Pain-in-the- ...er, rear. Proctalgia fugax?


I get severe cramping in my rectal area. It only happens at night when I'm asleep. I happened to mention this to several male friends, and they all eventually confessed to having this same severe problem. One of them said it was "Ass Cramps." Ever hear of this? Is this another problem that men get that no one ever hears of?

Dear Reader,

It can be a relief to know that you aren’t alone, but keep in mind that you and your buddies may or may not have the same issues. It can be hard to admit to nightly pain in the rear even in a circle of friends, and understandably, it may be even harder to go see a health care provider about it. Anal cramping and pain can be caused by many conditions, but without a medical visit, it won’t be possible to know the cause for sure. Some health issues that may lead to anal pain include:

  • Hemorrhoids
  • Infection
  • Neuropathy (isolated nerve pain)
  • Disorder of the blood vessels in that area
  • Anal or rectal cancer

Rectal pain has even been implicated in anxiety or depression. To determine the possible cause of the pain, a health care provider may conduct an anorectal exam (which could include a rectal examination, colonoscopy, and fecal blood testing). If the exam is negative on these issues, other possibilities might include proctalgia fugax or levator ani syndrome. There is some disagreement among experts about the differences between these two conditions, but they are both forms of cramping in and around the anal area. Some state that the difference is where the cramping occurs. Proctalgia fugax is cramping related to the spasms in the muscles that line the sigmoid colon and the anal sphincter. Levator ani syndrome is characterized by cramping in the levator ani muscles on the pelvic floor. Others claim the difference is in the length of time the pain lasts — levator ani syndrome pain and cramping tends to last longer (20 minutes or more) than proctalgia fugax.

The pains that you describe do sound similar to the way that proctalgia fugax is described. In the literature, the pain has been described as localized in the lower rectal area or in the anus and can last from seconds to over an hour. No one knows what causes either proctalgia fugax or levator ani syndrome, although it has been correlated with irritable bowel syndrome. The episodes of either condition could occur daily, weekly, or once every few months, and may be strong enough to wake you up at night or keep you from falling asleep. Some individuals have reported pain so severe that they lost consciousness — in that case people are often advised to lie down until the spasm ends. For others, defecating might be painful during an episode, but emptying the rectum could provide relief. Some treatments that have been used to reduce pain or discomfort are:

  • Botulinum toxin injection, which prevents the muscles from moving or spasming
  • Biofeedback, which is a way to help train parts of your conscious mind to take control over bodily functions that typically are controlled by the autonomic nervous system and to respond to chronic pain in ways that minimize the sensation
  • Nerve blocks
  • Rectal massage, which may help reduce spasms
  • Electrogalvanic stimulation (electrical stimulation using an anal probe)
  • Corticosteroid injections into the muscles involved
  • Salbutamol, an anti-asthma medication
  • Other drugs have also been used such as nitroglycerin, diltiazem, and tricyclic antidepressants
  • Home remedies such as self-massaging the area, taking a hot bath, or applying ice to the anal area (though not scientifically proven)

While the name proctalgia fugax may sound exotic, data suggests that it’s not all that uncommon. Current research indicates that somewhere between 4 to 18 percent of the general population may experience the condition. Women have actually reported on proctalgia fugax about twice as often as men, however, some of this data suggests that it might be because women may have less resistance to reporting anal pain than men. So rest assured, if it is proctalgia fugax, it’s definitely not just a “guy’s issue.”

Here’s to hoping you can get the pain resolved so you don’t have to spend your nights with your mind on your behind!

Last updated Dec 12, 2014
Originally published Apr 02, 1999

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