Proctalgia fugax

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Proctalgia fugax
Classification and external resources
ICD-10 K59.4
ICD-9 564.6

Proctalgia fugax (or levator syndrome) is a severe, episodic, rectal and sacrococcygeal pain.[1] It can be caused by cramp of the pubococcygeus or levator ani muscles.[2]

Presentation[edit]

It most often occurs in the middle of the night[3] and lasts from seconds to minutes,[4] 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.[5] 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.[4]

Defecating is suggested as emptying the rectum provides relief, even though it might be extremely painful at the first seconds or minutes[citation needed].

Treatment and prevention[edit]

Traditional remedies have ranged from warm baths (if the pain lasts long enough to draw a bath), warm to hot enemas,[6] relaxation techniques, and various medications.

In patients who suffer frequent, severe, prolonged attacks, inhaled salbutamol has been shown in some studies to reduce their duration.[7]

The use of botulinum toxin has been proposed as analgesic,[8] and low dose diazepam at bedtime has been suggested as preventative.[9]

The most common approach is simply reassurance and topical treatment.[10]

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.[citation needed]

Taking 40–80 mg Drotaverine (an antispasmodic drug, No-Spa) also gives fast relief.[citation needed]

References[edit]

  1. ^ "levator syndrome" at Dorland's Medical Dictionary
  2. ^ Olden, Kevin W. (1996). Handbook of functional gastrointestinal disorders. New York: M. Dekker. p. 369. ISBN 0-8247-9409-5. 
  3. ^ Takano M (2005). "Proctalgia fugax: caused by pudendal neuropathy?". Dis. Colon Rectum 48 (1): 114–20. doi:10.1007/s10350-004-0736-3. PMID 15690667. 
  4. ^ a b Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS (September 1999). "Functional disorders of the anus and rectum". Gut 45 (Suppl 2): II55–9. doi:10.1136/gut.45.2008.ii55. PMC 1766682. PMID 10457046. 
  5. ^ de Parades V, Etienney I, Bauer P, Taouk M, Atienza P (2007). "Proctalgia fugax: demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients". Dis. Colon Rectum 50 (6): 893–8. doi:10.1007/s10350-006-0754-4. PMID 17164968. 
  6. ^ Olsen B (2007). "Proctalgia fugax - a nightmare drowned in enema". Colorectal Disease 10 (5): 522–3. doi:10.1111/j.1463-1318.2007.01399.x. PMID 17949444. 
  7. ^ Eckardt VF, Dodt O, Kanzler G, Bernhard G (1996). "Treatment of proctalgia fugax with salbutamol inhalation". Am. J. Gastroenterol. 91 (4): 686–9. PMID 8677929. 
  8. ^ Wollina U, Konrad H, Petersen S (2005). "Botulinum toxin in dermatology - beyond wrinkles and sweat". Journal of Cosmetic Dermatology 4 (4): 223–7. doi:10.1111/j.1473-2165.2005.00195.x. PMID 17168867. 
  9. ^ Pfenninger JL, Zainea GG (2001). "Common anorectal conditions: Part I. Symptoms and complaints". Am Fam Physician 63 (12): 2391–8. PMID 11430454. 
  10. ^ Jeyarajah S, Chow A, Ziprin P, Tilney H, Purkayastha S (September 2010). "Proctalgia fugax, an evidence-based management pathway". Int J Colorectal Dis 25 (9): 1037–46. doi:10.1007/s00384-010-0984-8. PMID 20556402. 

External links[edit]