A Real Pain in the Butt—Proctalgia Fugax

Problems in the pelvic region can be embarrassing to talk about, even with health professionals. One condition in particular, ‘proctalgia fugax’, is experienced by up to 18% of the population but only reported by around 20% of these individuals.

Symptoms of Proctalgia Fugax

‘Proctalgia fugax’ means recurrent episodes of sudden pain in the anus. What does proctalgia fugax feel like? Patients describe it as a stabbing or sharp pain in anus, ‘like a hot poker up the backside’. 

Symptoms of proctalgia fugax can be unpredictable and may occur in episodes, with periods of remission in between. The pain comes on very suddenly and is sometimes so strong that it prevents any movement at all. 

It can occur during day-to-day activities, in sitting, standing or even while sleeping! It’s almost impossible to find relief at the moment, and sufferers say they just have to wait between a few seconds and several minutes for the pain to pass before they can move normally again.

Causes of Proctalgia Fugax

Sounds scary, right? And it is, when you don’t know what the cause is. In most cases, the pain seems to be caused by a strong, involuntary spasm in the external anal sphincter muscle (EAS). The EAS is a ring of muscle at the anal opening that is usually closed, and relaxes when you pass a bowel motion.

The EAS goes into spasm as a faulty protective mechanism. Your brain thinks something bad is about to happen, and it’s trying to ready your body for action (‘fight or flight’). The spasm might be a reaction to an experience of high levels of psychological stress, or to recent or old damage to the tissues around the anus.

We think this is why proctalgia fugax is associated with anxiety, and with other pelvic pain conditions like a fall onto your tailbone, irritable bowel syndrome, endometriosis, birth-related trauma, vaginal hysterectomy, haemorrhoids and anal fissures.

Treatment Options

Proctalgia fugax treatment focuses on relieving pain during an attack and preventing future episodes. Options include warm baths, massage, and anal sphincter exercises. Medications like muscle relaxants and painkillers can also provide relief. Moreover, lifestyle changes such as avoiding trigger foods and stress management techniques can help prevent future episodes.

If you are experiencing proctalgia fugax, it is important to consult with a medical professional to determine the best course of action for how to treat proctalgia fugax and alleviate your symptoms.

Physiotherapy treatment is an excellent choice for treating this condition. It is commonly used to help the anal muscles and other muscles in the area learn to relax. The person affected will usually visit the clinic for some treatment here, and then be given exercises to take home to help prevent further attacks. 

Supplementation with magnesium, under medical supervision, can be helpful to regulate the electrical signal in the muscles. In rare cases, when people aren’t getting better as they should, we refer them to a specialist doctor for further management.

If you’ve experienced ‘a pain in the butt’ like I’ve described here, and it’s happened more than once or is causing you to worry, please get in touch with us for a pelvic health assessment. 

Learning how to stop proctalgia fugax involves identifying triggers, managing underlying conditions, and consulting with a medical professional to develop a personalised treatment plan that includes lifestyle changes, medications, and stress-management techniques.