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home - Colon - Anal Diseases - Anal Pain 1 Proctalgia Written by Dr Sebastian Zeki
Knowledge

Understands the clinical anatomy of the rectum and anus
Knows the causes of rectal bleeding and the methods of investigation
to determine the cause

Has awareness of the range of perianal conditions (which includes
abscesses and fistula), their clinical presentation and their
complications

Knows the techniques of investigation and the possible medical and
surgical treatments

Is aware of the treatment options for radiation proctitis
Skills
Take a history and appropriately examines the anus and rectum
Refers the patient for the appropriate endoscopic and radiological
investigations

Behaviours
Manages patients with anorectal disease in a sympathetic manner,
recognising and addressing the concerns caused by such conditions

Anal Pain 1 Proctalgia

Anal Pain 1- Proctalgia Fugax Clinical Manifestations :It is more common in females.The average age of presentation is <45.Attacks occur <5 times per year in 50%.Patients are asymptomatic between episodes.Episodes can occur at day or at night and are not associated with bowel movements. 2 ii) 2 iii) 2 iii) 2 iv) — Theories 1) Pathology of the external anal sphincter or voluntary striated muscles of the anorectum.2)Other theories- related to smooth muscle of the internal anal sphincter.i)Paroxysmal hyperkinesis of the anus .ii)Higher resting anal pressure.iii)Internal anal sphincter show hypertrophy, disarrangement, and vacuolization of fibers, with the presence of polyglycosan bodies in many fibers in a family with proctalgia fugaxiii)Pudendal nerve- Possibly due to neuralgia involving the pudendal nerves.iv)Psychological factors - Depression/ anxiety association not proven Treatment:-Albuterol (beta agonist)-In RCT albuterol is assoc with reduction in severe pain; mechanism of action unclear.-Pudendal nerve block- Effective in uncontrolled studies.-Oral clonidine (150 micrograms twice daily).-Topical nitroglycerin (0.3 %).Anecdotal-Injection of botulinum toxin.-Edrophonium chloride (a cholinesterase inhibitor).-Lidocaine iv.Anecdotal. Rome III Criteria for diagnosis:Recurrent anal/ lower rectal pain.Episodes last from seconds to minutes .There is no anorectal pain between episodes.There is no organic pathology. 2 i) Some urogenital abnormalities and chronic benign prostatitis can produce similar symptoms. Written by Dr Sebastian Zeki Pathophysiology

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