Functional Anorectal Pain

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Functional anorectal pain is a relatively common condition where there’s an absence of any clinical abnormality, but patients may suffer from other anorectal diseases that lead to anorectal pain syndromes. Despite the benign nature of functional anorectal pain, it can cause the patient debilitating pain.

There are two functional anorectal pain syndromes:

• Proctalgia fugax (PF)
• Levator ani syndrome (LAS)

Proctalgia fugax

Proctalgia fugax, which translates to “fleeting pain” in Latin, is a recurrent anorectal pain syndrome that results from cramping of the levator ani muscle. Episodes can last from seconds to minutes and usually occur in the middle of the night (daytime episodes can also occur, however). Symptoms include spasm-like, sharp pain in the anus that’s often confused with an urge to defecate. This may also be accompanied by an involuntary erection in men.

Proctalgia fugax episodes typically start after the age of 45. An estimated 8-18 percent of people in the developed world are affected by proctalgia fugax, but true figures are not clear since only about 20-30 percent of people seek a professional diagnosis.

While this condition is not curable, treatments are available. Conservative, at-home pain management methods include warm baths, warm/hot enemas and relaxation techniques. Applying ice/cold packs to the afflicted area can help pain as well. Severe attacks can be mitigated using salbutamol, a medication that can loosen the muscles.

For most cases, topical calcium-channel blockers, salbutamol inhalers and sublingual nitroglycerine are used for treatment. Botulinum toxin A (Botox) injections are a new way to effectively reduce the tone of anal sphincters and reduce anorectal pain. Co-existent psychological issues should be addressed with behavioral and/or pharmacological therapies. Increased fiber intake and withdrawing gut-affecting medication can also help with pain. High-voltage pulsed galvanic stimulation has been shown to reduce short-term frequency of the attacks. Treating underlying diseases, such as hemorrhoids and anal fissures, can also help reduce muscle spasms by decreasing local inflammatory irritation to the anal sphincter muscles.

Levator ani syndrome

Levator ani syndrome leads to a regularly-occurring, dull aching or pressure high in the rectum. Symptoms can worsen by sitting but relieved by walking. The pain tends to be constant and lasts from hours to days.

To be diagnosed with levator ani syndrome, a patient must experience symptoms for three months, with symptom onset occurring at least six months prior to diagnosis. Other causes of similar anorectal pain must have been excluded.

Management and treatment of levator ani syndrome is similar to that of proctalgia fugax, including biofeedback treatment, Inhaled salbutamol, Botulinum toxin A, electrogalvanic stimulation and nerve stimulation.

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