Proctalgia fugax

Proctalgia fugax

This problem is characterised by attacks of severe pain arising in the rectum, recurring at irregular intervals and apparently unrelated to organic disease. The pain is described as cramp-like, often occurring at night, lasting minutes and disappearing spontaneously . It seems to occur more commonly in patients su ff ering from anxiety or undue stress. The pain may be intense but gradually subsides. It may be caused by cramp in the pubococcygeus muscle. A salbutamol inhaler can be used to treat acute attacks while amitriptyline may reduce the frequency . A more chronic form of the disease has been termed the ‘levator syndrome’ and can be associated with -

Figure 80.19 Mobilised skin /f_l ap prior to suturing intra-anally over the debrided and freshened posterior /f_i ssure base.

severe evacuatory dysfunction (see Chapter 73 ). Biofeedback techniques have been used to help such patients.

Figure 80.20 ‘Mixed’ haemorrhoids; third-degree internal haemor rhoids become visible when the patient strains. This can be repro duced by withdrawal of a small swab inserted into the anal canal.