Proctalgia fugax and levator ani syndrome are conditions which cause anal pain. Proctalgia fugax is a fleeting pain in the anus, lasting less than 20 minutes, with no symptoms whatsoever in between episodes. Levator ani syndrome is a pain which lasts for longer, but for which no other cause is found.
Anal pain is, quite literally, a pain in the bum. And it's no laughing matter, and can make life a misery.
Your anus (other than when it's spelt differently, in which case it's a planet) is the very end of your gut, and where it opens out on your bottom. The anal canal is the short tube just above, and leads to the rectum just above it.
What can give you a pain there?
Read about some of the many possible causes of pain in this part of your body.
The conditions proctalgia fugax and levator ani syndrome are what is left when all these causes have been ruled out. They are a "diagnosis of exclusion", meaning there is no specific test for them, and that all other possible causes must be ruled out first. This leaflet is mainly about these two conditions.
What is the difference between proctalgia fugax and levator ani syndrome?
It's mostly about how long it lasts. If you have proctalgia fugax, you have short spells of intense pain in your back passage, but it's all over within seconds or minutes, and you feel absolutely normal in between attacks. You may get clusters of episodes, several over a week or two, but most people don't get the pain very often.
Levator ani syndrome pain tends to be worse when sitting, and lasts at least 20 minutes. More often it's there all the time, or comes and goes persistently. It is usually an aching type of pain.
Learn more about symptoms of anal pain.
Is it serious?
That depends what you mean. It is not at all serious in the way that cancer is serious, for example. Proctalgia fugax doesn't usually affect your life too much. Once your doctor has established nothing more serious is the cause then it is usually an occasional problem for most people. Levator ani syndrome can, however, be a significant ... well, pain in the backside. It can wake you up at night, and prevent you doing things that involve sitting. Which can get in the way of work, and leisure activities such as cycling, for example. It can, for some people, really interfere in the quality of life, and so for those people, yes it can be serious.
Why does it happen?
The bottom (excuse the pun) line is that the cause isn't really known. It's thought to be caused by a tightening or spasm of the muscles inside your bottom. In some people, it's possible to find what set this off, but in many it remains a mystery.
Will I need any tests?
Sorry, but yes, probably. At the very least, it is worth visiting your doctor. And sorry, they will want to examine your bottom. Baring your bum is a tad undignified, but the doctor will need to be sure there isn't anything more serious causing your pain. He or she will need to look/feel at/inside your anus. If you describe brief spells of pain and nothing in between, and this examination is entirely normal, you probably won't need any more tests. But if your pain lasts longer, or the doctor finds anything examining you, then you will probably be referred to a specialist for further tests. Mainly this involves tubes and cameras in places you'd rather not think about to check it all out. Very occasionally other tests such as scans are needed.
Learn more about diagnosis of anal pain.
What treatment can I have?
You may not necessarily need any treatment. Particularly for proctalgia fugax, once you've been reassured you haven't got cancer, often you can just put up with it when you get it. If it is troublesome, though, there are some treatment options. The more persistent pain of levator ani syndrome may need some medical help. Normally this will be through a specialist.
Will it settle in time?
This is variable. Proctalgia fugax usually isn't a long-term problem. Either you get a few episodes here and there with long spells of no problems in between, or it goes away altogether. Each individual episode, by definition, is very short-lived. Levator ani syndrome can drag on for a long time in some people and it may be difficult to find a treatment which helps.
Further reading and references
Jeyarajah S, Purkayastha S; Proctalgia fugax. CMAJ. 2013 Mar 19185(5):417. doi: 10.1503/cmaj.101613. Epub 2012 Nov 26.
Chiarioni G, Asteria C, Whitehead WE; Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options. World J Gastroenterol. 2011 Oct 2817(40):4447-55. doi: 10.3748/wjg.v17.i40.4447.
Guidelines on Chronic Pelvic Pain; European Association of Urology (2015)
The attacks described on this forum are exactly the same as what i've been experiencing for 4-5years now. I get a stabbing/pressure pain in my butt that feels really deep inside and like something in...Guest
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