From the Research
The initial management for rectal spasm involves a combination of conservative measures and medications, with a focus on reducing muscle tension and promoting normal bowel function. The most recent and highest quality study 1 supports the use of rectal application of lidocaine to reduce the severity of autonomic dysreflexia, which can be associated with rectal spasm. Key components of the initial management include:
- Warm sitz baths for 10-15 minutes several times daily to relax the rectal muscles and reduce pain
- Topical muscle relaxants such as nitroglycerin ointment (0.2%) applied to the anal area 2-3 times daily to reduce sphincter pressure and improve blood flow
- Oral muscle relaxants like diazepam (5-10mg) or cyclobenzaprine (5-10mg) may be prescribed for short-term use in severe cases
- Over-the-counter pain relievers such as acetaminophen or ibuprofen to manage associated discomfort
- Dietary modifications, including increased fiber intake (25-30g daily) and adequate hydration (at least 8 glasses of water daily) to prevent constipation that can worsen spasms
- Stool softeners like docusate sodium (100mg twice daily) may be beneficial
- Avoiding straining during bowel movements and practicing proper toileting habits, such as not sitting for prolonged periods, can prevent triggering spasms. It is essential to note that the management of rectal spasm should prioritize reducing morbidity, mortality, and improving quality of life, and the approach may vary depending on the individual patient's needs and underlying conditions.