Although proctalgia fugax, also known as levator syndrome in English-speaking countries, is not a rare disease, almost nothing is known about it. Even sufferers often do not know they have proctalgia fugax for decades. Sufferers are afflicted by sudden, cramping, almost seizure-like pain in the rectum. Often this pain passes quickly and is therefore not perceived as an illness. In these cases, patients also do not always see a need for therapy. In others, the quality of life is so severely limited by frequent, prolonged attacks that there is enormous suffering.
Proctalgia fugax: causes and diagnosis.
About the causes of proctalgia fugax, medical experts are completely in the dark. Cramps of the internal sphincter or the pelvic floor are suspected. Chronic constipation and psychosomatic factors are also discussed – perfectionists and anxious people are often said to be affected by proctalgia fugax. Increasingly, pelvic floor insufficiency, disturbances of the autonomic nervous system and hormonal disturbances are also suspected behind proctalgia fugax. As triggering factors, sufferers sometimes observe stressful situations; men more often report attacks after sexual intercourse (although women are about twice as likely to suffer from proctalgia fugax). Affected persons often hear from their doctors that no physical causes for proctalgia fugax can be determined; the diagnosis is usually made – if at all – on the basis of the description of the symptoms. If proctalgia fugax is suspected, the patient should undergo extensive examinations to rule out neurologic and hormonal conditions as well as conditions with similar symptoms, such as anogenital syndrome or anal fissure.
Proctalgia fugax: symptoms and signs.
People affected by proctalgia fugax uniformly report almost unbearable pain of the anal area. Especially when proctalgia fugax occurs for the first time, patients suffer from a great deal of anxiety because they fear that a serious emergency is present. Before puberty, proctalgia fugax occurs extremely rarely, mostly affecting the age group between 40 and 50. Basically, two types of proctalgia fugax are distinguished:
- A daytime attack occurs from one moment to the next. The pain becomes increasingly severe and may be of variable localization. Starting from the anus, it can affect the anal canal, pelvic floor and abdomen.
- In contrast, the night attack is constant in its pain intensity, affecting the entire anal area. Accompanying both forms of Proctalgia fugax are usually nausea to vomiting, dizziness, sweating and even fainting. The pain sometimes stops after a short time, and most attacks of proctalgia fugax last no longer than 30 minutes. In particularly severe cases, the pain lasts for several hours.
The attacks occur irregularly; the intervals may be days, weeks or months. The general average does not exceed six seizures a year. With age, these become less frequent.
Proctalgia fugax: treatment and therapy.
Unfortunately, experts are still relatively clueless on the question of treatment for proctalgia fugax. Occasionally, freedom from symptoms is achieved by taking the drugs clonidine, nifedipine, and salbutamol (when used by inhalation). Hemorrhoidal therapy is also reported to be successful in some cases. Patients with proctalgia fugax report varying success with antispasmodic and analgesic medications. Some patients can relieve pain somewhat with acetaminophen. The main problem is that the effect often only occurs when the pain stops on its own. Regular preventive use of painkillers (such as ibuprofen or diclofenac), however, is not useful in proctalgia fugax because it is unknown when the next attack will occur. Other sufferers report pain so severe that they are unable to take medication or perform enemas. In general, cramps are often related to magnesium or calcium deficiency. Some proctalgia fugax patients have been able to reduce the frequency of seizures by taking appropriate supplements.
Self-help for proctalgia fugax.
Because of inadequate treatment options, many sufferers of proctalgia fugax have figured out how to make the seizures more tolerable on their own.These include pressure on the perenium, inserting a finger into the anus, or applying heat (for example, using the showerhead of the shower on the painful area or a hot sitz bath). Certain body positions, such as the knee-elbow position, or stretching (touching the toes with the fingers when the legs are extended), can also be effective. In the long run, in addition to pain management, regulation of bowel function, psychotherapy, relaxation techniques, and pelvic floor training may be recommended. In general, however, these self-help options should be discussed with a physician for the individual case.
