Deciphering Rectal Pain: Proctalgia Fugax vs Levator Ani Syndrome

Anorectal pain can be a real bummer. Literally. It doesn’t discriminate and it can be tough to find the culprit. The two conditions we’ll discuss today, proctalgia fugax and levator ani syndrome, are considered functional anorectal pain disorders.

Rectal pain is pretty common. One paper suggests that it affects 10% of us. But there are several different entities that can cause pain in that area. The differential diagnosis includes, for example, inflammatory bowel disease, intramuscular abscess, fissure, thrombosed hemorrhoids, prostatitis, and coccygodynia.

  • Inflammatory Bowel Disease produces bloody diarrhea and colicky abdominal pain with urgency and fecal incontinence.
  • Abscesses cause pain and possibly fever and chills
  • Thrombosed hemorrhoids are fairly obvious with a hard, tender violaceous nodule
  • Prostatitis would produce pain on a rectal exam as well as symptoms of frequency and dysuria
  • Coccygodynia is diagnosed when the patient complains of pain sitting made worse by leaning back

Levator ani syndrome is believed to result from spasms of pelvic floor muscles. It’s related to piriformis syndrome. Biofeedback has been shown to improve the muscle coordination required in defecation which suggests another etiology for levator ani syndrome.

Muscle coordination may also be behind proctalgia fugax. However, it’s intermittent nature has made it difficult to study. Proctalgia fugax can follow stress or anxiety. One study found that patients who suffer from proctalgia fugax tend to be perfectionistic and anxious.

Anorectal Pain Infographic

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