Proctalgia Fugax

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Proctalgia fugax (fugax-fleeting) is characterized by brief episodes of rectal pain. Although a common problem, information regarding this disorder is limited because the published medical literature consists mostly of anecdotal reports and small case series. Several prospective studies, however, have determined that the prevalence of proctalgia ranges from 3% to 14%.1 Proctalgia occurs worldwide and affects men and women of all races and socioeconomic status, although there appears to be a slight female predominance.

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Rectal pain is the defining characteristic of proctalgia.2 Patients generally have fairly stereotypical episodes, although there is great variability in symptoms among patients. Proctalgia occurs unpredictably and without warning. Patients may describe the pain as sharp, stabbing, twisting, cramping, or lancinating in nature. Although patients often vividly remember nocturnal episodes because they cause sudden awakening, proctalgia can occur just as frequently during the day as well. The pain generally remains localized within the rectum, although occasionally the pain may radiate into the gluteal or perineal region. Episodes are generally brief in nature, ranging from seconds up to 30 minutes, with each painful episode resolving spontaneously. The exceptional patient may have an episode that lasts for days. Most patients have several episodes per year; it is the rare patient who has 2 or more episodes per month.

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Treating patients with proctalgia can be difficult, because symptoms have usually completely resolved by the time the patient can initiate medical therapy. In addition, because the majority of patients have very infrequent episodes, most clinicians are reticent to treat a patient with a daily medication in order to prevent a single, brief monthly episode. After carefully explaining the nature of the condition to the patient and reassuring him or her that it is a benign disorder, conservative therapy is generally the best recommendation.

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