Sequential treatment for proctalgia fugax. Mid-term follow-up

Area of Science:

• Gastroenterology
• Colorectal Surgery

Background:

• Proctalgia fugax (PF) is a benign condition causing intense, episodic anorectal pain.
• Etiology of PF remains largely unknown despite its long history.
• Limited research exists on effective management strategies for PF.

Purpose of the Study:

• To investigate patients with proctalgia fugax.
• To evaluate a sequential therapeutic approach for PF management.

Main Methods:

• A prospective study of 15 patients with short-duration (less than 30 minutes) acute perianal pain.
• A three-step treatment protocol: 1) patient education, hip baths, benzodiazepines; 2) sublingual nifedipine or topical nitroglycerin; 3) internal anal sphincterotomy if IAS hypertrophy was confirmed by ultrasonography.
• Improvement defined as a 50% reduction in pain intensity or episode frequency.

Main Results:

• Seven patients improved and one was cured after the first treatment step.
• Three patients improved and one was cured after the second treatment step.
• Three patients with internal anal sphincter (IAS) hypertrophy underwent the third step, with one improving and one cured.

Conclusions:

• Sequential therapy can improve PF symptoms and reduce episode frequency, though complete resolution is not always achieved.
• Internal anal sphincter hypertrophy was identified in 30% of patients and may be a target for treatment.
• Anal endosonography is valuable for diagnosing IAS hypertrophy, guiding potential surgical intervention (internal anal sphincter myectomy).