Proctalgia fugax
Background
- Exact pathophysiology unclear, however may include anal sphincter spasm and hypertrophy
- Frequently brought on by stress
- Prevalence 8-18%, does not favor one sex
- Should be considered a diagnosis of exclusion
Clinical Features
- Spasm-like, sometimes excruciating, pain in the anus, often misinterpreted as a need to defecate
- Episodic pain (women, patients < 45yo)
- Brief, usually only seconds to minutes in duration
- Incontinence
- Urgency
Differential Diagnosis
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Coccydynia
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Fecal impaction
- Hemorrhoids
- Levator ani syndrome
- Pedunculated polyp
- Pilonidal cyst
- Proctalgia fugax
- Proctitis
- Pruritus ani
- Enterobius (pinworms)
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Non-GI Look-a-Likes
Evaluation
- Diagnosis is largely clinical, and one of exclusion
- Digital rectal examination should be performed, with special attention and care noted to assess the external areas for contributing sources of pain
- This includes a prostate examination in men
- Women should also have pelvic examination to assess for pelvic etiology masking as rectal complaint
- Laboratory evaluation, including ESR and CRP, may be obtained though are frequently normal
- If febrile or leukocytosis present, consider advanced imaging to assess for deeper infections or process not easily evaluated by physical examination
Rome IV Criteria
- The Rome IV criteria are meant to differentiate and assist in the diagnosis of functional gastrointestinal disorders (FGID)[1]
- For the diagnosis of proctalgia fugax, the following should be present
- Recurrent episodes of pain unrelated to defecation
- Episode duration no longer than 30 minutes (>30 minutes suggest levator ani syndrome)
- Absence of pain between episodes
- Exclusion of other causes
Management
- In majority of cases, reassurance and explanation of process is sufficient
- This is due to brief duration of episodes and difficulty in both treating and preventing
- Referral to gastroenterology if symptoms severe
- Some research into inhaled beta agonists and topical anti-spasmodics, but best provided and managed by GI
Disposition
- Can be safely discharged home when emergent causes excluded
- Provide GI follow up information
See Also
References
- ↑ Rao SSC, Bharucha AE, Chiarioni G, et al. Anorectal Disorders. Gastroenterology. March 2016:S0016-5085(16)00175-X 10.1053/j.gastro.2016.02.009. doi:10.1053/j.gastro.2016.02.009., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035713/