Symptoms, Causes, Diagnosis, and Treatment

Written by WebMD Editorial Contributors

Medically Reviewed by Dan Brennan, MD on April 28, 2021

• Symptoms
• Proctalgia Fugax vs. Levator Syndrome
• Causes
• Diagnosis
• Treatment

Pain is part of life. Headaches, stiff knees, and sudden back pain may make you feel uncomfortable. Similarly, you may have pain in your buttocks. 

Proctalgia fugax is pain or cramping felt around your buttocks and rectum. The rectum is the last part of the large intestine, ending in the anus, which removes solid waste from the body. ‌

This pain is the result of spasms or cramps of your pelvic floor muscles, anal sphincter muscles, or rectum muscles. Because proctalgia fugax is unpredictable, it is difficult for doctors to diagnose or researchers to study.

Proctalgia fugax is temporary rectal pain. You may have intense pain for a short time. Cramps in your rectum may last from a few seconds to several minutes.

Severe episodes of proctalgia fugax can be painful enough to wake you up from your sleep or keep you from going to work or school. Between episodes, you probably won’t have any pain or discomfort. If you do have pain that isn’t coming from another spasm, another anorectal condition may be causing it, so talk to your doctor to rule out other conditions.

Chronic proctalgia fugax. Episodes of chronic proctalgia fugax usually last for more than 20 minutes and happen more often than occasionally. Other long-term symptoms include discomfort from sitting for too long and painful bowel movements.

Proctalgia fugax is a form of levator syndrome (also called levator ani syndrome). Both include spasms of muscles in the pelvic area. Proctalgia fugax is temporary, but other types of levator syndrome can last for several days.

Another major difference is the location of the pain. Pain from proctalgia fugax is felt mainly in the rectum. Pain due to levator syndrome is felt in the pelvic floor — specific or vague areas — and in the thighs and buttocks.

Symptoms of levator syndrome are usually felt higher in the pelvis than the symptoms of proctalgia fugax. You may notice that symptoms worsen when sitting and improve when standing or lying down.

Finding the cause of proctalgia fugax may be difficult. The causes vary from person to person and need different approaches for treatment. Other conditions in the anorectal area may cause spasms that seem similar to proctalgia fugax but are diagnosed and treated as separate issues. Sometimes an underlying condition causes proctalgia fugax, and treating that condition will relieve the symptoms of proctalgia fugax.

Stress. Proctalgia fugax may be related to stress and anxiety. In some cases, people with proctalgia fugax felt stressed just before the spasms.

Studies have shown a similar relationship between stress and levator syndrome. Many people with levator syndrome have psychosocial distress, including depression and anxiety.

The following activities may cause proctalgia fugax:

• Sexual activity
• Constipation
• Abnormal bowel movement
• Menstruation

Proctalgia fugax is difficult to diagnose because of how quick and random the spasms can be. There are no tests for proctalgia fugax. But your doctor will rule out other possible causes for your anorectal pain.

Other anorectal conditions your doctor may check for are:

• Hemorrhoids
• Ulcers, abscesses, or other abnormal growths
• Anal fissures, or small tears
• Inflammatory bowel disease

History. Your doctor may make a diagnosis based on your symptom history. Keep an accurate record of when the spasms happen, how long they last, how severe they are, and what happened before the spasms to help your doctor make a better diagnosis.

Physical exam. Your doctor may do a physical exam to check for places of tenderness in the rectum, or pain when the area is touched. Tenderness in the rectum or its nerves can be the cause of proctalgia fugax. A similar physical exam is performed to rule out any other conditions that cause anorectal pain.

Most treatment options for proctalgia fugax depend on the symptoms. Treatments aim to ease pain and discomfort. This is mainly because the episodes are short, irregular, and without a clear cause.

At-home treatment. Before trying treatment options, check with your doctor to rule out other causes. You can take care of your symptoms on your own with the following methods:

• Over-the-counter (OTC) antispasmodic drugs
• OTC muscle relaxers and pain relievers
• Warm baths
• Heating pads and ice packs

Another at-home method that may help you avoid proctalgia fugax is to eat more fiber. Fiber will allow you to have softer bowel movements. These will keep your anorectal muscles from working too hard and may lower the risk of proctalgia fugax spasms.

Injections. For more severe pain, your doctor may recommend a variety of injections to stop muscle spasms. A Botox injection around the anorectal areas will relax the muscles. An epidural injection or a local anesthetic will numb the pelvic areas to ease muscle spasms.

Electrical stimulation. For severe proctalgia fugax, electrical stimulation of the anorectal muscles may provide relief. This treatment option involves inserting a small, finger-sized probe into the rectum and using a low voltage current to relax spastic muscles through vibration.

Top Picks

Symptoms, Causes, Diagnosis, and Treatment

Written by WebMD Editorial Contributors

Medically Reviewed by Dan Brennan, MD on April 28, 2021

• Symptoms
• Proctalgia Fugax vs. Levator Syndrome
• Causes
• Diagnosis
• Treatment

Pain is part of life. Headaches, stiff knees, and sudden back pain may make you feel uncomfortable. Similarly, you may have pain in your buttocks. 

Proctalgia fugax is pain or cramping felt around your buttocks and rectum. The rectum is the last part of the large intestine, ending in the anus, which removes solid waste from the body. ‌

This pain is the result of spasms or cramps of your pelvic floor muscles, anal sphincter muscles, or rectum muscles. Because proctalgia fugax is unpredictable, it is difficult for doctors to diagnose or researchers to study.

Proctalgia fugax is temporary rectal pain. You may have intense pain for a short time. Cramps in your rectum may last from a few seconds to several minutes.

Severe episodes of proctalgia fugax can be painful enough to wake you up from your sleep or keep you from going to work or school. Between episodes, you probably won’t have any pain or discomfort. If you do have pain that isn’t coming from another spasm, another anorectal condition may be causing it, so talk to your doctor to rule out other conditions.

Chronic proctalgia fugax. Episodes of chronic proctalgia fugax usually last for more than 20 minutes and happen more often than occasionally. Other long-term symptoms include discomfort from sitting for too long and painful bowel movements.

Proctalgia fugax is a form of levator syndrome (also called levator ani syndrome). Both include spasms of muscles in the pelvic area. Proctalgia fugax is temporary, but other types of levator syndrome can last for several days.

Another major difference is the location of the pain. Pain from proctalgia fugax is felt mainly in the rectum. Pain due to levator syndrome is felt in the pelvic floor — specific or vague areas — and in the thighs and buttocks.

Symptoms of levator syndrome are usually felt higher in the pelvis than the symptoms of proctalgia fugax. You may notice that symptoms worsen when sitting and improve when standing or lying down.

Finding the cause of proctalgia fugax may be difficult. The causes vary from person to person and need different approaches for treatment. Other conditions in the anorectal area may cause spasms that seem similar to proctalgia fugax but are diagnosed and treated as separate issues. Sometimes an underlying condition causes proctalgia fugax, and treating that condition will relieve the symptoms of proctalgia fugax.

Stress. Proctalgia fugax may be related to stress and anxiety. In some cases, people with proctalgia fugax felt stressed just before the spasms.

Studies have shown a similar relationship between stress and levator syndrome. Many people with levator syndrome have psychosocial distress, including depression and anxiety.

The following activities may cause proctalgia fugax:

• Sexual activity
• Constipation
• Abnormal bowel movement
• Menstruation

Proctalgia fugax is difficult to diagnose because of how quick and random the spasms can be. There are no tests for proctalgia fugax. But your doctor will rule out other possible causes for your anorectal pain.

Other anorectal conditions your doctor may check for are:

• Hemorrhoids
• Ulcers, abscesses, or other abnormal growths
• Anal fissures, or small tears
• Inflammatory bowel disease

History. Your doctor may make a diagnosis based on your symptom history. Keep an accurate record of when the spasms happen, how long they last, how severe they are, and what happened before the spasms to help your doctor make a better diagnosis.

Physical exam. Your doctor may do a physical exam to check for places of tenderness in the rectum, or pain when the area is touched. Tenderness in the rectum or its nerves can be the cause of proctalgia fugax. A similar physical exam is performed to rule out any other conditions that cause anorectal pain.

Most treatment options for proctalgia fugax depend on the symptoms. Treatments aim to ease pain and discomfort. This is mainly because the episodes are short, irregular, and without a clear cause.

At-home treatment. Before trying treatment options, check with your doctor to rule out other causes. You can take care of your symptoms on your own with the following methods:

• Over-the-counter (OTC) antispasmodic drugs
• OTC muscle relaxers and pain relievers
• Warm baths
• Heating pads and ice packs

Another at-home method that may help you avoid proctalgia fugax is to eat more fiber. Fiber will allow you to have softer bowel movements. These will keep your anorectal muscles from working too hard and may lower the risk of proctalgia fugax spasms.

Injections. For more severe pain, your doctor may recommend a variety of injections to stop muscle spasms. A Botox injection around the anorectal areas will relax the muscles. An epidural injection or a local anesthetic will numb the pelvic areas to ease muscle spasms.

Electrical stimulation. For severe proctalgia fugax, electrical stimulation of the anorectal muscles may provide relief. This treatment option involves inserting a small, finger-sized probe into the rectum and using a low voltage current to relax spastic muscles through vibration.

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Pain and spasms in the anus

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Pain and spasms in the anus are one of the most common symptoms that indicate a malfunction e in the work of the intestinal tract, namely about the problem in the anus and colon. Pain can be of different nature:

• Pain is sudden, local, intense, burning and directly related to defecation – then most likely it is an acute anal fissure.
• Constant pain in the anal passage most often indicates thrombosis of hemorrhoids, acute paraproctitis or rectal fistula.
• Pressing pain, sometimes associated with defecation, usually accompanies colitis, proctitis.
• Accompanying defecation dull, burning pain can cause incomplete fistula of the rectum, cryptitis, papillitis.
• Discomfort in the rectum and anus, itching, burning, stabbing pain, often combined with bleeding – such complaints are characteristic of hemorrhoids.

In any case, you should not make a diagnosis yourself. Pain in the anus is already a signal for you that you need immediate consultation with a doctor – proctologist.

The most important thing is to identify the CAUSE of the pain!

A proctologist treats diseases that cause pain in the anus. The clinic employs male and female proctologists. Our doctors are proctologists.

Make an appointment with a proctologist

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• Diseases
• Diagnosis
• Treatment
• Causes

Do you feel pain in your anus?

This may be an alarming symptom of the following diseases:

• Hemorrhoids.
• Thrombosis of hemorrhoids.
• Anal fissures. Regular heavy discharge may indicate the presence of this disease.
• Anal polyps. There is also mucus or pus

It is necessary to start treatment, because the consequences can be unpredictable!

Diagnosis of any disease, proctological – is no exception, it is, first of all, an examination by a doctor. Based on what the doctor reveals during the examination, a diagnosis will be made and treatment will be prescribed. An examination by a proctologist at “Alan Clinic” gives a complete picture of your problem, since it is based on two pillars – the doctor’s experience and modern diagnostic equipment.

Comprehensive diagnostics in the Department of Proctology “Alan Clinic” includes:

• Digital rectal examination
• Hardware diagnostics
  • Videoanoscopy
  • Videorectoromanoscopy
• Doctor’s consultation with diagnosis.

Treatment of pain in the anus

Treatment is prescribed by a proctologist and carried out on the territory of the clinic, under the full control of the attending physician. Without surgery and hospitalization!

Our Methods:

• Desarterization of hemorrhoids
• Proxon
• Latex ligation
• Infrared photocoagulation (INFRARED device) 9000 4
• Radio wave method of treatment (SURGITRON device)
• Sclerotherapy
• Drug treatment
• Physiotherapy

As a rule, pain in the anus appears as a result of several factors or a combination of causes.

Main reasons:

• Sedentary lifestyle. There is congestion in the pelvic area, blood supply to the anus is disturbed and usually this is mainly due to the fact that people lead a sedentary lifestyle, have a sedentary job or just sit on the toilet for a long time
• Injuries of the anus . arising from constipation or the practice of anal sex
• Hemorrhoids , in which hemorrhoids affect the walls of the anus, weakening them, which leads to trauma to the anus during diffication
• Interruptions in the work of the intestines (constipation, diarrhea)
• Circulatory disorders (thrombosis) , stagnation in the blood with hemorrhoids also leads to anal fissures
• Hereditary predisposition
• Against the background of any pathologies of the nervous system a prolonged spasm of the sphincter can occur, which leads to a violation of the innervation of the rectum

Make an appointment!

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Pain in the anus in women

Pain in the anus in women, occurs with diseases of the rectum, female genital organs, urinary system. It happens constant, short-term, sharp, dull, sharp, burning, pulsating, pressing, aching, stabbing, pulling. Sometimes combined with stool disorders, tenesmus, blood, mucus. The causes of the symptom are established on the basis of the data of the survey, external, proctological and gynecological examination, anoscopy, sigmoidoscopy, ultrasound, anal manometry, coprogram, analysis for worm eggs, biopsy studies. For treatment, rectal suppositories, microclysters, physiotherapy, and general preparations are used.

Why there is pain in the anus in women

External irritants

The most common cause of pain in women in the absence of pathological changes is uncomfortable underwear, especially thongs that rub the skin, exert increased pressure on the anus. During menstruation, pain can be provoked by the use of poor-quality pads. Sometimes pressing sensations are observed when using tampons, more often against the background of an empty bowel.

Anal fissure

Patients with an acute form of the disease report severe pain that appears with the onset of defecation, sometimes radiating to the sacrum or perineum. In chronic pathology, the pain syndrome is provoked by a spasm of the anus, worries after defecation, persists for a long time, and intensifies in a sitting position. Bloody discharge is scanty. Possible itching.

Hemorrhoids

In uncomplicated chronic hemorrhoids, the pain is dull, pulling, aching, there is a predominance of burning, bursting. Unpleasant manifestations occur during the act of defecation, gradually disappear in the period from several minutes to several hours. Thrombosis of hemorrhoids is characterized by constant severe pain in the perineum and anus, not associated with defecation.

Pain in thrombosis increases with the development of inflammation, worries at night, combined with a sensation of a foreign body, sometimes with weakness, fatigue, fever. Pain and inflammation are also present with prolapsed hemorrhoids, especially in the final stages of the disease. There is anal itching, frequent bleeding. The development of the infectious process is evidenced by increased symptoms, severe pain, general hyperthermia.

Pain in the anus in women

Proctitis

The main symptoms of proctitis are pain that worsens at the time of bowel movement, itching, defecation disorders. In acute proctitis, the pain is severe, appears suddenly, and is combined with tenesmus. Sometimes it gives to the genitals, perineum, lower back. Body temperature subfebrile, rarely febrile. The nature of symptoms varies somewhat depending on the form of the disease:

• Catarrhal proctitis. Pathology develops within a few days, all manifestations are moderately expressed. Constipation is replaced by periodic diarrhea.
• Erosive proctitis. Increased stool predominates. Tenesmus is possible, followed by discharge of a mixture of mucus and blood. In a severe case, there is gaping of the anus, free flow of liquid feces, bloody-mucous discharge.
• Ulcerative proctitis. The signs are the same as in other forms, but the course is more severe. A significant amount of blood covers the formed feces or is located in the form of inclusions in liquid feces.
• Radiation proctitis. Symptoms appear during or after radiation therapy. Painful urge to defecate. Mucus is released from the anus, less often – blood.

In patients with chronic proctitis, the signs of pathology are mild or moderate, the pain is dull, the condition is satisfactory. There are periodic relapses with symptoms resembling the clinical picture of acute proctitis.

Proctalgia

Pain in the anus due to muscle spasm, not associated with defecation, occurs at any time of the day, including at night. Feels like stabbing, sharp, spasmodic. It can give to the perineum, coccyx, hip joints. Spasm of the anal sphincter develops suddenly, lasting minutes or hours. Over time, attacks often become more frequent.

Tumors

The symptom is provoked by benign and malignant tumors. Polyps and villous tumors are hidden for a long time. The symptom appears with large neoplasia, accidental injury, the development of inflammation, the appearance of erosion. With cancer, melanomas of the anorectal region, the clinical manifestations progress rapidly, the pains intensify, from dull they become sharp, supplemented by tenesmus, blood and mucus.

Injuries and foreign bodies

Soreness in the anus is often observed after anal intercourse, due to multiple microtraumas of the mucous membrane, may be supplemented by burning, stool disorders, fecal incontinence. Foreign bodies enter the rectum through the gastrointestinal tract, are introduced into the anus during non-standard sexual practices, when trying to independently perform medical procedures, mental disorders.

With a recently inserted blunt object, aching, pressing, bursting. Foreign bodies with pointed edges, fish bones, toothpicks cause damage to the intestinal wall, which is manifested by severe pain, frequent urges. Unbearable excruciating pain is evidence of damage to the intestinal wall and the release of a foreign object beyond its limits.

A fecal stone can be considered as a kind of foreign body. Small stones are asymptomatic, with large stones there are spastic pain, chronic constipation, alternating with bouts of diarrhea. After injury to the intestine, the symptom intensifies.

Other proctological diseases

Acute paraproctitis is characterized by sharp jerking throbbing pains, swelling, suppuration, signs of general intoxication. In women with chronic paraproctitis, the symptom occurs against the background of blockage of the fistula. Regular arching pain during defecation, followed by an improvement in the condition, is noted with an incomplete internal fistula. In patients with rectal prolapse, pain in the lower abdomen predominates at the time of prolapse. Unpleasant sensations in the anus may be associated with compression and the development of inflammation. Other possible reasons are:

• cryptite;
• papillitis;
• perianal dermatitis;
• pararectal dermoid cyst;
• coccygodynia.

Urgent, painful urges with inability to hold feces may occur in women with fecal incontinence. Pathology often manifests itself after childbirth, less often occurs some time after the birth of a child.

Stool disorders

Pain in constipation is provoked by the pressure of fecal masses, injuries of the anus during bowel movements. Acute and chronic diarrhea also leads to soreness of the anus, which is explained by spasms, overstretching of the sphincter, and the development of perianal dermatitis.

Physiological conditions in women

Some women report dull pressure pain in the anus during premenstrual syndrome due to the accumulation of fluid in the utero-rectal cavity. Soreness often worries during pregnancy. The causes are constipation, pressure of the enlarged uterus. The likelihood of developing pain syndrome increases in the presence of proctological diseases, previous injuries, and operations.

Diseases of the female reproductive system

The symptom accompanies the following diseases of the internal genital organs:

• Adnexitis. Soreness is more pronounced in an acute process. There is pain in the lower abdomen, radiating to the anus, the region of the sacrum. Possible pathological discharge from the vagina, violations of the general condition, bloating, dysuria.
• Endometriosis of the rectum. Cyclic pain occurs during menstruation or a few days before it begins. They can be local or spilled, cover the anus, perineum. Increased during intercourse. With the germination of the deep sections of the intestinal wall, they become more intense, accompanied by constipation, bloating.
• Ectopic pregnancy. When the fetal egg is rejected, a sharp pain appears in the lower abdomen, radiating to the anus, legs, lower back. Spotting or bleeding from the vagina, tachycardia, decreased blood pressure, severe weakness, loss of consciousness are detected.
• Ovarian apoplexy. Pain is constant or paroxysmal, cramping, stabbing. It is localized in the lower abdomen, gives into the anus, rectum, perineum, navel, lower back. Fainting, weakness, vomiting, cold sweat are possible.
• Rectovaginal fistula. Soreness in the projection of the anus is combined with burning in the vagina, perineum. Increases during sexual intercourse. Gases, feces are released from the vagina.

Diseases of the genitourinary system

Irradiation to the anus in women is observed with cystitis, bladder stones. The clinical picture is complemented by cutting, aching or pressing pains in the lower abdomen, pronounced dysuric phenomena. With urolithiasis, acute attacks are possible, followed by the appearance of blood impurities in the urine.

Proctological examination

Diagnosis

The cause of pain in the anus is determined by a proctologist. Women with suspected pathology of the reproductive system are referred to a gynecologist. With signs of damage to the urinary tract, an examination by a urologist is required. The examination program includes the following methods:

• External examination . When examining the anus, the perianal zone, rashes, maceration, fistulous passages, prolapsed hemorrhoids or rectum can be detected.
• Digital rectal examination. Helps confirm the presence of enlarged hemorrhoids, neoplasms, inflammatory infiltrates, foreign bodies, intussusceptions. Complemented by examination using rectal mirrors.
• Chair examination (gynecological). Performed to assess the condition of the vagina and external genitalia, detect fistulas, areas of endometriosis. Palpation examines the perineum, urethra, pelvic floor muscles, uterus, appendages.
• Anoscopy and sigmoidoscopy. Allow visualization of signs of inflammation, erosion, ulcers, volumetric processes, fissures, enlarged and inflamed hemorrhoids, foreign bodies, fistulous tracts, cicatricial changes.
• Sonography. Ultrasound of the rectum is performed to diagnose traumatic injuries, hemorrhoids, fistulas, pararectal cysts, polyps, tumors. Contraindicated in acute conditions. Ultrasound of the pelvic organs in women reveals mass formations, ectopic pregnancy, endometriosis, and other gynecological pathologies.
• Anal manometry. It is prescribed to determine the decreased or increased tone of the sphincter during incontinence and muscle spasm. May be supplemented with electromyography.
• Laboratory tests . According to the coprogram, inflammation, signs of bleeding from erosions, ulcers and neoplasms, parasitosis are confirmed. Microbiological examination makes it possible to clarify the nature of the causative agent of the inflammatory process, morphological analysis – to establish the structure and degree of differentiation of tumors.
• Other methods . According to indications, women are prescribed colonoscopy, irrigoscopy, diagnostic laparoscopy, biochemical studies of feces.

Treatment

Assistance at the pre-hospital stage

A woman needs to exclude domestic and sexual causes of pain: use comfortable underwear, high-quality pads, prevent functional constipation by dieting, exclude anal sex and sexual games with elements of anal masturbation. Reception of medicines before establishment of the diagnosis is not shown. Increasing pain, worsening of the general condition, copious discharge of blood from the anus are the reason for an urgent consultation with a proctologist.

Conservative therapy

The program of conservative treatment of proctological diseases includes the following methods:

• Diet. Women are advised to give up spicy, salty and fatty foods to prevent constipation, reduce the amount of coarse fiber to form soft feces, reduce the intensity of pain and trauma to the anus during defecation.
• Rectal suppositories . Suppositories with analgesic, emollient and anti-inflammatory action reduce the severity of symptoms, have an enveloping effect, protect the rectal mucosa from damage during bowel movements.
• Antibiotics . Recommended for women with acute inflammatory processes: proctitis, paraproctitis, papillitis, cryptitis, complications of non-inflammatory diseases.
• Hormonal agents . Corticosteroids are prescribed during an exacerbation of hemorrhoids, with severe proctitis. Quickly eliminate swelling and inflammation. Used in a short course in the presence of sufficient evidence.
• Phleboprotectors . Shown to patients with hemorrhoids. They help strengthen veins, slow down the increase in nodes, reduce the risk of bleeding and thrombosis.
• Local Procedures . Effective microclysters with oil solutions, chamomile decoction, local anesthetics, perineal shower, sitz baths with a solution of potassium permanganate.
• Physiotherapy . In diseases of the rectum and perianal zone, ultrasound, laser therapy, diadynamic therapy are used.

For diseases of the female genital area, antibiotic therapy, hormone therapy, pain medication may be required. Systemic therapy is complemented by local procedures and physiotherapy.

Surgical treatment

For women with proctological pathologies, the following operations may be indicated:

• Hemorrhoids : sclerotherapy, electrocoagulation, laser coagulation, desarterization, infrared photocoagulation, radio wave removal, evacuation thrombosed nodes, hemorrhoidectomy with an ultrasonic scalpel, Milligan-Morgan techniques , Longo, Ferguson, Parks.
• Anal fissure : excision, treatment of anal fissures with laser and Botox.
• Formations, foreign bodies : removal of polyps, coprolites, neoplasms, foreign bodies.
• Prolapse of the rectum : reduction, rectopexy, Delorme, Altmeyer, Zerenin-Kummel operations.