Functional anorectal pain is a relatively common symptom that occurs in the absence of any clinical abnormality although some patients may also have other anorectal diseases, such as hemorrhoids. It is not sure if the local inflammation caused by hemorrhoids contributes to the development of anorectal pain syndromes in those patients. Despite their benign nature of functional anorectal pain, they can cause debilitating to the sufferer.
There are two functional anorectal pain syndromes.
• Proctalgia fugax (PF) (fugax = fugitive/fleeting in Latin)
• Levator ani syndrome (LAS)
Proctalgia Fugax is an anorectal pain syndrome that occurs as a result of cramping of the levator ani muscle. It occurs in episodes lasting seconds or minutes, typically in the middle of the night, though it is very possible to experience it during the day as well. Patients may feel spasm-like, sharp pain in the anus that is often mistaken for a sign that they must defecate. This may also be accompanied by an involuntary erection in men. Attacks, and typically start at the age of 45. An estimated 8-18% of people in the developed world are affected by proctalgia fugax, but true figures are not clear because many people do not seek professional diagnosis. It is estimated that only 20-30% of people with this condition seek out professional diagnosis.
The condition is recurrent, and while not curable, treatments are available.
Traditional ways to manage pain include warm baths, warm/hot enemas, relaxation techniques. Applying ice or some similar cold pack to the afflicted area can help pain as well. Severe attacks can be mitigated a bit using salbutamol. For most cases, reassurance, and topical calcium-channel blockers, salbutamol inhalers, and sublingual nitroglycerine are used for treatment. Botulinum toxin A injection is 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.9. The treatments of the underlying diseases, such as hemorrhoids and anal fissures, may help to reduce the muscle spasm by decreasing the local inflammatory irritation to anal sphincter muscles.
Levator ani syndrome presents the symptoms with vague, aching or pressure feeling high in the rectum. It could be worsened by sitting and relieved by walking. The pain tends to be constant and lasts from hours to days. It recurs regularly.
The diagnostic criteria of levator ani syndrome is that the symptoms must be present for three months with symptom onset at least six months prior to diagnosis, and other causes of similar anorectal pain must have been excluded.
Management of levator ani syndrome is similar to that of proctalgia fugax, including biofeedback treatment, Inhaled salbutamol, Botulinum toxin A, electrogalvanic stimulation and nerve stimulation.