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Proctalgia fugax
Classification and external resources
ICD-10 K59.4
ICD-9 564.6

Proctalgia fugax (or levator syndrome) is a severe, episodic, rectal and sacrococcygeal pain.[1] It can be caused by cramp of the pubococcygeus or levator ani muscles.[2]



It most often occurs in the middle of the night[3] and lasts less than 20 minutes, an indicator for the differential diagnosis of levator ani syndrome, which presents as pain and aching lasting twenty minutes or longer. In a study published in 2007 involving 1809 patients, the attacks occurred in the daytime, (33 percent) as well as at night (33 percent) and the average number of attacks was 13. Onset can be in childhood, however, in multiple studies the average age of onset was 45. Many studies showed that women are affected more commonly than men.[4] The pain is sometimes described as an "anal charlie horse," an anal cramp, an anal spasm, a Dani spasm, or repeated spasms of the anus.

During an episode, the patient feels spasm-like pain in the anus, often misinterpreted as a need to defecate. Simultaneous stimulation of the local autonomic system can cause erection in males. Because of the high incident of internal anal sphincter thickening with the disorder, it is thought to be a disorder of the internal anal sphincter or that it is a neuralgia of pudendal nerves. It is recurrent and there is also no known cure. However, some studies show effective use of botulinum toxin, pudendal nerve block, and calicum channel blockers. It is not known to be linked to any disease process and data on the number of people afflicted varies, but is more prevalent than usually thought.

Like all ordinary muscle cramps, it is a severe, deep rooted pain. Proctalgia fugax (fleeting pain).

In males, it has been reported to occur immediately following ejaculation. There seems to be some indication that prolonged and tense sexual arousal may lead to an episode later that night.

Episodes happen almost always with an empty colon. Defecation of any feces present can worsen the spasm, but may relieve it, or provide a measure of comfort. The pain might subside by itself as the spasm disappears on its own, or may persist or reoccur during the same night.

Treatment and prevention

Traditional remedies have ranged from warm baths (if the pain lasts long enough to draw a bath), warm to hot enemas,[5] relaxation techniques, gentle massage of the anus, and various medications including medical marijuana.

One method of quickly alleviating the pain is to stretch the area by touching one's toes, followed by taking the anti-inflammatory ibuprofen (e.g. Advil) with a glass of water.[6] Alternatively, it has been suggested that one takes acetaminophen / paracetamol (e.g. Tylenol) with a hot drink (or simply a glass of water).[7]

In patients who suffer frequent, severe, prolonged attacks, inhaled salbutamol has been shown in some studies to reduce their duration.[8]

The use of botulinum toxin has been proposed,[9] as has diazepam.[10]


  1. ^ levator syndrome at Dorland's Medical Dictionary
  2. ^ Olden, Kevin W. (1996). Handbook of functional gastrointestinal disorders. New York: M. Dekker. p. 369. ISBN 0-8247-9409-5.  
  3. ^ Takano M (2005). "Proctalgia fugax: caused by pudendal neuropathy?". Dis. Colon Rectum 48 (1): 114–20. doi:10.1007/s10350-004-0736-3. PMID 15690667.  
  4. ^ de Parades V, Etienney I, Bauer P, Taouk M, Atienza P (2007). "Proctalgia fugax: demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients". Dis. Colon Rectum 50 (6): 893–8. doi:10.1007/s10350-006-0754-4. PMID 17164968.  
  5. ^ Olsen B (2007). "Proctalgia fugax - a nightmare drowned in enema". Colorectal Disease 10: 522. doi:10.1111/j.1463-1318.2007.01399.x. PMID 17949444.  
  6. ^ Charlie Horse : KOLAAP 2008-01-18
  7. ^ Anal problems - anal pain
  8. ^ Eckardt VF, Dodt O, Kanzler G, Bernhard G (1996). "Treatment of proctalgia fugax with salbutamol inhalation". Am. J. Gastroenterol. 91 (4): 686–9. PMID 8677929.  
  9. ^ Wollina U, Konrad H, Petersen S (2005). "Botulinum toxin in dermatology - beyond wrinkles and sweat". Journal of cosmetic dermatology 4 (4): 223–7. doi:10.1111/j.1473-2165.2005.00195.x. PMID 17168867.  
  10. ^ Pfenninger JL, Zainea GG (2001). "Common anorectal conditions: Part I. Symptoms and complaints". Am Fam Physician 63 (12): 2391–8. PMID 11430454.  

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