Proctalgia fugax

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Proctalgia fugax (also called Levator Syndrome) is characterised by severe, episodic, anal pain. It can be caused by a spasm or cramping of the anal sphincter muscles (including the pubo-coccygeus or levator ani muscles). It is a diagnosis of exclusion, and provided other conditions that cause anal pain are excluded, then the approach is generally simple reassurance and symptom control.

PRESENTATION
Proctalgia fugax commonly occurs at night time, causing waking from sleep. It is typically severe and lasts for a few seconds to minutes. It may be associated with back pain, or pain that shoots down the legs.

WHO IS AFFECTED?
The onset can be as early as childhood however it typically presents during young adulthood.

TREATMENT AND PREVENTION
Traditional remedies include warm compress or warm baths, however the pain is often of such short duration that there is not sufficient time to organise these. In patients who suffer frequent, severe, prolonged attacks, inhaled salbutamol (Ventolin ®) has been shown in some studies to reduce their duration. Oral ingestion of calcium channel blockers such as diltiazem (Cardizem®) has also been found to work. Caffeine may relieve pain once ingested. Low dose diazepam at bedtime has been suggested as preventative, but is generally advised against because of its addictive nature.
Surgery is not indicated however there have been reports of the use of botulinum toxin injection in severe cases as a method of relaxing the anal sphincter temporarily.

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