anal spasm; proctodynia; proctalgia fugax; levator ani syndrome; anal cold
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Etiology
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
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]
More general terms
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: https://www.ncbi.nlm.nih.gov/pubmed/17164968
- ↑ 3.0 3.1 Jeyarajah S et al Proctalgia fugax, an evidence-based management pathway. Int J Colorectal Dis. 2010 Sep;25(9):1037-46 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20556402
- ↑ emedicine: Rectal Pain http://www.emedicinehealth.com/rectal_pain/article_em.htm