Proctaglia fugax is a disorder characterised by rectal pain that is considered to be functional in aetiology, and thus is a diagnosis of exclusion.
The classic presentation, which form the Rome IV diagnostic criteria if all present for three months, include 1,2:
recurrent episodes of rectal pain that occur independently to defaecation
pain lasts for no longer than 30 minutes
in between episodes of pain, there is no pain
The underlying aetiology of proctalgia fugax is unknown. Popular theories postulate that it may be related to psychiatric disorders, anal sphincter cramps, or pudendal nerve compression or neuralgia 2,3.
Proctalgia fugax has no radiographic features. Imaging may be performed to exclude other potential clinical differential diagnoses (e.g. pelvic inflammatory disease, inflammatory bowel disease, rectal cancer) 4.
Treatment and prognosis
Management, if required, is often multi-faceted, involving pharmacotherapy (e.g. antispasmodics, salbutamol), psychotherapy, and even invasive therapy (e.g. pudendal nerve blocks) 2,3,5.
- 1. Simren M, Palsson OS, Whitehead WE. Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice. (2017) Current gastroenterology reports. 19 (4): 15. doi:10.1007/s11894-017-0554-0 - Pubmed
- 2. Rao SS, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, Malcolm A, Wald A. Functional Anorectal Disorders. (2016) Gastroenterology. doi:10.1053/j.gastro.2016.02.009 - Pubmed
- 3. Takano M. Proctalgia fugax: caused by pudendal neuropathy?. (2005) Diseases of the colon and rectum. 48 (1): 114-20. Pubmed
- 4. Greenhalgh R, Cohen CR, Burling D, Taylor SA. Investigating perianal pain of uncertain cause. (2008) BMJ (Clinical research ed.). 336 (7640): 387-9. doi:10.1136/bmj.39455.393299.AD - Pubmed
- 5. Jeyarajah S, Chow A, Ziprin P, Tilney H, Purkayastha S. Proctalgia fugax, an evidence-based management pathway. (2010) International journal of colorectal disease. 25 (9): 1037-46. doi:10.1007/s00384-010-0984-8 - Pubmed