Proctalgia fugax

Though Proctalgia fugax, which is also known as Levator Syndrome in English-speaking countries, is not a rare disease, almost nothing is known about it. Even those affected often do not know for decades that they suffer from Proctalgia fugax. Sick people are afflicted by sudden, spasmodic, almost attack-like pain in the rectum. Often these pains pass quickly and are therefore not perceived as a disease. In these cases, patients do not always see a need for therapy. For others, the quality of life is so limited by frequent, long-lasting seizures that an enormous amount of suffering arises.

Proctalgia fugax: causes and diagnosis
Doctors feel completely in the dark about the causes of Proctalgia fugax. Spasms of the internal sphincter or pelvic floor are suspected. Chronic constipation and psychosomatic factors are also discussed – often perfectionist and anxious people are said to be affected by Proctalgia fugax. Pelvic floor insufficiency, disorders of the autonomic nervous system and hormonal disorders are increasingly suspected behind Proctalgia fugax.

Sick people sometimes observe stressful situations as triggering factors; Men more often report seizures after intercourse (with women about twice as likely to get Proctalgia fugax). Those affected often hear from their doctor that no physical causes for Proctalgia fugax can be determined; if at all, the diagnosis is usually made on the basis of the description of the symptoms.

If Proctalgia fugax is suspected, the patient should undergo extensive examinations in order to exclude neurological, hormonal and similar symptoms such as anogenital syndrome or anal fissure .

Proctalgia fugax: symptoms and signs
Proctalgia fugax sufferers consistently report almost unbearable pain in the anal area. Especially when Proctalgia fugax occurs for the first time, patients suffer from great anxiety because they fear that there is a serious emergency. Proctalgia fugax occurs extremely rarely before puberty; the age group between 40 and 50 is usually affected.

Basically, there are two types of Proctalgia fugax:

A day attack occurs suddenly. The pain becomes more and more intense and can be of variable localization. Starting from the anus, it can affect the anal canal, pelvic floor and abdomen .
In contrast, the night attack is constant in its pain intensity, affecting the entire anal area. In both forms of Proctalgia fugax, there are usually nausea to vomiting, dizziness, sweating and even fainting . The pain sometimes stops after a short time; most Proctalgia fugax attacks last no more than 30 minutes. In particularly severe cases, the pain lasts for a few hours.
The seizures occur irregularly; the intervals can be days, weeks or months. The general average does not exceed six seizures a year. These become less and less common in old age.

Proctalgia fugax: treatment and therapy
Unfortunately, experts are still relatively at a loss when it comes to treating Proctalgia fugax. Occasionally, it is possible to achieve freedom from symptoms by taking the drugs clonidine , nifedipine and salbutamol (when used by inhalation). Hemorrhoid therapy is also said to be successful in some cases.

Patients with Proctalgia fugax report varying degrees of success with anticonvulsant and pain reliever medication. Some patients can take some pain relief with paracetamol . The main problem is that the effect often only occurs when the pain stops on its own. Regular preventive use of painkillers (such as ibuprofen or diclofenac ), however, does not make sense with Proctalgia fugax, as it is not known when the next attack will occur.

Others have reported pain so severe that they are no longer able to take medication or perform enemas. In general, cramps are often associated with a magnesium or calcium deficiency. Some Proctalgia fugax patients have been able to reduce the frequency of attacks by taking appropriate preparations.

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