Fleeting proctalgia is manifested by very intense cramp-like pain, which occurs in the anal region, often in the middle of the night. No functional disorder remains between seizures. Although unbearable, these pains of unknown origin are benign. The effectiveness of the available treatments is not established. Fortunately, painful attacks are often several months apart.

Definition

Fleeting proctalgia is defined as a recurring acute pain in the anal canal and lower rectum. Painful, cramp-like episodes occur without warning, more readily at night, with bouts of about twenty minutes on average. They are separated by painless intervals that can last several weeks or months.

Causes

The causes of pain attacks are not clear. They are most often linked to a spasm of the internal anal sphincter, a powerful and circular muscle, but other mechanisms have been mentioned: contraction of other muscles in the anal region (external sphincter and / or levator anus) , vascular spasm, neurological pathology …

Various triggering factors but with random impact have been described: stress, defecation or constipation, menstruation, sexual intercourse, alcohol intake, administration of suppositories, bad posture, etc.

Diagnostic

Clinical examination of the anorectal region, which can only be performed outside of seizures since they are unpredictable and rare, is normal. Further explorations confirm that everything is functioning normally. The diagnosis is therefore based only on the description of the symptoms and the elimination of other possible causes of pain.

The transient and unpredictable nature of painful spasms, combined with a certain reluctance to talk to the doctor, especially if the attacks are very short and very far apart, makes it difficult to estimate the number of people affected. According to studies, the frequency of transient proctalgia in the general population has been estimated from 3 to 4% (low range) to 15 to 18% (high range), the diagnostic criteria not always being the same. 

This pathology rather affects people aged 30 to 60 years, and predominates in women.

Risk factors

Anxious states, stress and fatigue would promote the occurrence of fleeting proctalgia.

This pathology is also more common in people with irritable bowel syndrome than in the general population. Studies have also suggested an association with other pathologies: pelvic prolapse (organ descent), inflammatory bowel disease, ulcer, urinary incontinence, etc.

Very rare cases of transient proctalgia emerge in a family context suggesting the involvement of hereditary factors.

Most often intense, the pain appears unexpectedly and immediately reaches its paroxysm. It is described as a sensation of cramping, stabbing or even crushing or electric shock. It does not irradiate or in a very limited area. It is most often isolated, even if a few people describe other dysfunctions (colic accompanied by a false urge to have a bowel movement, abdominal pain, nausea, sweating, etc.).

This pain usually resolves within a few minutes, but in extreme cases it may last only a few seconds or, on the contrary, last for an hour or more.

The time intervals between attacks are very variable (from a few days to a few months). Most people suffering from this pathology experience about ten painful attacks per year.

Once people suffering from transient proctalgia reassured about the completely benign nature of their pathology, many are no longer in demand for medical treatment and are content to implement means which, in their case, make it possible to shorten the crisis: relaxation exercises , rectal examination or postural maneuvers, defecation, sitz baths, introduction of an enema or a suppository …

In the most severe cases, the management is delicate because the effectiveness of the treatments tried in this pathology so far has not been established.

• Salbutamol has been the subject of a few publications. This bronchodilator drug used by inhalation in asthmatics also seems to relax the sphincters …
• Among other crisis treatments, molecules having a relaxing effect on smooth muscle seem to have helped isolated patients: clonidine, calcium channel blockers administered orally, sublingually or topically, etc.
• As a background treatment, anxiolytics or antidepressants, but also a drug used in the treatment of angina pectoris, diltiazem, botox injections in the anal region or even infusions of lidocaine, a local anesthetic, also have been proposed.
• Some testimonies also report relief provided by natural methods or alternative medicine: acupuncture and moxibustion, reflexology, herbal medicine, homeopathy … These methods can be tried, but it is better to be wary of websites reporting miracle cures …