Proctalgia Fugax

I.e., fleeting pain in the rectum. I'm a male age 49 and have had episodes of this (about 6 per year maybe) since about age 21. This is self-diagnosed, as I never meantioned it to my doctor (common, I read) but I was amazed to find out a few years ago using Google that this is a common (~14% adults) condition that has been known for millennia, with the dreaded "etiology unknown" and "no specific treatent other than reassurance."

My situation follows the descriptions exactly, i.e., happens almost always at night, wakes me out of a sound sleep, lasts for about 15 minutes like clockwork, pain is intense.

Nothing I've tried in the past seems to shorten or alleviate this cycle much, I just have to ride it out. One symptom I've always noticed is that if I get up when the pain is intense, I am extremely lightheaded to the point of collapsing. That made me think of low blood pressure. Sure enough, one time I mustered the will to take my blood pressure during an episode, and it read 85/55. Not sure what that means.

Are there any new treatments at all for this condition? Since it happens so rarely I suppose it would have to be a very quick-acting thing taken on the spot (as the episodes last on 15 minutes anyway). I can live with these rare occurrences of course (as I have been doing for years) but it is very mysterious!

One technique I've used just the last few times which appears to have some success is as soon as I wake up, which is usually well before the pain has crested, get out of bed and pace the floor. These last few times (small sample aize, yes), the duration and intensity of the pain have lessened.

[Kevin Pho, MD]

For most patients, symptomatic episodes are brief and infrequent, requiring no specific treatment other than reassurance and explanation of the disorder. On the other hand, a small percentage of patients have more frequent and troubling symptoms. There are limited data to guide such treatment.

Albuterol treatment was associated with a significant reduction in the duration of severe pain; the effect was most pronounced in patients who had prolonged attacks. However, the mechanism of benefit was unclear since albuterol had no significant effect on anal resting tone, sphincter relaxation, or rectal compliance while patients were asymptomatic. Other potential treatment options that have been suggested in case reports include oral clonidine (150 micrograms twice daily), topical nitroglycerin (0.3 percent), and injection of botulinum A toxin. One study demonstrated exaggerated post-relaxation contractions in proctalgia fugax patients following the administration of edrophonium chloride (a cholinesterase inhibitor).

You may want to discuss these treatments with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Barto et al.  Proctalgia fugax.  UptoDate, 2004.

[Scannerhead]

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[willardp]

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[MOTOMARC]

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[Cindy B.]

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[chippo]

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[damson]

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[boomboy]

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[JimNasium]

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[littleteej]

I have been experiencing the same thing for about a yeaar now.  Frequency of once or twice per month, occurs at night waking me from sleep, or following intercourse.

I have had genital HPV for 4 years..since I met my husband.  Never had a pap or confirmation from a doctor- too embarassed.

[ValleyGirl79]

A related discussion, Littleteej was started.