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This prospective study was designed to describe a typical attack of proctalgia fugax.
Patients were recruited from May 2003 to June 2004. Whatever the reason for consultation, they were systematically asked: "Do you ever suffer intermittent and recurring anorectal pain lasting for at least three seconds?" If the answer was yes, they were interviewe...
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Context 1
... mean age of the 54 patients with proctalgia fugax was 51 (range, 18-87) years. Thirty-seven patients were females (69 percent; Fig. 1). Of these 54 patients, 4 were consulting for the first time for their proctalgia fugax, and 50 were consulting for another proctologic reason (n = 20; Table 3) or a nonprocto- logic reason (n = 30). Of the latter 50 patients, only 5 had previously consulted for their proctalgia fugax. Overall, 45 patients (83 percent) had never consulted a physician for their proctalgia fugax. We have compared the patients with proctalgia fugax who chose not to seek medical attention with those who did. The characteristics of proctalgia fugax were not significantly different between these two groups of ...
Context 2
... prospective study highlighted the details of common proctalgia fugax. The mean age of our patients, 51 years, was close to that reported in other series (Table 2). 9,11,13,14,16 However, the age distribu- tion was wide (range, 18-87 years; Fig. 1) as that of between 18 and 75 years reported in the litera- ture. 5,[8][9][10][11][13][14][15][16] Proctalgia fugax was more frequent in females, with a ratio of 37 to 17 in our study (Fig. 1), echoing most of the series published (Table 2). 6,7,[12][13][14][15][16]18 There is no clear explanation for this. Gynecologic disorders of the pelvic floor may explain the female predominance. Unfortunate- ly, we did not study this possibility and, to our knowledge, this potential relationship has been stud- ied rarely in the literature. Moreover, Jelovsek et al. 17 speculated that the question of Bintermittent and recurring anorectal pain^ may be inappropriate in a female with gynecologic prolapse because of her difficulty in distinguishing pressure resulting from a prolapsed vagina from anorectal ...
Context 3
... prospective study highlighted the details of common proctalgia fugax. The mean age of our patients, 51 years, was close to that reported in other series (Table 2). 9,11,13,14,16 However, the age distribu- tion was wide (range, 18-87 years; Fig. 1) as that of between 18 and 75 years reported in the litera- ture. 5,[8][9][10][11][13][14][15][16] Proctalgia fugax was more frequent in females, with a ratio of 37 to 17 in our study (Fig. 1), echoing most of the series published (Table 2). 6,7,[12][13][14][15][16]18 There is no clear explanation for this. Gynecologic disorders of the pelvic floor may explain the female predominance. Unfortunate- ly, we did not study this possibility and, to our knowledge, this potential relationship has been stud- ied rarely in the literature. Moreover, Jelovsek et al. 17 speculated that the question of Bintermittent and recurring anorectal pain^ may be inappropriate in a female with gynecologic prolapse because of her difficulty in distinguishing pressure resulting from a prolapsed vagina from anorectal ...
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Citations
... [4] In contrast, proctalgia fugax refers to sudden severe pain in the rectal area, which continues for a few seconds to minutes, but rarely up to 30 minutes, and completely disappears thereafter. [5] Approximately 10% of the adult population in the USA, Canada, and the UK had "Rome IV functional dyspepsia" with considerable association with health impairment, [6] indicating that a high incidence rate of FAP in these populations as a common but difficult to control syndrome, which leads to anal pain and defecation disorders. [7] Clinically, physicians may have some difficulty firmly diagnosing FAP because it is a functional disorder with special pain localization and the mutual influences of adjacent organs. ...
Background
Patients with functional anorectal pain (FAP) usually feel pain in the anal region, foreign body sensation, and defecation disorders. The pain may radiate to the perineum, thighs, and waist. Conventional biofeedback, local nerve block and surgical treatment have certain limitations. Thread-embedding acupuncture (TEA) is a complementary and alternative therapy, which is widely used in the clinical practice of traditional Chinese medicine to treat functional anorectal pain. This study evaluated the efficacy and safety of the catgut-embedding acupuncture in patients with FAP.
Methods
FAP patients were enrolled and randomly divided into a thread-embedding acupuncture group (n = 35) and a sham-embedding acupuncture control group (n = 36). Patients underwent treatment twice monthly for 2 months and were assessed before and after treatments for visual analogue scales (VAS) of anorectal pain, VAS of lumbar pain or soreness, VAS of abdominal distension or pain, anal incontinence index, and SF-36 quality of life. The SF-36 quality of life score included assessment of physical functioning, role-physical, bodily-pain, general health, role-emotional, social functioning, vitality, and mental health.
Result
The total effective rate was 85.71% for the treatment group versus 8.33% of the controls after 2 months (P < .001). The patients’ anal rectum VAS score was significantly higher after treatment versus pretreatment (P < .01), while the physical functioning, role-physical, bodily-pain, role-emotional, and mental health in the experimental group and the role-emotional, and mental health in the control group were all significantly improved versus pretreatment (P < .05). The anorectal VAS score, anal incontinence index, and the SF-36 scores of the physical functioning, role-physical, bodily-pain, role-emotional, and mental health were better in the treatment group compared to the control group (P < .05). Most importantly, there were no adverse reactions observed in either group during the treatment.
Conclusion
The thread-embedding acupuncture treatment effectively and safely improved the emotional anxiety and quality of life in FAP patients.
... 6 Diagnosis is based on a history of sudden-onset pain in the rectal area lasting for only seconds or minutes (mean 15 minutes in 1 study 7 ) then disappearing completely. 7,8 The pain can occur night or day and vary in severity from uncomfortable to unbearable. ...
Chronic anal pain is difficult to diagnose and treat, especially with no obvious anorectal cause apparent on clinical examination. This review identifies 3 main diagnostic categories for chronic anal pain: local causes, functional anorectal pain, and neuropathic pain syndromes. Conditions covered within these categories include proctalgia fugax, levator ani syndrome, pudendal neuralgia, and coccygodynia. The signs, symptoms, relevant diagnostic tests, and main treatments for each condition are reviewed.
... In contrast to LAS, proctalgia fugax presents as a sudden severe pain in the rectum that typically lasts seconds to minutes before disappearing just as rapidly. 3,39 These attacks rarely last longer than 30 minutes in duration and can be quite infrequent, occurring less than 5 times per year in more than half of patients. 40 The pain has been described as "shock-like" and ranges from uncomfortable to unbearable. ...
Constipation, irritable bowel syndrome, fecal incontinence, abdominal pain, and anorectal pain are problems that affect 40% of the population. They commonly present with overlapping symptoms indicating that their pathophysiology affects multiple segments of the gut as well as brain and gut interactions. Clinically, although some conditions are readily recognized, dyssynergic defecation, fecal incontinence, and anorectal pain are often missed or misdiagnosed. Consequently, the assessment of lower gastrointestinal symptoms in patients with suspected colonic or anorectal motility disorder(s) remains challenging for most clinicians. A detailed history, use of the Bristol stool form scale, prospective stool diaries, ideally through a phone App, digital rectal examination, and judicious use of complementary diagnostic tests are essential. Additionally, it is important to evaluate the impact of these problems on quality of life and psychosocial issues, because they are intricately linked with these disorders. The Rome IV diagnostic questionnaire for functional gastrointestinal disorders can provide additional information often missed during history taking. Here, we discuss a systematic approach for the clinical evaluation of patients with suspected lower gastrointestinal problems, grouped under 4 common diagnostic categories. We describe how to take a detailed history, perform meticulous digital rectal examination, and use validated tools to supplement clinical evaluation, including assessments of quality of life and scoring systems for disease severity and digital Apps. These tools could facilitate a comprehensive plan for clinical management including diagnostic tests, and translate the patients' complaints into definable, diagnostic categories.
... The prevalence of functional anorectal pain is estimated to range between 8 and 18%, with both sexes being equally affected across almost all age groups in the community [57]. ...
Functional anorectal disorders such as faecal incontinence (FI), functional anorectal pain, and functional defecation disorders (FDD) are highly prevalent and represent a high socioeconomic burden. Several tests of anorectal function exist in this setting; however, high-resolution anorectal manometry (HR-ARM) is a new tool that depicts pressure all along the anal canal and can assess rectoanal coordination. HR-ARM is used in the diagnosis of FI and especially FDD although data in health is still sparse, and pressure phenomena seen during simulated defecation, such as dyssynergia, are highly prevalent in health.
... Definition-Proctalgia fugax is defined as sudden, severe pain in the rectal area, lasting for a few seconds to several minutes (rarely up to 30 minutes), and then disappearing completely. 128,129 Pain is localized to the rectum in 90% of cases. 130 Attacks are infrequent, typically occurring fewer than 5 times per year in 51% of patients. ...
... 130 The pain has been described as cramping, gnawing, aching, or stabbing and may range from uncomfortable to unbearable. 129 Almost 50% of patients had to interrupt their normal activities during an attack. 131 The symptoms may awaken the patient from sleep. ...
... 125,128 Symptoms rarely begin before puberty, but there have been cases reported in 7-year old children. 128,129 ...
This report defines criteria and reviews the epidemiology, pathophysiology, and management of common anorectal disorders: fecal incontinence (FI), functional anorectal pain and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into three subtypes. In proctalgia fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome (LAS) and unspecified anorectal pain the pain lasts more than 30 minutes, but in LAS there is puborectalis tenderness. Functional defecation disorders are defined by >2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with >2 features of impaired evacuation i.e., abnormal evacuation pattern on manometry, abnormal balloon expulsion test or impaired rectal evacuation by imaging. It includes two subtypes; dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating LAS and defecatory disorders.
... Proctalgia fugax Deze vorm van anuskrampen wordt gekenmerkt door scherpe, hevige pijn rond het rectum, die vaker 's nachts optreedt en die enkele seconden tot maximaal 20 min duurt (meestal minder dan 1 min). 1, 3 De pijn recidiveert vaak, met intervallen van weken tot maanden; tussen de episodes door heeft de patiënt geen pijn. Geregeld is er sprake van begeleidende symptomen zoals loze aandrang, misselijkheid en zweten. ...
... De aanvallen komen bij 50% van de patiënten minder dan 5 keer per jaar voor, maar er bestaat grote variatie in de frequentie. 3 Chronische proctalgie Patiënten met chronische proctalgie beschrijven een meer drukkende pijn, die minimaal 20 min en soms uren tot dagen aanhoudt. Bij palpatie van de M. puborectalis bij rectaal toucher kan de kenmerkende pijn worden opgewekt door het aanspannen van deze spier -vaak asymmetrisch links meer dan rechts; dit wordt ook wel het levator-anisyndroom genoemd. ...
Anorectal pain is a common symptom, often as part of functional gastrointestinal disorders. Children seldom present with this complaint. Proctalgia fugax and chronic proctalgia are both anorectal pain syndromes but differ in duration and frequency of episodes and in pain characteristics. No research has been conducted on anorectal pain syndromes in children. We present two patients. Firstly, an 8-year-old girl who suffered from anorectal cramps. We found no underlying cause apart from constipation. The symptoms disappeared spontaneously. The second concerned an 8-year-old boy who presented with recurrent anorectal cramps. He was diagnosed with celiac disease. Anorectal dysfunction and visceral hypersensitivity have been described in adult celiac patients. Symptoms of anorectal pain in children are rare probably because it often remains unrecognised. Noninvasive diagnostic methods and interventions are preferred in paediatric medicine. Screening for celiac disease in children with anorectal pain episodes should be considered.
... The average age of onset was 51years. Study showed that women are affected more commonly (69 percent) than men 6 . However, its prevalence in the general population ranges from 4% to 18%. ...
Proctalgia fugax or gudaarti is an uncommon clinical condition, in which recurring attacks of distressing rectal pain with no positive local findings in the rectum or in anal canal are present. Leech therapy was done in ten diagnosed cases of Proctalgia fugax in OPD unit. Four follow up sittings at the regular interval of one week were done. Significant improvement in severity of pain and its frequency was observed. It can be concluded that leech application can be an option for such patients.
... Attacks last from 5 seconds to 90 minutes, occur any time of the day, and sometimes wake patients from sleep. 56 Attacks tend to be infrequent, averaging 1 episode monthly. 57 Based on Rome III criteria, proctalgia fugax is defined as recurrent episodes of pain localized to the anus or lower rectum. ...
... 58,59 Patients cannot typically identify a trigger for the onset of pain, which does not radiate and occurs without concomitant symptoms. 56 The pathophysiology of proctalgia fugax is incompletely understood but is thought to be due, in part, to spasm of the internal anal sphincter and/or pudendal nerve compression. Anorectal manometry has shown increased resting pressures and higher internal anal sphincter thickness. ...
Anorectal disorders result in many visits to healthcare specialists. These disorders include benign conditions such as hemorrhoids to more serious conditions such as malignancy; thus, it is important for the clinician to be familiar with these disorders as well as know how to conduct an appropriate history and physical examination. This article reviews the most common anorectal disorders, including hemorrhoids, anal fissures, fecal incontinence, proctalgia fugax, excessive perineal descent, and pruritus ani, and provides guidelines on comprehensive evaluation and management.
... Proctalgia fugax (PF) is a benign painful rectal condition which has posed diagnostic and therapeutic challenges to several levels of medical practice, most particularly general practitioners, colorectal surgeons and physicians. It has a modern definition of intermittent, recurring and selflimiting pain in the anorectal region in the absence of organic pathology [1]. It was first described in 1883 by Myrtle [2] and then termed nocturnal proctalgia by the Scottish physician Maclennan [3] as it is thought to occur most particularly at night [4][5][6][7][8][9]. ...
... This produced 73 references. Articles excluded were those not directly related to PF and were related to dermatology [1,22], overviews of functional bowel and anorectal disease with short mention of PF [4,[23][24][25][26], case reports of rectal pain caused by other pathologies [3,[27][28][29][30], paediatric cases [3,[31][32][33][34] and an article unrelated to PF but with the term in the title [1,35]. One paper was cited twice in the search [36]. ...
... This produced 73 references. Articles excluded were those not directly related to PF and were related to dermatology [1,22], overviews of functional bowel and anorectal disease with short mention of PF [4,[23][24][25][26], case reports of rectal pain caused by other pathologies [3,[27][28][29][30], paediatric cases [3,[31][32][33][34] and an article unrelated to PF but with the term in the title [1,35]. One paper was cited twice in the search [36]. ...
Proctalgia fugax (PF) is a benign anorectal condition which has been described in the literature since the nineteenth century commonly presenting to general surgeons. There is little high level evidence on the subject and its therapeutic modalities. We aimed through this systematic literature review to outline the definition and diagnostic criteria of this condition, the aetiology and differential diagnoses and describe the different treatment modalities that have been attempted and their success.
A literature search of Google Scholar and Medline using Pubmed as the search engine was used to identify all studies directly related to the definition, aetiology and treatment options for this condition (latest at 12 August 2008) was performed.
The search produced 61 references with three others obtained from the references of these papers. The prevalence of PF in the general population ranges from 4% to 18%. The diagnosis is based on the presence of characteristic symptoms as defined by Rome III guidelines and physical examination. The mainstay of treatment is reassurance and careful counselling with evidence in the literature for warm baths, topical treatment with glyceryl trinitrate or diltiazem and salbutamol inhalation. In persistent cases, local anaesthetic blocks, clonidine or Botox injections can be considered after clarification of risk and benefit.
Based on this we suggest that diagnosis should be made through exclusion of common organic causes such as haemorrhoids, anal fissure or anorectal carcinoma and on the fulfillment of Rome III criteria. The main treatment for this benign condition remains reassurance and topical treatment.
... Functional anorectal pain belongs in the functional gastrointestinal disorders category, namely among functional anorectal disorders together with incontinence and defecation changes (7). Its prevalence among the general population is estimated between 3 and 14% (8,9) according to the various series, and its diagnosis requires the exclusion of organic causes with physical, endoscopic, and radiographic exams. Patients consulting for this type of pain are few, less than 15% of cases, since attacks are self-limited and uncommon, with a frequency of around 1 per month (yearly mean of 13, range between 1 and 180) (8). ...
... Its prevalence among the general population is estimated between 3 and 14% (8,9) according to the various series, and its diagnosis requires the exclusion of organic causes with physical, endoscopic, and radiographic exams. Patients consulting for this type of pain are few, less than 15% of cases, since attacks are self-limited and uncommon, with a frequency of around 1 per month (yearly mean of 13, range between 1 and 180) (8). Two types of functional anorectal pain exist: chronic proctalgia and proctalgia fugax. ...
... El dolor anorrectal funcional se encuadra dentro del marco de las alteraciones funcionales gastrointestinales, en concreto es una de las alteraciones funcionales anorrectales, junto con la incontinencia y las alteraciones de la defecación (7). Su prevalencia en la población general se estima entre un 3 y un 14% (8,9), dependiendo de las series estudiadas y su diagnóstico requiere de la exclusión de una causa orgánica mediante exámenes físicos, endoscópicos y radiológicos. Son muy pocos los pacientes que consultan al médico por este tipo de dolor, menos del 15% de los que lo padecen, ya que los ataques son autolimitados y con una frecuencia baja, aproximadamente uno al mes (la media anual es de 13 con un rango entre 1 y 180) (8). ...
