From the Research
Proctalgia fugax treatment primarily involves managing the acute pain episodes and preventing recurrences, with the most recent and highest quality study suggesting botulinum A toxin injection as a promising option for patients who do not respond to other treatments 1.
Treatment Options
- For immediate relief during an attack, applying a warm bath or using a heating pad on the rectal area can help relax the muscles.
- Taking deep breaths and practicing relaxation techniques may also reduce the spasm.
- Over-the-counter pain medications like acetaminophen or ibuprofen can be used for pain management.
- For more severe cases, topical nitroglycerin (0.2% ointment applied to the anal canal) or diltiazem (2% gel) may help by relaxing the anal sphincter muscles.
- Some patients benefit from inhaled salbutamol (albuterol) using 2 puffs during an attack, as shown in a study published in 1996 2.
Prevention
- Maintaining regular bowel habits, increasing dietary fiber, staying hydrated, and avoiding constipation are recommended.
- Stress reduction techniques like meditation or yoga may help prevent attacks triggered by anxiety.
Underlying Cause
- Proctalgia fugax is thought to be related to spasms of the pelvic floor muscles or anal sphincter, with a study published in 2010 suggesting that the mainstay of treatment is reassurance and careful counselling 3.
Treatment Approach
- A sequential treatment approach, as described in a study published in 2005, may be effective in managing proctalgia fugax, with steps including information, hip bath, benzodiazepines, sublingual nifedipine, and internal anal sphincterotomy in cases of hypertrophy of the internal anal sphincter 4.
- Botulinum A toxin injection, as described in a study published in 2017, may be a promising option for patients who do not respond to other treatments, with minimal morbidity 1.