Proctalgia fugax
| Classification according to ICD-10 | |
|---|---|
| K59.4 | Anal spasm - Proctalgia fugax |
| ICD-10 online (WHO version 2019) | |
The Proctalgia fugax (lat .: proctalgia = "After pain," fugax = "volatile") is an anorectal pain syndrome spasmodic with short-term pain in the anal - and rectum area associated.
distribution
Proctalgia fugax occurs in 8 to 18% of the population. Since the symptoms often only appear very briefly and rarely, only between 17 and 20% of those affected seek medical help. Women are affected a little more often. Proctalgia fugax occurs most frequently in patients under 45 years of age.
Causes and Pathophysiology
Due to the short-term symptoms and the irregular and rare occurrence, there are no pathophysiologically usable test results. There are indications that spasms of the smooth muscle of the rectum are responsible for the symptoms. Anorectal muscle dysfunctions are found in the patient during an attack, while no abnormalities are present in a symptom-free state. Many patients are described as overly perfectionist, anxious, or hypochondriac. However, a psychosomatic cause is no longer accepted today, even if stress can trigger symptoms.
Clinical manifestations
Those affected complain of sudden anorectal pain that can last anywhere from a few seconds to a few minutes. Often the patients are surprised in their sleep. Additional symptoms such as nausea, dizziness, or an urge to defecate may occur.
Investigation methods
The diagnosis is made by taking anamnesis. During the physical examination, coccygodynia can be ruled out by a digital rectal examination.
Differential diagnosis
There are a number of diseases that can trigger anorectal symptoms similar to Proctalgia fugax. In the case of levator ani syndrome, chronic or episodic recurring pain for up to 20 minutes and longer can be seen. Coccygodynia should also be considered in the differential diagnosis.
treatment
In the seizure stage, relaxation exercises for the anorectal muscles are recommended. Walking, crouching or local heat can be relaxing and pain relieving.
Local massage of the perineum or massage of the rectum can also stop the pain attack.
In the case of drug therapy with nitroglycerin preparations , this should reduce the frequency of seizures. Patients should be educated to relieve their fear of tumors . After a pudendal blockade , the symptoms disappeared in up to 65% of those affected and improved in a further 25%.
forecast
The data situation does not allow any reliable statements about the prospects for a cure or prognosis. An effective prophylaxis is not known.
history
It was first described in 1883 by the English doctor A. S. Myrtle, who had noticed several patients with unexplained anal complaints in his practice.
literature
- Henning Rohde: Teaching Atlas of Proctology: Diagnostics, Therapy, Case Studies ; Georg Thieme Verlag, 2007
Individual evidence
- ↑ a b c W. E. Whitehead, A. Wald, NE Diamant, P. Enck, JH Pemberton, SS Rao: Functional disorders of the anus and rectum. In: Good . Volume 45 Suppl 2, September 1999, pp. II55-II59. PMID 10457046 . PMC 1766682 (free full text). (Review).
- ↑ a b c d e f Henning Rohde: Teaching Atlas of Proctology: Diagnostics, Therapy, Case Studies Georg Thieme Verlag, 2007
- ↑ G. Staude: [Proctalgia fugax. Differential diagnosis and therapy of fleeting anal cramp]. In: Advances in Medicine. Volume 110, Number 15, May 1992, pp. 278-280. PMID 1634166 .
- ↑ C. Vincent: Anorectal pain and irritation: anal fissure, levator syndrome, proctalgia fugax, and pruritus ani. In: Primary care. Volume 26, Number 1, March 1999, pp. 53-68. PMID 9922294 . (Review).
- ↑ M. Takano: Proctalgia fugax: caused by pudendal neuropathy? In: Diseases of the Colon and Rectum . Volume 48, Number 1, January 2005, pp. 114-120. PMID 15690667 .
- ^ AS Myrtle: Some Common Affections of the Anus Often Neglected by Medical Men and Patients. In: British Medical Journal . Volume 1, Number 1170, June 1883, pp. 1061-1062. PMID 20750621 . PMC 2372541 (free full text).
