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I am a 59-year old male and have suffered from PF for about 7 years. My episodes were about 6x/year earlier, but thankfully are down to about one per year. The attacks can be incredibly painful, and scary—with the worst ones, you feel like you’re going to pass out.
After suffering through these for four years, I discovered something that consistently gives me very fast and complete relief. It’s a hot bath—the hottest you can stand. And while you are waiting for the tub to fill (you only need 2-3 inches of water), apply a washcloth, soaked in hot water, to your anus. Stay in the bath until the pain is completely gone. Run more hot water if necessary.
As for cause, a couple times it has come on after ejaculation, but mostly it comes on while sleeping. My theory is that there is a stool in close proximity to the anal sphincter that cause the sphincter to spasm. So I think there is a correlation between the episodes and mild constipation.
That said, though the episodes often are accompanied by the strong sensation of needing to poop, don’t try! The sphincter is in no condition to permit a bowel movement during spasm. If anything, trying to poop lengthens the episode.
Other tips - lying on side is better than on back; passing gas, if you can, helps a little, anti-anxiety meds (e.g., Ativan) help, but not nearly as fast as the bath; deep breathing helps take focus off the pain. This is as close as I’ll ever get to childbirth!
Some consolation—no matter how long or painful the episode is, it will not kill you and it WILL pass.
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