From the Research
Proctalgia fugax is best treated with reassurance and self-management techniques, and for severe cases, botulinum A toxin injection can be considered as a promising option with minimal morbidity, as shown in a recent case report 1. The exact cause of proctalgia fugax remains unclear, but several etiologies have been proposed including:
- Anal sphincter spasm
- Pudendal nerve irritation
- Pelvic floor muscle dysfunction
- Psychological stress
- Rectal hypersensitivity Some cases may be associated with irritable bowel syndrome, anal fissures, or hemorrhoids. During an attack, patients can try:
- Warm sitz baths
- Topical heat application
- Gentle massage of the perineum and anal area
- Inhaling and exhaling slowly while relaxing the pelvic floor muscles to reduce pain For medication options,
- Topical nitroglycerin (0.2% ointment applied to the anal canal) can provide relief by relaxing smooth muscle, though headaches are a common side effect
- Calcium channel blockers like diltiazem (2% gel applied locally) may also be effective
- Salbutamol inhalation has been shown to shorten the duration of severe pain in patients with proctalgia fugax 2 Lifestyle modifications like:
- Avoiding constipation through adequate fiber intake (25-30g daily)
- Proper hydration
- Regular exercise may help prevent recurrences by reducing strain during defecation. It is essential to note that the treatment should be individualized, and the patient should be reassured that the condition is benign and self-limiting, as stated in a study published in the European journal of gastroenterology & hepatology 3. The most recent and highest quality study suggests that botulinum A toxin injection can be an effective treatment option for proctalgia fugax, with minimal morbidity 1.