Proctalgia fugax: Difference between revisions
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[[Caffeine]] or other [[stimulants]] almost instantaneously relieve pain once ingested. However, seeing as most Proctalgia fugax episodes occur at night, the 'upper' effects from the treatment might cause an unwanted loss of sleep. |
[[Caffeine]] or other [[stimulants]] almost instantaneously relieve pain once ingested. However, seeing as most Proctalgia fugax episodes occur at night, the 'upper' effects from the treatment might cause an unwanted loss of sleep. |
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Ingesting potassium via food or supplements typically relieve symptoms within 15 minutes, which can alleviate night time episodes with no affect on sleep. |
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The use of [[botulinum toxin]] has been proposed as analgesic,<ref name="pmid17168867">{{cite journal |author=Wollina U, Konrad H, Petersen S |title=Botulinum toxin in dermatology - beyond wrinkles and sweat |journal=Journal of Cosmetic Dermatology |volume=4 |issue=4 |pages=223–7 |year=2005 |pmid=17168867 |doi=10.1111/j.1473-2165.2005.00195.x}}</ref> and low dose [[diazepam]] at bedtime has been suggested as preventative.<ref name="pmid11430454">{{cite journal |author=Pfenninger JL, Zainea GG |title=Common anorectal conditions: Part I. Symptoms and complaints |journal=Am Fam Physician |volume=63 |issue=12 |pages=2391–8 |year=2001 |pmid=11430454 |url=http://www.aafp.org/afp/20010615/2391.html}}</ref> |
The use of [[botulinum toxin]] has been proposed as analgesic,<ref name="pmid17168867">{{cite journal |author=Wollina U, Konrad H, Petersen S |title=Botulinum toxin in dermatology - beyond wrinkles and sweat |journal=Journal of Cosmetic Dermatology |volume=4 |issue=4 |pages=223–7 |year=2005 |pmid=17168867 |doi=10.1111/j.1473-2165.2005.00195.x}}</ref> and low dose [[diazepam]] at bedtime has been suggested as preventative.<ref name="pmid11430454">{{cite journal |author=Pfenninger JL, Zainea GG |title=Common anorectal conditions: Part I. Symptoms and complaints |journal=Am Fam Physician |volume=63 |issue=12 |pages=2391–8 |year=2001 |pmid=11430454 |url=http://www.aafp.org/afp/20010615/2391.html}}</ref> |
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Revision as of 18:28, 1 December 2011
| Proctalgia fugax | |
|---|---|
| Specialty | Gastroenterology  |
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
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]
During an episode, which sometimes occurs after orgasm, 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. 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.
The pain episode subsides by itself as the spasm disappears on its own, but may reoccur.[4]
Treatment and prevention
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]
Caffeine or other stimulants almost instantaneously relieve pain once ingested. However, seeing as most Proctalgia fugax episodes occur at night, the 'upper' effects from the treatment might cause an unwanted loss of sleep.
Ingesting potassium via food or supplements typically relieve symptoms within 15 minutes, which can alleviate night time episodes with no affect on sleep.
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]
References
- ^ "levator syndrome" at Dorland's Medical Dictionary
- ^ Olden, Kevin W. (1996). Handbook of functional gastrointestinal disorders. New York: M. Dekker. p. 369. ISBN 0-8247-9409-5.
- ^ 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.
- ^ a b Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS (1999 Sep). "Functional disorders of the anus and rectum". Gut. 45 (Suppl 2): II55–9. doi:10.1136/gut.45.2008.ii55. PMC 1766682. PMID 10457046.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: multiple names: authors list (link) - ^ 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.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ 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.
- ^ 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.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ 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.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Pfenninger JL, Zainea GG (2001). "Common anorectal conditions: Part I. Symptoms and complaints". Am Fam Physician. 63 (12): 2391–8. PMID 11430454.
- ^ Jeyarajah S, Chow A, Ziprin P, Tilney H, Purkayastha S (2010 Sep). "Proctalgia fugax, an evidence-based management pathway". Int J Colorectal Dis. 25 (9): 1037–46. doi:10.1007/s00384-010-0984-8. PMID 20556402.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: multiple names: authors list (link)