proctalgia fugax

[paiute]

i'm getting several male patients who complain of severe anal pain after ejaculation. i found one brief paragraph on treatment for this in titonelli's emergency medicine text.

i suspect this is more common than admitted to in the literature, because most men are embarrassed to talk about it. does it occur in women too?

the pain is often severe. it can last from minutes to hours. it feels like you need to take a bowel movement, but there is no feces in the rectum. some treat it with a hot sitz bath. i have had good success with 2% nitroglycerin ointment applied to the anus.

anybody with any experience with this?

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[Sneezing]

I saw one study once citing some evidence for using an albuterol inhaler of all things for the condition, PRN.

 

[SLUser11]

i'm getting several male patients who complain of severe anal pain after ejaculation. i found one brief paragraph on treatment for this in titonelli's emergency medicine text.

i suspect this is more common than admitted to in the literature, because most men are embarrassed to talk about it. does it occur in women too?

the pain is often severe. it can last from minutes to hours. it feels like you need to take a bowel movement, but there is no feces in the rectum. some treat it with a hot sitz bath. i have had good success with 2% nitroglycerin ointment applied to the anus.

anybody with any experience with this?

I have some experience treating Proctalgia Fugax, but it is in the colorectal patient population. Usually it is female patients presenting with anal pain, and on exam they have extreme tenderness with palpation of the levator sling, which usually has increased tone.

I don't think NTG cream would be too effective (beyond placebo) because it's really a levator problem, not a sphincter problem. Perhaps a topical cream would help the spasm if you really got it in there deep....if so, I'd try Diltiazem cream since it's better tolerated than NTG....but I have no experience with it. I've also heard of inhaled beta agonists working, but have never tried it.

Probably the best treatment is biofeedback. It seems to work in the majority of patients, and may be worth looking into. I don't have time now to do a lit search, but I'll try to check back later.

 

[paiute]

i've had this myself, and there is no localized tenderness. just a boring, deep ache which is sometimes incapacitating. i would sometimes lie on the floor moaning in pain. a friend had the same thing and said a hot bath (soak your butt) worked. it feels like you need a BM, but there are no feces in the rectum.

i picked ntg ung because i know that ntg is smooth muscle relaxant. it is used for esophageal spasm. also, we use in for uterine tetany post c-section to help deliver the placenta.

the first time i tried ntg, it worked immediately with complete relief. in a few subsequent episodes, the ntg reduced the pain from a 10 to a 2-4, not complete relief, but i was able to function. now, i carry it with me all the time.

 

[paiute]

i must add that it once started about 30 min after a rectal exam (routine prostate check). i was driving home and it started. takes about 2-3 min to reach peak pain, then lasted about 30 min. offset was similar to onset, took 2-3 min. it was so bad i had to pull over and stop, lie down and wait.

it might be the levator ani. i do know that it will make the hemorrhoids bulge out. but the 'rhoid is not painful, just under increased venous pressure. it shrinks back in when the pain subsides. massage seemed to help sometimes. offset is unpredictable, and rather sudden, 2-3 min. it once woke me from sleep. this started when i reached my late 40's. never had it before, though i had a prolonged perineal ache when i first got married, lasted about 2 days. this was after a prolonged erection related to marital bliss. the level of pain was only about 2-3 though. it was in the same area: vague perineal location, not scrotal pain. but this new proctalgia fugax is a 10 sometimes, nearly the worst pain i have ever experienced.

i looked this up after i started using the ntg. indeed, ntg is listed as a possible rx. along with CCB.

this is not the cramp like pain i have gotten since adolescence if i delay a bm too long. that cramp lasts just 10-20 sec and is associated with a strong urge to defecate. the proctalgia fugax is associated with only a mild urge to defecate.

i agree that the placebo effect is a possibility with any thing that spontaneously remits. i'll keep using the ntg. if it loses activity after a few months, then it's probably placebo.

i wish i knew what was causing this.

 

[SLUser11]

i must add that it once started about 30 min after a rectal exam (routine prostate check). i was driving home and it started. takes about 2-3 min to reach peak pain, then lasted about 30 min. offset was similar to onset, took 2-3 min. it was so bad i had to pull over and stop, lie down and wait.

it might be the levator ani. i do know that it will make the hemorrhoids bulge out. but the 'rhoid is not painful, just under increased venous pressure. it shrinks back in when the pain subsides. massage seemed to help sometimes. offset is unpredictable, and rather sudden, 2-3 min. it once woke me from sleep. this started when i reached my late 40's. never had it before, though i had a prolonged perineal ache when i first got married, lasted about 2 days. this was after a prolonged erection related to marital bliss. the level of pain was only about 2-3 though. it was in the same area: vague perineal location, not scrotal pain. but this new proctalgia fugax is a 10 sometimes, nearly the worst pain i have ever experienced.

i looked this up after i started using the ntg. indeed, ntg is listed as a possible rx. along with CCB.

this is not the cramp like pain i have gotten since adolescence if i delay a bm too long. that cramp lasts just 10-20 sec and is associated with a strong urge to defecate. the proctalgia fugax is associated with only a mild urge to defecate.

i agree that the placebo effect is a possibility with any thing that spontaneously remits. i'll keep using the ntg. if it loses activity after a few months, then it's probably placebo.

i wish i knew what was causing this.

You tricked me into providing medical advice.

It's probably smart to stop self-medicating and see a colo-rectal surgeon. Who knows what you really got going on down there....somebody should take a look.

 

[Depakote]

SDN is not the appropriate place to seek medical advice. Closing.

 

[paiute]

i am not asking for medical advice. i have researched this phenomena and am aware of the suggested treatments. i am seeking other practioners experience with this syndrome. from my research, i believe this is a poorly understood problem and we need more open discussion of its causes and treatments. i also believe it is vastly underreported and practitioners need to be aware of its existence.

for my own sx's, i have already discovered an effective treatment.

 

[Apollyon]

but this new proctalgia fugax is a 10 sometimes, nearly the worst pain i have ever experienced.

If it's "nearly" the worst, it's not a 10, by definition. What would the worst be - an 11?

And, likewise, the worst you've experienced, or you can imagine? I mean, if my insulin shot is the worst pain I've ever felt, then that would be a 10 (by definition). It's not that bad - I can imagine much more. Much more.