Anal Pain (Proctalgia fugax and Levator ani syndrome).
The anal canal (see diagram) is surrounded by various organs, such as the prostate in men and the uterus in women, and is supported by the pelvic floor muscles (or levator ani). The pain caused by the muscles spasming can occur without any trigger in particular. In some situations we know that this may be due to damage or entrapment of the nerve that supplies the anal canal muscles. It can affect anyone, although sufferers tend to be women.
However because the symptoms that people describe can be so variable, your specialist will investigate you thoroughly to exclude other conditions related to organs that surround the anal canal and pelvic floor.
Proctalgia fugax means ‘anal pain of unknown cause’. ‘Levator ani syndrome’ is a similar condition with slightly different patterns of pain, but essentially they belong to the same ‘family’ of conditions. They are caused by the muscles in the anal canal and pelvic floor suddenly tightening (spasming). You may have symptoms of sudden, severe muscle cramps that you feel in the anal canal. These spasms tend to happen at night and you might even be woken up by them. Some people also describe having episodes of anal pain followed by long periods in between which they feel completely well.
After a thorough examination, including with your permission a check of your genital region, your doctor will organise some blood tests and an endoscopy (telescope test to look at the lining of the bowel). In some cases, you may be referred for investigations related to your reproductive or urinary organs. No investigation can be done to specifically confirm the diagnosis of proctalgia fugax – only to exclude other more serious conditions.
Many treatments have been tried for this condition but few have been properly studied in a scientific way. Often the episodes of pain are so short that a medication would not actually work quickly enough.
If you do have long, frequent or severe episodes then you may find hot baths or massage helpful. Medicines can be prescribed and include salbutamol (a medicine that comes as an inhaler, also used by people who suffer from asthma), or muscle relaxants.
Unfortunately because we don’t really know what causes these conditions, no single treatment is known to work. Often with professional support and by talking about it, you may find that your symptoms are more bearable.
The information on this page is reproduced from material put together by the Colorectal Development Unit at the Royal London Hospital, part of Barts and the London NHS Trust.