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Dr. Robert D. Fusco, Medical Director    
Proctalgia Fugax, A pain in the butt....

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Ouch!!! It's happened to all of us. You wake up in the middle of the night with a terrible cramp in your leg. You leap out of bed, jump up and down, and walk it off knowing that your leg is going to be sore in the morning. That pain is caused by a strong involuntary spasm, or "charlie horse," in the muscles of your leg. What if the same painful spasm occurred in muscles of your rectum? How terrible would that be? If you have been diagnosed with a condition called Proctalgia Fugax, you already know.

What is Proctalgia Fugax?

This condition was first described in Ancient Rome over 2000 years ago and still carries the Latin name which translates to "fleeting rectal pain." Proctalgia Fugax is basically just that - a fleeting rectal pain. Although few sufferers even mention it to their doctor, it is not uncommon. Health surveys of the general population estimate that about 5% of individuals experience the symptoms occasionally. Most report less than 6 attacks per year. Sufferers often describe waking up from a sound sleep with a sharp pain, often described as stabbing pain "like a knife sticking deep in the rectum." Mercifully, the pain is usually brief - lasting less than 20 minutes - and disappears as mysteriously as it comes.

What causes Proctalgia Fugax?

No one knows. Just like the "charlie horse," Proctalgia Fugax is an uncontrolled spasm or contraction of the muscles in the rectal area and pelvis. The cause is not known. It is not caused by hemorrhoids, fissures, polyps, or other rectal conditions. It is not felt to be psychosomatic in origin, but some patients report more attacks during times of emotional stress. To be honest, we know little more today than the physicians of Ancient Rome knew.

How is Proctalgia Fugax diagnosed?
There are no blood tests, x-rays, or procedures that can diagnose Proctalgia Fugax. Even in rare circumstances when patients have been examined during an attack, no consistent abnormality has been found. Unlike the pain of a hemorrhoid or anal fissure, this pain does not occur during a bowel movement. Indeed, passing some gas or a bowel movement often ends the attack. Your doctor bases his diagnosis on typical symptoms and the lack of any other cause. This means that often a flexible sigmoidoscopy or colonoscopy "scope" test is done to be sure that no serious problem is present in the rectal area.

Is Proctalgia Fugax serious?

No. Sufferers should be confident that the pain is not an indication of something serious. Also, this condition does not increase the risk of colon cancer, colitis, hemorrhoids, anal fissures or other bowel disorders. It is simply a muscle cramp in the wrong place at the wrong time.

What treatment is available?

There is no cure. The attacks are too short for any medical therapy to be effective. Although, there have been some reported successes using an asthma inhaler called salbutamol to abort prolonged episodes. There is no surgical procedure that has been shown to be effective. The most common therapy is simply pushing on the anal area. This may be done manually or by straddling the edge of a bathtub. Soaking in a warm bath may help, but usually the pain begins to subside before the bathtub is filled.

How can one prevent future attacks?

Sadly there is no way to reliably prevent further attacks. Some doctors feel that a high fiber diet and plenty of fluids helps keep the stools soft and prevents spasm. Often, a fiber supplement such as Metamucil or Citrucel is recommended. The best plan is to let your doctor rule out any other serious disorders and be happy that nothing more important was found.

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