What Is Chronic Proctalgia?

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Chronic proctalgia is a condition in which a person experiences recurrent rectal pain of at least 20 minute duration, with no identifiable structural or associated health condition to account for the pain. The prevalence of chronic proctalgia is estimated to be as high as 6%.

Chronic proctalgia is distinguished by the length of time of its symptoms from proctalgia fugax, which is marked by sudden sharp anorectal pain that lasts less than 20 minutes.

A person with chronic proctalgia may have some fugax episodes, but this is rare. Researchers think that there are different underlying reasons for the two different disorders, although what those underlying reasons are is not clear at this point.

Symptoms of Chronic Proctalgia

Chronic proctalgia is typically experienced as a prolonged dull ache or pressure-like sensation in the rectum - often experienced more toward the top of the rectum. It may worsen when you are sitting for a prolonged period of time and may ease when you stand up or lie down. Discomfort may increase as the day wears on, but rarely occurs at night. The pain of chronic proctalgia may be felt more often during the following times:

  • Following sexual intercourse
  • Following a bowel movement
  • During times of stress.
  • During long-distance travel

Chronic Proctalgia Sub-Types:

Levator ani syndrome: In this form of chronic proctalgia, people experience tenderness on the pubicrectalis (muscle within your pelvis) when it is touched during a doctor's rectal examination.

Unspecified Functional Anorectal Pain: This form of chronic proctalgia is diagnosed if you feel no such tenderness on the pubicrectalis when it is touched during a rectal examination.

How Is Chronic Proctalgia Diagnosed?

As chronic proctalgia is considered a functional gastrointestinal disorder (FGD), diagnostic tests will only be administered to rule out other health problems.

Otherwise, doctors will make a diagnosis based on symptoms according to the Rome III criteria for FGDs:

  • "Chronic or recurring rectal pain or aching"
  • Discomfort must last for at least 20 minutes
  • Other causes of rectal pain (structural or systemic) must be ruled out
  • Symptoms must be present for at least three months with onset at least six months prior.

In order to identify the presence of levator ani syndrome, your doctor is likely to perform a rectal examination to test for tenderness.

Why Does a Person Get Chronic Proctaglia?

The exact reason behind the condition is currently unknown. In the past, it was hypothesized that the condition was the result of chronic tension or inflammation of the muscles within the pelvic floor, although research support for this theory has been limited. Some emerging research points to the possible role of dyssynergic defecation, a condition in which the muscles of the pelvic floor do not operate as they should.  

Factors that may increase a person's risk for developing chronic proctalgia include:

  • Anal surgery
  • Childbirth
  • Pelvic surgery
  • Spinal surgery

There is also an association between chronic proctalgia and higher rates of depression and anxiety disorders. However, it is unknown if these emotional symptoms increase the risk of, or are the result of, experiencing chronic rectal pain symptoms.

Treatment of Chronic Proctalgia

Tradtional treatment options included digital massage of the levator ani muscle, muscle relaxants, and the use of sitz baths, but all have shown limited effectiveness. Fortunately, newer treatments such as the use of electrogalvanic stimulation using a rectal probe and biofeedback have shown some research-based effectiveness, with biofeedback showing a slight superiority. If levator ani syndrome is confirmed, treatments that involve relaxing the pelvic floor may be helpful. Surgery is not considered to be an effective treatment for chronic proctalgia.

Also known as:

  • Levator ani syndrome
  • Levator spasm
  • Puborectalis syndrome
  • Pyriformis syndrome
  • Pelvic tension myalgia

Sources:

Barucha, A., et.al. "Functional Anorectal Disorders" Gastroenterology 2006 130:1510-1518.

Chiarioni, G., Asteria, C. & Whitehead, W. "Chronic proctalgia and chronic pelvic pain syndromes: New etiologic insights and treatment options" World Journal of Gastroenterology 2011 17:4447-4455.

"Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders" Appendix A

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