Functional and Chronic Anorectal and Pelvic Pain Disorders
Functional GI pain disorders (things like IBS /the fancy doctor term is "disorders of gut brain interaction or DGBI may be more frequent in those of us exposed to increased levels of discrimination, chronic stressors, and anxiety, and IBD can sometimes also increase those risk factors.
Functional anorectal disorders (i.e., proctalgia fugax) and levator ani syndrome are definitely very real causes of pain and discomfort in your butt, but cannot be associated with a structural or other specified pathology (as in, there is not a visible reason that someone can point out on a CT scan why it hurts).
This does not mean your discomfort isn't there or isn't real!
These conditions are defined by predominant pain, they can be associated with functional disturbances (i.e., disordered voiding (peeing/pooping) or defecation).
These conditions can include (but are not limited to)
Functional dyspepsia ( chronic indigestion)
Rumination syndrome – effortless regurgitation of recently swallowed food
Functional abdominal bloating/distension
Irritable bowel syndrome (IBS) – a group of bowel disorders characterized by abdominal discomfort or pain associated with defecation or a change in bowel habit
Functional constipation – a group of functional disorders characterized by persistent difficult, infrequent, or seemingly incomplete defecation.
Functional diarrhea – continuous or recurrent passage of loose or watery stools without abdominal pain.
Fecal incontinence – recurrent uncontrolled passage of fecal material where no structural or neurological cause is evident. (leaking poop/stool when there is not a physical cause anyone can find)
Functional defecation disorders (Dyssynergic defecation) - meaning your pelvic floor muscles don’t communicate with each other at the right times when it’s time to poop, making pooping difficult) or inadequate defecatory propulsion (translates to “your butt/anal muscles don’t have the force/strength to push the poop out”)
Functional anorectal pain: Levator ani syndrome is a dull ache in the rectum that lasts for hours to days.
Functional anorectal pain: Proctalgia fugax is an infrequent sudden, severe pain in the anal area of short duration.
Levator ani syndrome
In levator ani syndrome, pain is generally prolonged (i.e., lasts for hours), is constant or frequent (i.e, doesn’t just happen for a few seconds and go away)
The pain is characteristically dull (not like a sharp, stabbing pain)
People often describe the pain as a vague, dull ache, or pressure sensation high in the rectum.
It is often worse with sitting than with standing or lying down.
Often associated with tenderness to palpation of the levator ani (the main pelvic floor muscle) but not urinary symptoms.
Tenderness is often asymmetric and more frequently affects the left than the right side (I don't know why)
If you notice these symptoms, it’s important to go to your doctor though - don't ignore it!
Your doctor may order testing (e.g., sigmoidoscopy, defecography, ultrasound, or pelvic MRI) to exclude other causes of pain (e.g., Crohn’s disease, anal fissures), and to identify associated conditions (e.g., defecatory disorders
Management and treatment of levator ani can seem hard, but there are promising therapies and treatments with lots of success (and some of them we use for IBD too!)
This includes:
Electrogalvanic stimulation (sounds weird, but it is rectal probe to stimulate the levator muscles with a special-designed probe and is very effective and safe.)
Biofeedback training
Digital massage of the levator ani muscles (not digital like technology, digital as in a trained person uses their hands to massage the levator ani muscles to relax them, improve muscle function and treat pain)
Sitz baths! We know about those!
In a study of 316 patients with the levator ani syndrome, 68% percent of patients reported “good results” after a combination of massage, sitz baths, muscle relaxants, and diathermy (they didn't specify the method, but diathery is using deep heat to an area of tissue/bone/etc, in this case, the levator ani muscle)
It can seem frustrating at first, but keep trying - I promise you will find something that helps make it better.
Proctalgia fugax
Proctalgia fugax is characterized by sudden, severe intermittent pain in the anal area lasting several seconds or minutes in the absence of an organic disorder to explain pain
This means a sharp, really bad pain in your anus area that goes away really quickly, and there isn't any other explanation or cause anyone can find.
Diagnosis of procalgia fugax is based on 12 weeks of:
Recurrent episodes of pain localized to the anus or lower rectum
Episodes lasting from seconds to minutes (a few seconds to 30 minutes max) (not having anal pain lasting for 45 minutes for example)
There is no anorectal pain between episodes. It comes and it goes - it feels 100% fine until it doesn’t.
Attacks are generally not related to a specific triggering factor, are often precipitated by stressful life events or anxiety
The pain has been described as cramping, gnawing, aching, or stabbing, may range from uncomfortable to unbearable, and radiates infrequently.
In managing proctalgia fugax, for most people, the episodes of pain are so brief that remedial treatment is impractical - if it only happens for 3 seconds at very sporadic and infrequent times, it can be hard to predict and treat.
However, for people with frequent symptoms, treatment may be considered.
The α2-adrenergic agonist clonidine (Catapres-TTS-2, Catapres-TTS-1, Catapres-TTS-3) reduced symptoms of proctalgia fugax in a patient who treated himself (don't do this, but I respect the hustle) and has been reported to be effective as a treatment as well as botox (botulinum) injections in treatment-resistant cases
NOTE: These are just examples from the literature! The best treatment for you will come from working with your healthcare team. Don’t neccessarily go asking for an albuterol inhaler because of this page - what’s best for you may very well not be what works for someone else.