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Proctalgia fugax

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Title: Proctalgia fugax  
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Subject: ICD-10 Chapter XI: Diseases of the digestive system, Rectal pain, Acute muscle soreness, Cold pressor test, FLACC scale
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Proctalgia fugax

Proctalgia fugax
Classification and external resources
ICD-10 K59.4
ICD-9-CM 564.6

Proctalgia fugax (a variant of levator ani syndrome) is a severe, episodic, rectal and sacrococcygeal pain.[1] It can be caused by cramp of the levator ani muscle, particularly in the pubococcygeus.[2]

Contents

  • Presentation 1
  • Treatment and prevention 2
  • References 3
  • External links 4

Presentation

It most often occurs in the middle of the night[3] and lasts from seconds to minutes,[4] an indicator for the differential diagnosis of levator ani syndrome, which presents as pain and aching lasting twenty minutes or longer. In a study published in 2007 involving 1809 patients, the attacks occurred in the daytime, (33 per cent) as well as at night (33 per cent) and the average number of attacks was 13. Onset can be in childhood; however, in multiple studies the average age of onset was 45. Many studies showed that women are affected more commonly than men.[5] This fact can be at least partly explained by men's reluctance to seek medical advice concerning such a delicate case as rectal pain.

During an episode, the patient feels spasm-like, sometimes excruciating, pain in the anus, often misinterpreted as a need to defecate. Simultaneous stimulation of the local autonomic system can cause erection in males. In some people, twinges sometimes occur shortly after orgasm. Because of the high incident of internal anal sphincter thickening with the disorder, it is thought to be a disorder of the internal anal sphincter or that it is a neuralgia of pudendal nerves. It is recurrent and there is also no known cure. However, some studies show effective use of botulinum toxin, pudendal nerve block, and calcium channel blockers. It is not known to be linked to any disease process and data on the number of people afflicted varies, but is more prevalent than usually thought. Again, quite few people report these symptoms, so obtaining data on more or less precise ratio of occurrence of proctalgia in human populations presents a challenge.

The pain episode subsides by itself as the spasm disappears on its own, but may reoccur.[4]

Treatment and prevention

Traditional remedies have ranged from warm baths (if the pain lasts long enough to draw a bath), warm to hot enemas,[6] relaxation techniques, and various medications.

In patients who suffer frequent, severe, prolonged attacks, inhaled salbutamol has been shown in some studies to reduce their duration.[7]

The use of botulinum toxin has been proposed as analgesic,[8] and low dose diazepam at bedtime has been suggested as preventative.[9]

The most common approach is simply reassurance and topical treatment.[10]

References

  1. ^ "levator syndrome" at Dorland's Medical Dictionary
  2. ^ Olden, Kevin W. (1996). Handbook of functional gastrointestinal disorders. New York: M. Dekker. p. 369.  
  3. ^ Takano M (2005). "Proctalgia fugax: caused by pudendal neuropathy?". Dis. Colon Rectum 48 (1): 114–20.  
  4. ^ a b Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS (September 1999). "Functional disorders of the anus and rectum". Gut 45 (Suppl 2): II55–9.  
  5. ^ de Parades V, Etienney I, Bauer P, Taouk M, Atienza P (2007). "Proctalgia fugax: demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients". Dis. Colon Rectum 50 (6): 893–8.  
  6. ^ Olsen B (2007). "Proctalgia fugax - a nightmare drowned in enema". Colorectal Disease 10 (5): 522–3.  
  7. ^ Eckardt VF, Dodt O, Kanzler G, Bernhard G (1996). "Treatment of proctalgia fugax with salbutamol inhalation". Am. J. Gastroenterol. 91 (4): 686–9.  
  8. ^ Wollina U, Konrad H, Petersen S (2005). "Botulinum toxin in dermatology - beyond wrinkles and sweat". Journal of Cosmetic Dermatology 4 (4): 223–7.  
  9. ^ Pfenninger JL, Zainea GG (2001). "Common anorectal conditions: Part I. Symptoms and complaints". Am Fam Physician 63 (12): 2391–8.  
  10. ^ Jeyarajah S, Chow A, Ziprin P, Tilney H, Purkayastha S (September 2010). "Proctalgia fugax, an evidence-based management pathway". Int J Colorectal Dis 25 (9): 1037–46.  

External links

  • About.com
  • PatientPlus
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