Proctalgia fugax

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ICD10 = ICD10|K|59|4|k|55
ICD9 = ICD9|564.6
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Proctalgia fugax is a severe, episodic, anal pain. It can be caused by cramp of the pubococcygeus or levator ani muscles.cite book |author=Olden, Kevin W. |title=Handbook of functional gastrointestinal disorders |publisher=M. Dekker |location=New York |year=1996 |pages=369 |isbn=0-8247-9409-5 |oclc= |doi=]

Presentation

It most often occurs in the middle of the nightcite journal |author=Takano M |title=Proctalgia fugax: caused by pudendal neuropathy? |journal=Dis. Colon Rectum |volume=48 |issue=1 |pages=114–20 |year=2005 |pmid=15690667 |doi=] and lasts approximately 20 minutes, occasionally 30 minutes or longer. Because pain threshold drops during sleep, the pain intensifies as the sufferer goes to sleepFact|date=January 2008 and wakes up the sufferer again. Most sufferers encounter it fewer than six times a year and can go for many months without an episode. Onset can be in childhood. One study showed that women were affected more commonly than men.cite journal |author=de Parades V, Etienney I, Bauer P, Taouk M, Atienza P |title=Proctalgia fugax: demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients |journal=Dis. Colon Rectum |volume=50 |issue=6 |pages=893–8 |year=2007 |pmid=17164968 |doi=10.1007/s10350-006-0754-4] The pain is sometimes described as an "anal charlie horse," an anal cramp, an anal spasm, or repeated spasms of the anus.

During an episode, the patient feels spasm-like pain in the anus, often misinterpreted as a need to defecate. Simultaneous stimulation of the local autonomic system can cause erection in males. It is a disorder of skeletal muscle, it is recurrent and there is also no known cure. It is not known to be linked to any disease process and data on the number of people afflicted varies, but is more prevalent than usually thought.

Like all ordinary muscle cramps, it is a severe, deep rooted pain.

In males, it has been reported to occur immediately following ejaculation.Fact|date=November 2007 There seems to be some indication that prolonged and tense sexual arousal may lead to an episode later that night.Fact|date=January 2008

Episodes happen almost always with an empty colonFact|date=January 2008. Defecation of any feces present can worsen the spasm, but may relieve it, or provide a measure of comfortFact|date=January 2008. The pain might subside by itself as the spasm disappears on its own, or may persist or reoccur during the same night. At the time it can seem like "it will never go away."

Treatment and prevention

Traditional remedies have ranged from warm baths (if the pain lasts long enough to draw a bath), warm to hot enemas,cite journal |author=Olsen B |title=Proctalgia fugax - a nightmare drowned in enema |journal= |volume= |issue= |pages= |year=2007 |pmid=17949444 |doi=10.1111/j.1463-1318.2007.01399.x] relaxation techniques,gentle massage of the anus, and various medications.

One method of quickly alleviating the pain is to stretch the area by touching one's toes, followed by taking the anti-inflammatory ibuprofen (e.g. Advil) with a glass of water. [ [http://www.kolaap.com/archives/2004/07/16/charlie-horse/#comment-26003 Charlie Horse : KOLAAP 2008-01-18] ] Alternatively, it has been suggested that one takes acetaminophen / paracetamol (e.g. Tylenol) with a hot drink (or simply a glass of water). [ [http://embarrassingproblems.co.uk/anal_pain.htm#4 Anal problems - anal pain ] ]

In patients who suffer frequent, severe, prolonged attacks, inhaled salbutamol has been shown to reduce their duration. [cite journal |author=Eckardt VF, Dodt O, Kanzler G, Bernhard G |title=Treatment of proctalgia fugax with salbutamol inhalation |journal=Am. J. Gastroenterol. |volume=91 |issue=4 |pages=686–9 |year=1996 |pmid=8677929 |doi= |url=]

One of the most common ways to reduce the symptoms is by pushing on the anal area, especially on the perineum or "taint." [ [http://www.kolaap.com/archives/2004/07/16/charlie-horse/#comment-1931 Charlie Horse : KOLAAP 2006-05-10] ] One can either do this manually or by straddling the edge of a bathtub.cite web |url=http://painspecialists.co.nz/Rectal%20Pain.htm |title=Rectal Pain |format= |work=Rotorua Pain Specialists |accessdate=]

The use of botulinum toxin has been proposed,cite journal |author=Wollina U, Konrad H, Petersen S |title=Botulinum toxin in dermatology - beyond wrinkles and sweat |journal=Journal of cosmetic dermatology |volume=4 |issue=4 |pages=223–7 |year=2005 |pmid=17168867 |doi=10.1111/j.1473-2165.2005.00195.x] as has diazepam. [cite journal |author=Pfenninger JL, Zainea GG |title=Common anorectal conditions: Part I. Symptoms and complaints |journal=Am Fam Physician |volume=63 |issue=12 |pages=2391–8 |year=2001 |pmid=11430454 |doi= |url=http://www.aafp.org/afp/20010615/2391.html]

An episode may sometimes be avoided by making sure not to engage in sexual activity within a close time proximity to defecation.Fact|date=January 2008 Those afflicted can usually tell after either sex or after defecation whether they would be in danger of an episode if they were to engage in the other activity, the potential onset of an episode being usually preceded by a very slight version of the pain that will eventually become much more intense.Fact|date=November 2007

Several people have experienced relief by cold water enema. Fact|date=January 2008Also, moist heat, for example a warm wet towel has been reported to have more or less effect. Fact|date=January 2008

Keeping one's body well hydrated and having a high fiber diet may help reduce the frequency of these onsets.

References

External links

* [http://menshealth.about.com/cs/embarrassments/g/proctalgia.htm About.com]
* [http://www.patient.co.uk/showdoc/40024939/ PatientPlus]
* [http://www.gihealth.com/html/education/proctalgiaFugax.html Three Rivers Endoscopy Center]
* [http://www.embarrassingproblems.co.uk/anal_pain.htm healthpress.co.uk]