Proctalgia fugax

Proctalgia fugax is a poorly-understood syndrome of severe intermittent, usually sudden, but short-lived, deep rectal pain.  Patients describe it as feeling like someone just stuck a sword up their behind.  The pain may be so severe that the patient will fall down onto the ground, immobile until it passes.  Often, sufferers will be awoken from sleep with the pain.  Fortunately the pain usually only lasts for a matter of seconds.  But in some patients it can be longer.  Even if it is short-lived, it may be followed by a dull pelvic ache that may last a day or so.  Some sufferers experience it once or twice a year, but others may have it once or twice a week.  No one knows what really causes proctalgia fugax but it is thought to be due to spasms in some of the muscles in the floor of the pelvis.  It is sometimes seen in patients that strain a lot to have bowel movements or do a lot of heavy lifting.  Interestingly, it is more often left-sided than right-sided and sometimes a patient will have tenderness in the left-sided pelvic floor muscles when they are pulled on during a rectal examination by an experienced examiner. This tenderness is somewhat ‘diagnostic’ of the disease. The good news is that proctalgia fugax is a benign disorder.  A pelvic ultrasound and flexible sigmoidoscopy are reasonable tests to rule out more serious pathology.  A variety of treatments are recommended – a sure fire way of knowing that no one treatment works for everyone.  Treatments vary from pelvic floor muscle massage by the patient, to electrogalvanic stimulation of the muscles in special rectal pain clinics.

© Pezim Clinic, Vancouver, British Columbia, Canada