Differential Diagnosis for Night Time Rectal Pain

• Single most likely diagnosis
  • Proctalgia Fugax: This condition is characterized by sudden, severe, and fleeting rectal pain, often occurring at night. It is relatively common and can be caused by muscle spasms in the anal sphincter.
• Other Likely diagnoses
  • Anal Fissure: A tear in the lining of the anus can cause sharp pain, especially during and after bowel movements, but can also be exacerbated at night.
  • Hemorrhoids: While often associated with pain during bowel movements, thrombosed hemorrhoids can cause constant, severe pain that may worsen at night.
  • Levator Ani Syndrome: This condition involves chronic pain and tenderness in the levator ani muscle, which can cause rectal pain that may be worse at night.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Rectal Cancer: Although less common, rectal cancer can cause rectal pain, especially if the tumor is large or has invaded surrounding structures.
  • Ischemic Proctitis: Reduced blood flow to the rectum can cause severe pain, and if not addressed, can lead to tissue necrosis and perforation.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause rectal pain, among other symptoms, and require prompt diagnosis and treatment to prevent complications.
• Rare diagnoses
  • Coccygodynia: Pain in the coccyx (tailbone) can radiate to the rectum and be worse at night, especially if the coccyx is fractured or inflamed.
  • Pudendal Neuralgia: This condition involves chronic pain in the distribution of the pudendal nerve, which can include the rectum, and is often exacerbated by sitting or at night.
  • Solitary Rectal Ulcer Syndrome: This condition can cause rectal pain, among other symptoms like bleeding and difficulty with bowel movements, and is associated with chronic straining during defecation.