed that women are affected more commonly than men 5 but this can be at least partly explained by men s reluctance to seek medical advice concerning rectal pain 6 Data on the number of people affected vary but prevalence may be as high as 8 18 4 7 It is thought that only 17 20 of patients consult a physician so obtaining accurate data on occurrence presents a challenge 4 During an episode the patient feels spasm like sometimes excruciating pain in the rectum or anus often misinterpreted as a need to defecate To be diagnosed as proctalgia fugax the pain must arise de novo meaning the absence of clear cause As such pain associated with constipation either chronic or acute penetrative anal intercourse trauma such as tears or fissures of the rectal sphincter or anal canal side effects of some medications particularly opiates or rectal foreign body insertion preclude this diagnosis The pain episode subsides by itself as the spasm disappears on its own but may reoccur 4 Because of the high incidence of internal anal sphincter thickening with the disorder it is thought to be a disorder of that muscle or that it is a neuralgia of pudendal nerves It is not known to be linked to any disease process Prevention EditHigh voltage pulsed galvanic stimulation HGVS has been shown to be of prophylactic benefit to reduce the incidence of attacks The patient is usually placed in the left lateral decubitus position and a sterile probe is inserted into the anus The negative electrode is used and the stimulator is set with a pulse frequency of 80 to 120 cycles per second The voltage intensity is started at 0 progressively raised to a threshold of patient discomfort and then is decreased to a level that the patient finds comfortable As the patient s tolerance increases the voltage can be gradually increased to 250 to 350 Volts Each treatment session usually lasts between 15 and 60 minutes Several studies have reported short term success rates that ranged from 65 to 91 8 9 10 11 A low dose of oral diazepam taken at night may be of benefit for frequent or disabling attacks 12 Treatment EditFor milder cases simple reassurance and topical treatment with a calcium channel blocker such as diltiazem or nifedipine ointment salbutamol inhalation and topical nitroglycerine For persistent cases local anesthetic blocks clonidine or botulinum toxin injections can be considered 13 14 Supportive treatments directed at aggravating factors include high fiber diet withdrawal of drugs which have gut effects e g drugs that provoke or worsen constipation including narcotics and oral calcium channel blockers drugs that provoke or worsen diarrhea including quinidine theophylline and antibiotics warm baths rectal massage perineal strengthening exercises anticholinergic agents non narcotic analgesics sedatives or muscle relaxants such as diazepam In patients who have frequent severe prolonged attacks inhaled salbutamol has been shown in some studies to reduce their duration 15 Traditional remedies have ranged from cannabis suppositories warm baths if the pain lasts long enough warm to hot enemas 16 and relaxation techniques 17 References Edit Alberts Daniel 2012 Dorland s illustrated medical dictionary 32nd ed Philadelphia PA Saunders Elsevier p 1521 ISBN 978 1 4160 6257 8 Olden Kevin W 1996 Handbook of functional gastrointestinal disorders New York M Dekker p 369 ISBN 0 8247 9409 5 Takano M 2005 Proctalgia fugax caused by pudendal neuropathy Dis Colon Rectum 48 1 114 20 doi 10 1007 s10350 004 0736 3 PMID 15690667 S2CID 792567 a b c d Whitehead WE Wald A Diamant NE Enck P Pemberton JH Rao SS September 1999 Functional disorders of the anus and rectum Gut 45 Suppl 2 II55 9 doi 10 1136 gut 45 2008 ii55 PMC 1766682 PMID 10457046 de Parades V Etienney I Bauer P Taouk M Atienza P 2007 Proctalgia fugax demographic and clinical characteristics What every doctor should know from a prospective study of 54 patients Dis Colon Rectum 50 6 893 8 doi 10 1007 s10350 006 0754 4 PMID 17164968 S2CID 11697730 Brannon Linda Feist Jess 2009 03 19 Health Psychology An Introduction to Behavior and Health Cengage Learning p 54 ISBN 978 0495601326 Jeyarajah Santhini Purkayastha Sanjay 2013 03 19 Proctalgia fugax Canadian Medical Association Journal 185 5 417 doi 10 1503 cmaj 101613 ISSN 1488 2329 PMC 3602260 PMID 23184844 Sohn N Weinstein MA Robbins RD The levator syndrome and its treatment with high voltage electrogalvanic stimulation Am J Surg 1982 144 5 580 582 Oliver GC Rubin RJ Salvati EP Eisenstat TE Electrogalvanic stimulation in the treatment of levator syndrome Dis Colon Rectum 1985 28 9 662 663 Nicosia JF Abcarian H Levator syndrome A treatment that works Dis Colon Rectum 1985 28 6 406 408 Morris L Newton RA Use of high voltage pulsed galvanic stimulation for patients with levator ani syndrome Phys Ther 1987 67 10 1522 1525 Pfenninger JL Zainea GG 2001 Common anorectal conditions Part I Symptoms and complaints Am Fam Physician 63 12 2391 8 PMID 11430454 Jeyarajah S Chow A Ziprin P Tilney H Purkayastha S September 2010 Proctalgia fugax an evidence based management pathway Int J Colorectal Dis 25 9 1037 46 doi 10 1007 s00384 010 0984 8 PMID 20556402 S2CID 8635926 Wollina U Konrad H Petersen S 2005 Botulinum toxin in dermatology beyond wrinkles and sweat Journal of Cosmetic Dermatology 4 4 223 7 doi 10 1111 j 1473 2165 2005 00195 x PMID 17168867 S2CID 11333698 Eckardt VF Dodt O Kanzler G Bernhard G 1996 Treatment of proctalgia fugax with salbutamol inhalation Am J Gastroenterol 91 4 686 9 PMID 8677929 Olsen B 2007 Proctalgia fugax a nightmare drowned in enema Colorectal Disease 10 5 522 3 doi 10 1111 j 1463 1318 2007 01399 x PMID 17949444 S2CID 45958437 Carrington EV Popa SL Chiarioni G June 2020 Proctalgia Syndromes Update in Diagnosis and Management Curr Gastroenterol Rep 22 7 35 doi 10 1007 s11894 020 00768 0 PMID 32519087 External links EditPatientPlus Retrieved from https en wikipedia org w index php title Proctalgia fugax amp oldid 1161591521, wikipedia, wiki, book, books, library,

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