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Proctalgia fugax, an evidence-based management pathway

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

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.

Method

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.

Results

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.

Conclusion

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 fulfilment of Rome III criteria. The main treatment for this benign condition remains reassurance and topical treatment.

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References

  1. de Parades V, Etienney I, Bauer P, Taouk M, Atienza P (2007) Proctalgia fugax: demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients. Dis Colon Rectum 50(6):893–898

    Article  PubMed  Google Scholar 

  2. Myrtle AS (1883) Some common afflictions of the anus often neglected by medical men and patients. BMJ 1:1061–1062

    Article  Google Scholar 

  3. MacLennan A (1917) A short note of rectal crises of non-tabetic origin. Glasgow Medical Journal 88:129–131

    Google Scholar 

  4. Ibrahim H (1961) Proctalgia fugax. Gut 2:137–140

    Article  PubMed  CAS  Google Scholar 

  5. McEwin R (1956) Proctalgia fugax. Med J Aust 43(9):337–340

    PubMed  CAS  Google Scholar 

  6. Karras JD, Angelo G (1951) Proctalgia fugax. Am J Surg 82(5):616–625

    Article  PubMed  CAS  Google Scholar 

  7. Lans WR (1994) Proctalgia fugax: curable after all? Coloproctology 16:128–132

    Google Scholar 

  8. Gracia Solanas JA, Ramirez Rodriguez JM, Elia Guedea M, Aguilella Diago V, Martinez Diez M (2005) Sequential treatment for proctalgia fugax. Mid-term follow-up. Rev Esp Enferm Dig 97(7):491–496

    Article  PubMed  CAS  Google Scholar 

  9. Douthwaite AH (1962) Proctalgia fugax. Br Med J 2(5298):164–165

    Article  PubMed  CAS  Google Scholar 

  10. Thompson WG (1984) Proctalgia fugax in patients with the irritable bowel, peptic ulcer, or inflammatory bowel disease. Am J Gastroenterol 79(6):450–452

    PubMed  CAS  Google Scholar 

  11. Bharucha AE, Wald A, Enck P, Rao S (2006) Functional anorectal disorders. Gastroenterology 130(5):1510–1518

    Article  PubMed  Google Scholar 

  12. Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS (1999) Functional disorders of the anus and rectum. Gut 45(Suppl 2):II55–II59

    Article  PubMed  Google Scholar 

  13. Boyce PM, Talley NJ, Burke C, Koloski NA (2006) Epidemiology of the functional gastrointestinal disorders diagnosed according to Rome II criteria: an Australian population-based study. Intern Med J 36(1):28–36

    Article  PubMed  CAS  Google Scholar 

  14. Thompson WG, Heaton KW (1980) Proctalgia fugax. J R Coll Physicians Lond 14(4):247–248

    PubMed  CAS  Google Scholar 

  15. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG et al (1993) U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 38(9):1569–1580

    Article  PubMed  CAS  Google Scholar 

  16. Thaysen TE (1935) Proctalgia fugax. Lancet 2:243–246

    Article  Google Scholar 

  17. Ewing MR (1953) Proctalgia fugax. Br Med J 1(4819):1083–1085

    Article  PubMed  CAS  Google Scholar 

  18. Eckardt VF, Dodt O, Kanzler G, Bernhard G (1996) Anorectal function and morphology in patients with sporadic proctalgia fugax. Dis Colon Rectum 39(7):755–762

    Article  PubMed  CAS  Google Scholar 

  19. Takano M (2005) Proctalgia fugax: caused by pudendal neuropathy? Dis Colon Rectum 48(1):114–120

    Article  PubMed  Google Scholar 

  20. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C et al (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10

    Article  PubMed  Google Scholar 

  21. Rockville M (2000–2003) U.S. preventive services task force ratings: strength of recommendations and quality of evidence. Guide to clinical preventive services: Agency for Healthcare Research and Quality

  22. Wollina U, Konrad H, Petersen S (2005) Botulinum toxin in dermatology—beyond wrinkles and sweat. J Cosmet Dermatol 4(4):223–227

    Article  PubMed  Google Scholar 

  23. Pfenninger JL, Zainea GG (2001) Common anorectal conditions: part I. Symptoms and complaints. Am Fam Physician 63(12):2391–2398

    PubMed  CAS  Google Scholar 

  24. Schmulson M, Ortiz O, Santiago-Lomeli M, Gutierrez-Reyes G, Gutierrez-Ruiz MC, Robles-Diaz G et al (2006) Frequency of functional bowel disorders among healthy volunteers in Mexico City. Dig Dis 24(3–4):342–347

    Article  PubMed  Google Scholar 

  25. Whitehead WE (1996) Functional anorectal disorders. Semin Gastrointest Dis 7(4):230–236

    PubMed  CAS  Google Scholar 

  26. Peery WH (1988) Proctalgia fugax: a clinical enigma. South Med J 81(5):621–623

    PubMed  CAS  Google Scholar 

  27. Kornel EE, Vlahakos D (1988) Intraspinal schwannoma presenting solely with rectal pain. Neurosurgery 22(2):417–419

    Article  PubMed  CAS  Google Scholar 

  28. Singer MA, Cintron JR, Martz JE, Schoetz DJ, Abcarian H (2003) Retrorectal cyst: a rare tumor frequently misdiagnosed. J Am Coll Surg 196(6):880–886

    Article  PubMed  Google Scholar 

  29. Khan A, Ahmed M, Talati J (1989) Seminal vesicle cystic dilatation masquerading as proctalgia fugax. Br J Urol 64(4):428–429

    Article  PubMed  CAS  Google Scholar 

  30. Sinaki M, Merritt JL, Stillwell GK (1977) Tension myalgia of the pelvic floor. Mayo Clin Proc 52(11):717–722

    PubMed  CAS  Google Scholar 

  31. Nathan BN (1990) An early clinical account of proctalgia fugax. Dis Colon Rectum 33(6):539

    Article  PubMed  CAS  Google Scholar 

  32. Weizman Z, Binsztok M (1989) Proctalgia fugax in teenagers. J Pediatr 114(5):813–814

    Article  PubMed  CAS  Google Scholar 

  33. Brown ET (1971) Proctalgia fugax infantum. Ann Allergy 29(2):99–100

    PubMed  CAS  Google Scholar 

  34. Pounders CM (1957) Proctalgia fugax infantum: painful defecation in allergic infants. J Pediatr 51(4):413–415

    Article  PubMed  CAS  Google Scholar 

  35. Oatfield H (1962) fugax. Books, the unknown quantity to librarians. Bull Med Libr Assoc 50:224–235

    PubMed  CAS  Google Scholar 

  36. Karras JD, Angelo G (1963) Proctalgia fugax. Clinical observations and a new diagnostic aid. Dis Colon Rectum 6:130–134

    Article  Google Scholar 

  37. Sanchez Romero AM, Arroyo Sebastian A, Perez Vicente FA, Serrano Paz P, Candela Polo F, Calpena Rico R (2006) Treatment of proctalgia fugax with botulinum toxin: results in 5 patients. Rev Clin Esp 206(3):137–140

    Article  PubMed  CAS  Google Scholar 

  38. Eckardt VF, Dodt O, Kanzler G, Bernhard G (1996) Treatment of proctalgia fugax with salbutamol inhalation. Am J Gastroenterol 91(4):686–689

    PubMed  CAS  Google Scholar 

  39. Dodi G, Bogoni F, Infantino A, Pianon P, Mortellaro LM, Lise M (1986) Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles. Dis Colon Rectum 29(4):248–251

    Article  PubMed  CAS  Google Scholar 

  40. Olsen B (2008) Proctalgia fugax—a nightmare drowned in enema. Colorectal Dis 10(5):522–523

    Article  PubMed  CAS  Google Scholar 

  41. Jelovsek JE, Barber MD, Paraiso MF, Walters MD (2005) Functional bowel and anorectal disorders in patients with pelvic organ prolapse and incontinence. Am J Obstet Gynecol 193(6):2105–2111

    Article  PubMed  Google Scholar 

  42. Magni G, de Bertolini C, Dodi G, Infantino A (1986) Psychological findings in chronic anal pain. Psychopathology 19(4):170–174

    Article  PubMed  CAS  Google Scholar 

  43. Harvey RF (1979) Colonic motility in proctalgia fugax. Lancet 2(8145):713–714

    Article  PubMed  CAS  Google Scholar 

  44. Pilling LF, Swenson WM, Hill JR (1965) The psychologic aspects of proctalgia fugax. Dis Colon Rectum 8(5):372–376

    Article  PubMed  CAS  Google Scholar 

  45. Martin JE, Swash M, Kamm MA, Mather K, Cox EL, Gray A (1990) Myopathy of internal anal sphincter with polyglucosan inclusions. J Pathol 161(3):221–226

    Article  PubMed  CAS  Google Scholar 

  46. Penny RW (1970) The doctor's disease—proctalgia fugax. Practitioner 204(224):843–845

    PubMed  CAS  Google Scholar 

  47. Potthast OJ (1964) The treatment of proctalgia fugax: four more years of experience. South Med J 57:255–258

    PubMed  CAS  Google Scholar 

  48. Eibel P (1970) Proctalgia fugax: recurrent fulminating coccygodynia. A report of three cases with a review of the literature. Clin Orthop Relat Res 73:116–120

    Article  PubMed  CAS  Google Scholar 

  49. Paradis H, Marganoff H (1969) Rectal pain of extrarectal origin. Dis Colon Rectum 12(4):306–312

    Article  PubMed  CAS  Google Scholar 

  50. Mazza L, Formento E, Fonda G (2004) Anorectal and perineal pain: new pathophysiological hypothesis. Tech Coloproctol 8(2):77–83

    Article  PubMed  CAS  Google Scholar 

  51. Wald A (2001) Functional anorectal and pelvic pain. Gastroenterol Clin North Am 30(1):243–251, viii–ix

    Article  PubMed  CAS  Google Scholar 

  52. Potter MA, Bartolo DC (2001) Proctalgia fugax. Eur J Gastroenterol Hepatol 13(11):1289–1290

    Article  PubMed  CAS  Google Scholar 

  53. Wesselmann U, Burnett AL, Heinberg LJ (1997) The urogenital and rectal pain syndromes. Pain 73(3):269–294

    Article  PubMed  CAS  Google Scholar 

  54. Babb RR (1996) Proctalgia fugax: would you recognize it? Postgrad Med 99(4):263–264

    PubMed  CAS  Google Scholar 

  55. Nidorf DM, Jamison ER (1995) Proctalgia fugax. Am Fam Physician 52(8):2238–2240

    PubMed  CAS  Google Scholar 

  56. Vincent C (1999) Anorectal pain and irritation: anal fissure, levator syndrome, proctalgia fugax, and pruritus ani. Prim Care 26(1):53–68

    PubMed  CAS  Google Scholar 

  57. Scott D (1982) Proctalgia fugax. Postgrad Med 72(3):44–45

    PubMed  CAS  Google Scholar 

  58. Thompson WG (1981) Proctalgia fugax. Dig Dis Sci 26(12):1121–1124

    Article  PubMed  CAS  Google Scholar 

  59. Spiesman MG, Malow L (1952) Coccygodynia and proctalgia fugax. Am J Proctol 3(4):310–313

    PubMed  CAS  Google Scholar 

  60. de la Portilla F, Borrero JJ, Rafel E (2005) Hereditary vacuolar internal anal sphincter myopathy causing proctalgia fugax and constipation: a new case contribution. Eur J Gastroenterol Hepatol 17(3):359–361

    Article  PubMed  Google Scholar 

  61. Peleg R, Shvartzman P (2002) Low-dose intravenous lidocaine as treatment for proctalgia fugax. Reg Anesth Pain Med 27(1):97–99

    PubMed  Google Scholar 

  62. Katsinelos P, Kalomenopoulou M, Christodoulou K, Katsiba D, Tsolkas P, Pilpilidis I et al (2001) Treatment of proctalgia fugax with botulinum A toxin. Eur J Gastroenterol Hepatol 13(11):1371–1373

    Article  PubMed  CAS  Google Scholar 

  63. Konig P, Ambrose NS, Scott N (2000) Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation: further clinical and histological characterization in a patient. Eur J Gastroenterol Hepatol 12(1):127–128

    Article  PubMed  CAS  Google Scholar 

  64. Lowenstein B, Cataldo PA (1998) Treatment of proctalgia fugax with topical nitroglycerin: report of a case. Dis Colon Rectum 41(5):667–668

    Article  PubMed  CAS  Google Scholar 

  65. Guy RJ, Kamm MA, Martin JE (1997) Internal anal sphincter myopathy causing proctalgia fugax and constipation: further clinical and radiological characterization in a patient. Eur J Gastroenterol Hepatol 9(2):221–224

    PubMed  CAS  Google Scholar 

  66. Rao SS, Hatfield RA (1996) Paroxysmal anal hyperkinesis: a characteristic feature of proctalgia fugax. Gut 39(4):609–612

    Article  PubMed  CAS  Google Scholar 

  67. Celik AF, Katsinelos P, Read NW, Khan MI, Donnelly TC (1995) Hereditary proctalgia fugax and constipation: report of a second family. Gut 36(4):581–584

    Article  PubMed  CAS  Google Scholar 

  68. Kamm MA, Hoyle CH, Burleigh DE, Law PJ, Swash M, Martin JE et al (1991) Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation. A newly identified condition. Gastroenterology 100(3):805–810

    PubMed  CAS  Google Scholar 

  69. Waldman SD, Wilson WL, Kreps RD (1991) Superior hypogastric plexus block using a single needle and computed tomography guidance: description of a modified technique. Reg Anesth 16(5):286–287

    PubMed  CAS  Google Scholar 

  70. Swain R (1987) Oral clonidine for proctalgia fugax. Gut 28(8):1039–1040

    Article  PubMed  CAS  Google Scholar 

  71. Boquet J, Moore N, Lhuintre JP, Boismare F (1986) Diltiazem for proctalgia fugax. Lancet 1(8496):1493

    Article  PubMed  CAS  Google Scholar 

  72. Mountifield JA (1986) Proctalgia fugax: a cause of marital dysharmony. Cmaj 134(11):1269–1270

    PubMed  CAS  Google Scholar 

  73. Burdick GE (1979) Proctalgia fugax: a pain in the rear. Ariz Med 36(7):511–512

    PubMed  CAS  Google Scholar 

  74. Schuster MM (1977) Constipation and anorectal disorders. Clin Gastroenterol 6(3):643–658

    PubMed  CAS  Google Scholar 

  75. Bascom JU (1998) Pudendal canal syndrome and proctalgia fugax: a mechanism creating pain. Dis Colon Rectum 41(3):406

    Article  PubMed  CAS  Google Scholar 

  76. Shafik A (1997) Pudendal canal syndrome and proctalgia fugax. Dis Colon Rectum 40(4):504

    Article  PubMed  CAS  Google Scholar 

  77. Rockefeller R (1996) Digital dilatation for relief of proctalgia fugax. Am Fam Physician 54(1):72

    PubMed  CAS  Google Scholar 

  78. Wright JE (1985) Inhaled salbutamol for proctalgia fugax. Lancet 2(8456):659–660

    Article  PubMed  CAS  Google Scholar 

  79. Kaufman W (1982) Treatment of proctalgia fugax. Dig Dis Sci 27(10):955

    Article  PubMed  CAS  Google Scholar 

  80. Stanley OT (1981) Proctalgia fugax and psychiatric illness. Med J Aust 1(2):90

    PubMed  CAS  Google Scholar 

  81. Wright JE (1991) Trial of inhaled salbutamol for proctalgia fugax. Lancet 337(8737):359

    Article  PubMed  CAS  Google Scholar 

  82. Hertz AF (1909) Constipation and allied intestinal disorders. Oxford University Press, London

    Google Scholar 

  83. McHugh SM, Diamant NE (1987) Effect of age, gender, and parity on anal canal pressures. Contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci 32(7):726–736

    Article  PubMed  CAS  Google Scholar 

  84. Frenckner B, Euler CV (1975) Influence of pudendal block on the function of the anal sphincters. Gut 16(6):482–489

    Article  PubMed  CAS  Google Scholar 

  85. Clayton MR (1985) Therapy for proctodynia. Med J Aust 143(11):532

    PubMed  CAS  Google Scholar 

  86. Starke K (1981) Presynaptic receptors. Annu Rev Pharmacol Toxicol 21:7–30

    Article  PubMed  CAS  Google Scholar 

  87. Jennewein HMS, Stockhaus K, Lehr E (1983) The psychotropic effects of clonidine. Steinkopf, Darmstadt

    Google Scholar 

  88. Mao J, Chen LL (2000) Systemic lidocaine for neuropathic pain relief. Pain 87(1):7–17

    Article  PubMed  CAS  Google Scholar 

  89. Baranowski AP, De Courcey J, Bonello E (1999) A trial of intravenous lidocaine on the pain and allodynia of postherpetic neuralgia. J Pain Symptom Manage 17(6):429–433

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Biosurgery and Surgical Technology, Imperial College, St Mary’s Hospital, London, UK

    Santhini Jeyarajah, Andre Chow, Paul Ziprin & Sanjay Purkayastha

  2. Frimley Park NHS Foundation Trust, Camberley, Surrey, UK

    Henry Tilney

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  1. Santhini Jeyarajah
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  2. Andre Chow
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  3. Paul Ziprin
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  5. Sanjay Purkayastha
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Correspondence to Santhini Jeyarajah.

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Jeyarajah, S., Chow, A., Ziprin, P. et al. Proctalgia fugax, an evidence-based management pathway. Int J Colorectal Dis 25, 1037–1046 (2010). https://doi.org/10.1007/s00384-010-0984-8

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