Understanding Proctalgia Fugax: Causes, Symptoms, and Management Strategies

Although proctalgia fugax, also known as levator syndrome in English-speaking countries, is not a rare disease, almost nothing is known about it. Even those affected often do not know for decades that they suffer from proctalgia fugax. Patients are afflicted by sudden, cramping, almost paroxysmal pain in the rectum. This pain often passes quickly and is therefore not perceived as an illness. In these cases, patients do not always see a need for therapy. For others, the quality of life is so severely restricted by frequent, long-lasting seizures that an enormous burden of suffering arises.

Proctalgia fugax: causes and diagnosis

Doctors are entirely in the dark about the causes of proctalgia fugax. Spasms of the inner sphincter or the pelvic floor are suspected. Chronic constipation and psychosomatic factors are also discussed – perfectionistic and anxious people are said to be often affected by proctalgia fugax. Pelvic floor insufficiency, disorders of the autonomic nervous system and hormonal disorders are increasingly suspected to be behind proctalgia fugax.

Patients sometimes observe stressful situations as triggering factors; Men are more likely to report seizures after intercourse (although women are about twice as likely to develop proctalgia fugax). Those affected often hear from their doctor that no physical causes of proctalgia fugax can be identified; the diagnosis is usually made – if at all – based on the description of the symptoms.

If proctalgia fugax is suspected, the patient should undergo extensive examinations to exclude neurological and hormonal diseases as well as diseases with similar symptoms, such as anogenital syndrome or anal fissure.

 

Proctalgia fugax: symptoms and signs

Those affected by proctalgia fugax consistently report almost unbearable pain in the anal area. Mainly, when proctalgia fugax occurs for the first time, patients suffer from significant anxiety because they fear that there is a severe emergency. Before puberty, proctalgia fugax occurs exceptionally rarely, mainly in the age group between 40 and 50.

There are two types of proctalgia fugax:

• A daytime attack occurs from one moment to the next. The pain is getting worse and can be of variable localization. Starting from the anus, it can affect the anal canal, pelvic floor and abdomen.
• In contrast, the pain intensity of a nocturnal attack is constant, and the entire anal area is affected. Both forms of proctalgia fugax are usually accompanied by nausea vo, vomiting, dizziness, sweating, and even fainting. The pain sometimes stops after a short time; most attacks of proctalgia fugax last no longer than 30 minutes. In particularly severe cases, the pain lasts for a few hours.

The attacks are irregular; the intervals can be days, weeks or months. The general average does not exceed six seizures a year. With age, these become increasingly rare.

Proctalgia fugax: treatment and therapy

Unfortunately, experts are still relatively at a loss when treating Proctalgia fugax. In some cases, freedom from symptoms is achieved by taking the drugs clonidine, nifedipine and salbutamol (when used inhaled). Hemorrhoidal therapy is also said to be successful in some cases.

Patients with Proctalgia fugax report varying success with antispasmodic and pain-relieving medications. Some patients can relieve some of the pain with paracetamol. The main problem is that the effect often only occurs when the pain stops. However, regular preventive use of painkillers (such as ibuprofen or diclofenac ) does not make sense for Proctalgia fugax, as it is unknown when the next attack will occur.

Other sufferers report pain so severe that they are no longer able to take medication or perform enemas. In general, cramps are often related to magnesium or calcium deficiency. Some Proctalgia fugax patients were able to reduce the frequency of attacks by taking appropriate preparations.

 

Selbsthilfe bei Proctalgia fugax

Due to the inadequate treatment options, many sufferers of proctalgia fugax have found out for themselves how they can make the attacks more bearable. These include applying pressure to the perineum, inserting a finger into the anus, or applying heat (for example, using a shower head on the painful area or a hot sitz bath). Certain body positions, such as the knee-elbow or stretching (touching your toes with your fingers and your legs stretched out), can also be influential.

In the long term, in addition to pain therapy, regulation of bowel function, psychotherapy, relaxation techniques, and pelvic floor training may be recommended. In general, however, these possibilities of self-help should be discussed with a doctor for the individual case.