# Participate--proctalgia fugax



## Kathleen M.

Some excerpts from the Fall 2000 issue of Participate from www.iffgd.org Title. Proctalgia fugax--and other painsAuthor. W Grant Thompson MD. "...dull, throbbing, tearing, sickening pain comparable to nothing on earth--one feels as though a hard stone in the rectum was wanting to get out" --Anonymous sufferer of protalgia fugax"Many diseases of the anus and rectum may cause severe rectal pain. Usually a doctor can identify such a condition by examining the area. One pain that cannot be so identified is that with the Greco-Roman moniker, proctlagia fugax. This is a sudden, severe pain in the region of the rectum and the anus that lasts several minutes and then disappears completely. Even if the victim's nether region is examined during an attack of pain, no consistant abnormality has been identified. Despite the sometimes excrutiating pain, the proctalgia fugax sufferer is perfectly well, once the attack has subsided.""This puzzling phenomenon is reported in 5 15% of the respondants in population surveys""No doubt the pain can be severe. Some equate it with the pains of childbirth or a gallbladder attack, and it has been known to cause one to faint. Nevertheless, the pain of proctalgia fugax is mercifully brief. IT occurs without warning, often when one is in a depp sleep.""It has been described as 'searing', 'cramping', 'stabbing', 'grinding', and 'gnawing'. Attacks seem to average about 6 per year. In some it is much less frequent, and in other it may occure in clusters.""At one time, this pain was thought to be accociated with the irritable bowel syndrome or constipation, but it now appears that there are no associated conditions, and no risk of serious complications."" Several physician-sufferers have examined themselves during an attack and report a painful band of muscle pressing on the sides and back of the rectum. This suggests that proctalgia fugax is not an anorectal problem at all, but rather one of spasm of the puboretalis muscle. This muscle is a sling from the pubic bone that supports the anorectal angle, and normall relaxes during defecation. It is not an intestinal muscle at all, but rather a skelatal muscle similar to the muscles of the arm. If all this is true than proctalgia fugax is but a 'charlie horse' (or muscle cramp) of the backside""The typical spontaneous, infrequent, transient occurances require no medical attention. However, if there are other symptoms or the attacks are frequent and lengthy, a doctor should examine the anorectum. The area where the pain occures is very sensitive and disease there can cause excrutiating pain. Typically, however, pain due to anal pathology is unrelenting, or aggravated by the passage of stool.""When the anal pain is persistent and no abnormality can be seen on examination, the condition is known as levato syndrome. This phenomenon is as puzzling as proctalgia fugax, but in this case the pain is chronic and may intrude into a person's life.""One small trial showed that inhaling salbutamol, a drug used for asthma, shortens the attacks of proctalgia fugax. If you have severe lengthy attacks, you may wish to discuss the used of this drug with your doctor. For most of us, such treatment would be therapeutic overkill.""The most enduring treatment is the application of pressure to the anorectal area. This may be done manually, or by sitting on the edge of a table or counter."


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## moldie

Well kmottus, we meet again. You have hit my proctalgia nerve! Actually, your interest in intestinal over-growth, may be of significance here. I was diagnosed with proctalgia by an "experienced" GI doc at a nearby medical college. I am not sure, but he may have missed the boat. He prescribed nitro oint applications, which helped minimally for a short while, and then ceased to be effective. I read a Participate Publication about this a few years ago when I was having problems, actually before I was diagnosed. I thought that it might be the problem (either that, or the levator-ani problem), but I said nothing about it until after the GI doc mentioned diagnosed me with it. I have since changed my mind. My pain came after my frequent soft-stooling especially when my sphincter muscle became dilated for long periods during evacuation. I did not feel any "hard ball" sensation associated with it however, and it lasted for up to six hours, and never occurred during my sleep. The more stooling I had, the longer it lasted. I would lie quiet because the more I was up and around, the more I stooled, and the more pain I got. I also took levsin which took a couple hours to work, but not really effective if I did not lie quietly. It turned out, that after my Candida treatment (Diflucan and diet), the "proctalgia" went away. Could it have been proctitis? Blood was mysteriously found in my stool for occult blood test on more than one occasion. Nothing was seen on my colonoscopy exam, but a biopsy/microscopic examination was not done. They believed that it was proctalgia, perhaps, because it is another "algia" symptom and I have fibromyalgia. Sounds more like the levator problem to me, and I wonder whether or not the salbutamol would have helped me? Actually, I believe that it may have helped the symptom at the time, but it would have reoccurred because the cause would have still been aggravating it. My allergist was a little amazed, but said it may have been similar to the spasming felt by an asthmatic, only that the lower intestinal tissue area was irritated rather than the bronchial tubes of an asthmatic. I am not sure if he thought it was the Candida mold allergy/infection or my consuming things with my found allergen additives (citric or benzoic acid). I have read some interesting hypothesis done by a researcher named Rea that would explain this phenomenom, (who actually began his career as as a cardiothoracic surgeon). My Allergist later told me on another visit that he had another patient with this problem who was a wife of a surgeon, I believe he knew from perhaps the Mayo Heatlh Care System Medical Center in which he has his office in. The treatment also helped her get rid of her rectal pain she has been dealing with for years. Anyway, thank God I am rid of it, because it was excruciating and the frequent stooling and pain caused me to be unemployed and non-functional for six hours every 2-3 day cycle of stooling for a few years! I would not wish this on my worst enemy! Sometimes, I think I do experience proctalgia on occasion, but I contribute it to gas pain which stabs me right in the rectum, but passes with the passing of the flatus. Would you say that was proctalgia faux? It is not like the throbbing, grinding, relentless pain I used to get. I dunno.


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## Kathleen M.

There are a number of causes for pain. I'm not qualified to diagnose it.FWIW they used to think the PF only occured in doctors because no one ever saw a patient with it. Only doctors. Patients would NOT talk about it. Based on survey questionaires it is actually quite common (usually 5-15% of people report symptoms of it).K.


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## Phyllis McDonnell

I find the pain most closely compares to leg cramp. I will probably get it tonight - have been suffering C since before Christmas, and the volcano finally erupted 2 days ago and has been going on since then. A couple of days of violent activity in that area practically guarantees a proctalgia fugax episode. It's so severe that I often faint. If I get time I take a valium 2mg, and that acts as a muscle relaxant.I'm not looking forward to tonight!------------------Phyllis


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## jetbunny

My boyfriend seems to suffr from this after sexual activity. Any more males with this symptom?


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