Proctalgia fugax: Difference between revisions
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*[[Rectal prolapse]] | *[[Rectal prolapse]] | ||
*[[Constipation]] | *[[Constipation]] | ||
*Fecal impaction | *[[Fecal impaction]] | ||
*[[Prostatitis]] | *[[Prostatitis]] | ||
*[[Proctitis]] | *[[Proctitis]] | ||
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**Women should also have pelvic examination to assess for pelvic etiology masking as rectal complaint | **Women should also have pelvic examination to assess for pelvic etiology masking as rectal complaint | ||
*Laboratory evaluation, including ESR and CRP, may be obtained though are frequently normal | *Laboratory evaluation, including ESR and CRP, may be obtained though are frequently normal | ||
*If febrile or leukocytosis present, consider advanced | *If febrile or [[leukocytosis]] present, consider advanced imaging to assess for deeper infections or process not easily evaluated by physical examination | ||
'''Rome IV Criteria'''<ref name"test"=>Rao SSC, Bharucha AE, Chiarioni G, et al. Anorectal Disorders. Gastroenterology. March 2016:S0016-5085(16)00175-X 10.1053/j.gastro.2016.02.009. doi:10.1053/j.gastro.2016.02.009., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035713/ </ref> | '''Rome IV Criteria'''<ref name"test"=>Rao SSC, Bharucha AE, Chiarioni G, et al. Anorectal Disorders. Gastroenterology. March 2016:S0016-5085(16)00175-X 10.1053/j.gastro.2016.02.009. doi:10.1053/j.gastro.2016.02.009., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035713/ </ref> | ||
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**This is due to brief duration of episodes and difficulty in both treating and preventing | **This is due to brief duration of episodes and difficulty in both treating and preventing | ||
*Referral to gastroenterology if symptoms severe | *Referral to gastroenterology if symptoms severe | ||
**Some research into inhaled beta | **Some research into inhaled [[beta agonists]] and topical anti-spasmodics, but best provided and managed by GI | ||
==Disposition== | ==Disposition== | ||
Revision as of 23:40, 29 September 2019
Background
- Exact pathophysiology unclear, however may include anal sphincter spasm and hypertrophy
- Frequently brought on by stress
- Prevalence 8-18%, does not favor one sex
- Should be considered a diagnosis of exclusion
Clinical Features
- Spasm-like, sometimes excruciating, pain in the anus, often misinterpreted as a need to defecate
- Episodic pain (women, patients < 45yo)
- Brief, usually only seconds to minutes in duration
- Incontinence
- Urgency
Differential Diagnosis
- Levator ani
- External hemorrhoid
- Anal fissure
- Rectal prolapse
- Constipation
- Fecal impaction
- Prostatitis
- Proctitis
- Prolapsed internal hemorrhoid
- Anorectal abscess
- Coccydynia
Evaluation
- Diagnosis is largely clinical, and one of exclusion
- Digital rectal examination should be performed, with special attention and care noted to assess the external areas for contributing sources of pain
- This includes a prostate examination in men
- Women should also have pelvic examination to assess for pelvic etiology masking as rectal complaint
- Laboratory evaluation, including ESR and CRP, may be obtained though are frequently normal
- If febrile or leukocytosis present, consider advanced imaging to assess for deeper infections or process not easily evaluated by physical examination
Rome IV Criteria[1]
- The Rome IV criteria are meant to differentiate and assist in the diagnosis of functional gastrointestinal disorders (FGID)
- For the diagnosis of proctalgia fugax, the following should be present
- Recurrent episodes of pain unrelated to defecation
- Episode duration no longer than 30 minutes (>30 minutes suggest levator ani syndrome)
- Absence of pain between episodes
- Exclusion of other causes
Management
- In majority of cases, reassurance and explanation of process is sufficient
- This is due to brief duration of episodes and difficulty in both treating and preventing
- Referral to gastroenterology if symptoms severe
- Some research into inhaled beta agonists and topical anti-spasmodics, but best provided and managed by GI
Disposition
- Can be safely discharged home when emergent causes excluded
- Provide GI follow up information
See Also
References
- ↑ Rao SSC, Bharucha AE, Chiarioni G, et al. Anorectal Disorders. Gastroenterology. March 2016:S0016-5085(16)00175-X 10.1053/j.gastro.2016.02.009. doi:10.1053/j.gastro.2016.02.009., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035713/