|Classification and external resources|
It most often occurs in the middle of the night and lasts from seconds to minutes, an indicator for the differential diagnosis of levator ani syndrome, which presents as pain and aching lasting twenty minutes or longer. In a study published in 2007 involving 1809 patients, the attacks occurred in the daytime, (33 percent) as well as at night (33 percent) and the average number of attacks was 13. Onset can be in childhood, however, in multiple studies the average age of onset was 45. Many studies showed that women are affected more commonly than men. This fact can be at least partly explained by men's reluctance to seek medical advice concerning such a delicate case as rectal pain.
During an episode, the patient feels spasm-like, sometimes excruciating, pain in the anus, often misinterpreted as a need to defecate. Simultaneous stimulation of the local autonomic system can cause erection in males. In men, twinges sometimes occur shortly after orgasm. Because of the high incident of internal anal sphincter thickening with the disorder, it is thought to be a disorder of the internal anal sphincter or that it is a neuralgia of pudendal nerves. It is recurrent and there is also no known cure. However, some studies show effective use of botulinum toxin, pudendal nerve block, and calcium channel blockers. It is not known to be linked to any disease process and data on the number of people afflicted varies, but is more prevalent than usually thought. Again, quite few people report these symptoms, so obtaining data on more or less precise ratio of occurrence of proctalgia in human populations presents a challenge.
The pain episode subsides by itself as the spasm disappears on its own, but may reoccur.
Sometimes pain is so severe that that may cause loss of consciousness and possible injury. Staying down is suggested if in bed, and lying down is recommended. However, in many cases, defecating is suggested as emptying the rectum provides relief, even though it might be extremely painful at the first seconds or minutes.
Treatment and prevention
The most common approach is simply reassurance and topical treatment.
A fast effective treatment is to place one 0.125 Hyoscyamine lozenge under the tongue at the onset of pain, or the application of heat (warm water bottle or bath). Relief usually begins within 5 to 10 minutes.
Taking 40–80 mg Drotaverine (an antispasmodic drug, No-Spa) also gives fast relief.
- "levator syndrome" at Dorland's Medical Dictionary
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