Proctalgia fugax is a condition characterized by sudden, severe rectal pain that lasts seconds to minutes and occurs in episodes separated by pain-free periods. It is more common in younger females and has a prevalence of around 8%. The exact cause is unknown but may involve spasms of the pelvic floor or anal sphincter muscles. Diagnosis involves examination to rule out other conditions, and treatment focuses on reducing muscle spasms through warm baths, topical medications, or Botox injections.

1. PROCTALGIA FUGAX:
AN OVERVIEW
BY
TAUFIQUE AHMED
PG SCHOLAR, DEPTT. OF SHALYA TANTRA
GOVT. AYURVEDIC COLLEGE, GUWAHATI
GUIDED BY
CHAMPAK MEDHI
ASSISTANT PROFESSOR, DEPTT. OF SHALYA TANTRA
GOVT. AYURVEDIC COLLEGE, GUWAHATI

2. INTRODUCTION
 Proctalgia fugax has been defined as recurring attacks of
distressing rectal pain with no local positive findings in the
rectum characterized by paroxysms of rectal pain with pain-
free periods between attacks.
 The pain-free periods between attacks can last seconds to
minutes.

3. HISTORY
The first clinical description of this severe intermittent
idiopathic, rectal pain was apparently given by
MacLennan of Glasgow in 1917.
But the Term ‘Proctalgia Fugax’ was introduced by
Thaysen in 1935.

4. PREVALENCE
Most patients do not seek medical attention so the true
prevalence may be unknown, but a population study
found that proctalgia fugax has a prevalence of 8%, is
typically show prevalence in females, and occurs more
often in patients younger than 45 years of age.

5. PROCTALGIA FUGAX OTHER NAMES
 PF sometimes confused with Levator Ani Syndrome
(LAS) / Levator Ani Spasm Syndrome
 The two conditions are very similar in presentation,
but the pain with LAS can last up to 20 minutes, where
the pain in PF is usually seconds to minutes.

6. PROCTALGIA FUGAX CAUSES
The exact cause of this condition is unknown.
However, the following conditions are suspected to result
in this syndrome:
 Pelvic floor muscle spasm
 Anal sphincter muscle spasm
 Levator ani muscle spasm
 Pubococcygeus muscle cramp
 Low-fiber diet
 Pudendal nerve neuralgia
 IBS
 Constipation
 Psychogenic

7. PATHOPHYSIOLOGY
 Pathophysiology of PF remains unclear.
 It has been hypothesised that PF may arise either from spasm
of the rectal or the pubococcygeal muscle, but a specific anomaly
has not been found.
 Harvey suggested that phasic rectosigmoid contractions may
cause proctalgia, although, in their study 42% of contractions
were painless and anal motility was not recorded.
 Others have implicated stress or psychological issue.
 More recently a hereditary myopathy of the anal sphincter has
been described.
 The fault is believed to be in pudendal nerve situated in the
pelvis. It sends wrong signal to the anal muscles to contract.

8. CLINICAL FEATURES
 History of a sudden, severe pain in the anorectal area that lasts
from a few seconds to several minutes and then disappears
completely.
 Sharp, stabbing, cramp or spasm-like pain situated in the lower
rectum; it gradually increases the intensity till it become
unbearable and sometimes causes fainting.
 Attacks are infrequent although some patients can have pain
every day.
 Often patients have to stop what they are doing and wait for the
attack to subside.
 It often occurs at night and awaken the patient.

9.  The pain tends to occur spontaneously without a trigger, but some
patients describe aggravating factors such as sitting down,
defaecation, or psychological stress.
 One study reported that in 7% of patients the pain radiated to other
areas such as the buttock or pelvis, and in 19% there was an
associated symptom such as sweating or feeling faint.
 A proportion of patients describe passing out due to the severity of
their pain.

10. DIFFERENTIAL DIAGNOSIS
 Irritable bowel syndrome
 Haemorrhoids ± thrombosis
 Anal fissure
 Colorectal cancer
 Perirectal abscess or fistula
 Proctitis
 Rectal foreign body
 Pruritus ani
 Diverticular disease
Rectal prolapse
Coccygodynia
Retrorectal cysts
Condylomata acuminata
Prostatitis
Alcock's canal syndrome

11. DIAGNOSIS
 Diagnosis involves a thorough medical examination, including of
the genital region.
 It may also order blood tests and an endoscopy test to look at the
lining of the bowel.
In most cases, tests cannot confirm a diagnosis of proctalgia fugax
specifically. Instead, the examinations can exclude other, more
serious conditions.
Proposed diagnostic criteria for proctalgia fugax
(Rome III) include all of the following:
 Recurrent episodes of pain localized to the anus or lower
rectum
 Episodes last from seconds to minutes
 There is no anorectal pain between episodes

12. TREATMENT
Patients with more frequent and troubling symptoms need the
treatment.
There are limited data to guide treatment.
WARM WATER
Water at 40 degrees celsius reduces resting anal canal pressure, so
hot baths and warm water enemas have been employed in patients
requiring therapy.
TOPICAL TREATMENTS
Topical therapy with NITROGLYCERIN or antispasmodics has
been used.

13. ORAL AND INTRAVENOUS TREATMENTS
Oral treatments that can be try include NIFEDIPINE,
DILTIAZEM, and CLONIDINE.
Intravenous low dose of LIDOCAINE can be tried in severe
cases

14. INVASIVE TREATMENTS (Severe PF)
 Botulinum toxin injection
 Pudendal nerve blocks
 Superior hypogastric plexus blocks.
 Internal anal sphincterotomy
PSYCHOLOGIC TREATMENT
Treatment of concomitant psychological dysfunction
may also be helpful

15. OTHER MANAGEMENT:
The most common treatment for Proctalgia fugax is
simply to push on or massage the anal area or the
perineum.
This may be done manually, or by straddling the edge of
an empty bathtub (carefully) or sitting on a tennis ball

16. YOGA
Yoga has a significant role in the management of PF
 Pranayama
 Viparita Karani
 Ardha Matsyendrasana

17. SUMMARY AND CONCLUSION
Proctalgia fugax is a sudden, severe pain in the
anorectal region that lasts several seconds or
minutes, and then resolves completely but during the
episode pain causes fainting to the patient or patient
may die due to pain shock
So a patient should undergo definitive care

18. THANK YOU
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