A real pain in the butt – proctalgia fugax

Problems in the pelvic region can be embarrassing to talk about, even with health professionals. One condition in particular, ‘proctalgia fugax’, is experienced by up to 18% of the population but only reported by around 20% of these individuals.

‘Proctalgia fugax’ means recurrent episodes of sudden pain in the anus. Patients describe it as sharp or stabbing, ‘like a hot poker up the backside’. The pain comes on very suddenly and is sometimes so strong that it prevents any movement at all. It can occur during day-to-day activities, in sitting, standing or even while sleeping! It’s almost impossible to find relief in the moment, and sufferers say they just have to wait between a few seconds and several minutes for the pain to pass before they can move normally again.

Sounds scary, right? And it is, when you don’t know what the cause is. In most cases, the pain seems to be caused by a strong, involuntary spasm in the external anal sphincter muscle (EAS). The EAS is a ring of muscle at the anal opening that is usually closed, and relaxes when you pass a bowel motion.

The EAS goes into spasm as a faulty protective mechanism. Your brain thinks something bad is about to happen, and it’s trying to ready your body for action (‘fight or flight’). The spasm might be a reaction to an experience of high levels of psychological stress, or to recent or old damage to the tissues around the anus.

We think this is why proctalgia fugax is associated with anxiety, and with other pelvic pain conditions like a fall onto your tailbone, irritable bowel syndrome, endometriosis, birth-related trauma, vaginal hysterectomy, haemorrhoids and anal fissures.

Physiotherapy treatment is commonly used to help the anal muscles and other muscles in the area learn to relax. The person affected will usually visit the clinic for some treatment here, and then be given exercises to take home to help prevent further attacks. Supplementation with magnesium, under medical supervision, can be helpful to regulate the electrical signal in the muscles. In rare cases, when people aren’t getting better as they should, we refer on to a specialist doctor for further management.

If you’ve experienced ‘a pain in the butt’ like I’ve described here, and it’s happened more than once or is causing you to worry, please get in touch with us for a pelvic health assessment.


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