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anal spasm; proctodynia; proctalgia fugax; levator ani syndrome; anal cold
Etiology:
1) idiopathic
2) neurogenic
Epidemiology:
- mean age of onset = 45 years
- more common in women
Pathology:
- spasm of the pubococcygeus or levator ani
Physical examination:
- digital rectal exam: may feel tight, & palpation may reproduce pain
Clinical manifestations:
- proctalgia fugax
- most often occurs in the middle of the night
- lasts from seconds to minutes
- levator ani syndrome
- constant or frequently occurring dull pain
- felt higher up inside the rectal passage
- pain exacerbated by sitting
- pain improves with walking or standing
- pain usually lasts approximately 20 minutes & tends to reoccur at regular intervals
Laboratory:
- skin biopsy if diagnosis uncertain
Differential diagnosis:
- hemorrhoids
- anal fissure
- anal cancer, rectal cancer
Management:
- behavioral measures
- warm bath (if pain lasts long enough)
- warm to hot enemas
- sitting on a ball covered with a heating pad
- massage the levator ani muscles to relieve muscle spasms
- relaxation techniques
- pharmaceuticals
- topical nitroglycerin (spray or ointment)
- NSAIDs
- inhaled salbutamol
- botulinum toxin
- low dose diazepam at bedtime
- hyocyamine (Anaspaz)
- behavioral measures & topical treatment recommended [3]
General
muscle spasm
References
- Wikipedia: Proctalgia fugax
http://en.wikipedia.org/wiki/Proctalgia_fugax
- de Parades V et al
Proctalgia fugax: demographic and clinical characteristics.
What every doctor should know from a prospective study of 54
patients.
Dis Colon Rectum. 2007 Jun;50(6):893-8.
PMID: 17164968
- Jeyarajah S et al
Proctalgia fugax, an evidence-based management pathway.
Int J Colorectal Dis. 2010 Sep;25(9):1037-46
PMID: 20556402
- emedicine: Rectal Pain
http://www.emedicinehealth.com/rectal_pain/article_em.htm