Family doctor

What is it?

Proctalgia fugax is a severe anorectal pain of unknown origin which can last from a few seconds to several minutes and occurs unpredictably and at irregular intervals. It is a disturbance of the function of the lower bowel resulting in pain but without obvious pathology.

It is thought to affect 8% to 14% of the general population. It may be caused by spasm of the muscles of pelvis supporting the lower colon. It does not lead to any other problems with the bowel such as diverticulitis, ulcerative colitis, haemorrhoids or bowel cancer.

What can be done to help?

Treatment is aimed at relieving the muscle spasm but no single treatment is very effective.

Treatments which have been tried include:

• Physical therapies such as the administration of heat and pressure to the perineal area (around the anus).
• Electrical stimulation of spastic muscle groups.
• Sedatives and antispasmodic drugs have been used to obtain pain relief.

These treatments have side effects, and have not undergone careful controlled studies.

One of the newer treatments, involves using an asthma inhaler of the beta-adrenergic type such as salbutamol. This relaxes smooth muscle in the bronchi in the lung, has a rapid onset of action, and is rarely associated with significant side effects at normal doses. The muscle in the lower bowel is similar smooth muscle. A recent German study published in the American Journal of Gastroenterology involved a double-blind cross-over trial to evaluate the efficacy of inhaled salbutamol and the duration of symptoms in patients with proctalgia fugax.

The study showed that inhalation of 2 puffs of salbutamol shortened pain attacks in patients with severe proctalgia fugax compared with placebo (dummy treatment).

Compared to the placebo, salbutamol inhalation shortened the duration of severe pain, especially in patients having prolonged attacks. There were only 16 people involved in this study so the the results need to be confirmed in larger studies.