What Is Proctalgia Fugax?

Written by Marijke Vroomen Durning, RN
Medically Reviewed by Zilpah Sheikh, MD on October 07, 2025
6 min read

Pain is part of life for many people. You might have headaches, stiff knees, or back pain. Those types of pain are often shared with others — we have no trouble talking about them. But what about if you have pain in your anus, sudden pain that comes and goes?

Proctalgia fugax is a sharp, sudden pain felt in your anus. This is the end part of your rectum — the last part of the large intestine where solid waste (stool) leaves your body.

Proctalgia is pain that comes from spasms or cramps of your pelvic floor muscles, anal sphincter muscles, or rectum muscles. Fugax means it’s very brief. Because proctalgia fugax is unpredictable, it is difficult for doctors to diagnose or for researchers to study.

“I’ve been practicing gastroenterology for about 15 years, and I have clinics almost every day of the week. I probably see this condition like once a year at most, maybe even once every couple of years,” says Ying Wu, MD, a gastroenterologist at Kaiser Permanente in South Sacramento, California. “But the epidemiology says it affects anywhere from 4% to 18% of the general population.” That number is likely higher, she added, because not everyone would see a doctor about fleeting pain if it doesn’t happen often. They might not even think to mention it during a physical.

Proctalgia fugax is temporary anal pain. It causes intense pain that may last from a few seconds to 30 minutes.

Severe episodes of proctalgia fugax can be painful enough to wake you up from sleep or interrupt your activity. If it goes on for more than a few minutes, it might keep you from going to work or school. Between episodes, you won’t have any pain or discomfort, though. If you do have other pain, you may have a different or other anorectal condition.

The pain:

  • Is usually unexpected, and you can’t pinpoint why it started
  • Is sharp, not achy or like cramps
  • Feels like it’s coming from inside or around the anus alone

Chronic proctalgia fugax is when the pain episodes last more than 20 minutes and happen more often. Some people have said that they get the pain after sitting for too long or having a painful bowel movement, but there’s not much research linking these to proctalgia fugax.

Levator ani syndrome and proctalgia fugax are two different conditions, although both include spasms of muscles in the pelvic area. Proctalgia fugax is very short, but levator ani syndrome can last hours.

Another major difference is the location of the pain. Pain from proctalgia fugax is felt only in the anus. Pain due to levator ani syndrome is usually felt higher in the pelvis. It can be felt in the pelvic floor — specific or vague areas — as well as in the thighs and buttocks. You may notice that symptoms worsen when sitting and improve when standing or lying down.

Doctors don’t know why some people get proctalgia fugax. “We don’t know the exact cause,” Wu says. “We say it’s neurohormonal, meaning it’s something related to the interaction between the brain and the gut, something in that nerve connection between our central nervous system and anywhere in the GI [gastrointestinal] tract.”

Doctors don’t know the cause of the condition to occur, but they do know that some people have triggers that lead to the painful episodes. But even the triggers can be unpredictable, Wu said.

Proctalgia fugax may be related to stress and anxiety. In some cases, people with proctalgia fugax felt stressed just before the spasms.

Studies have shown a similar relationship between stress and levator syndrome. Many people with levator syndrome have psychosocial distress, including depression and anxiety.

The following activities may trigger episodes of proctalgia fugax in some people:

  • Sexual activity
  • Constipation
  • Abnormal bowel movement
  • Menstruation

Proctalgia fugax is difficult to diagnose because of how quick and random the spasms can be. There are no tests for proctalgia fugax, so the diagnosis is made when other possible causes are ruled out. This is called a diagnosis of exclusion.

Other anorectal conditions your doctor may check for are:

History. Your doctor may make a diagnosis based on your symptom history. Keeping an accurate record of when the spasms happen, how long they last, how severe they are, and what happened before the spasms will help your doctor make a diagnosis.

Physical exam. Your doctor may do a physical exam to check for places of tenderness in the rectum or pain when the area is touched. This helps rule out any other conditions that could be causing anorectal pain.

There is no specific treatment for proctalgia fugax, so management aims to ease pain and discomfort. This is mainly because the episodes are short, irregular, and without a clear cause.

Medical treatments

There isn’t much your doctor can do for proctalgia fugax that you can’t do at home. While some research and a few case studies have looked at other treatments, none are officially recommended for treating this condition. Wu says none of these are done in her clinical practice.

Injections. A Botox injection around the anorectal area may help relax the muscles. An epidural injection might be suggested for severe cases.

Electrical stimulation. For severe proctalgia fugax, electrical stimulation of the anorectal muscles may offer relief. This treatment option involves inserting a small, finger-sized probe into the rectum and using a low-voltage current to relax spastic muscles through vibration.

Once you know that the pain you’re having isn’t caused by something else, there are some steps you can take to help ease the painful episodes:

  • Over-the-counter (OTC) pain relievers
  • Warm baths
  • Heating pads and ice packs
  • Meditation and relaxation techniques

If you find that difficult bowel movements are a trigger, you could try eating more fiber. Fiber will allow you to have softer bowel movements. These will keep your anorectal muscles from working too hard and may lower the risk of proctalgia fugax spasms.

If you’re experiencing anal pain, it’s always a good idea to get it checked by a doctor. “[Someone having this pain] should definitely go get this checked first with their GP [general practitioner], who can do a rectal exam and rule out things like anal fissures, hemorrhoids, or any other abnormalities,” Wu says. “And if the GP doesn't see anything, then referral to a gastroenterologist is certainly appropriate, and we can take a look with a sigmoidoscopy, endoscopy, or colonoscopy, inside the colon to rule out things like inflammatory bowel disease or malignancies in the anal area.”  

Proctalgia fugax, which is painful but not serious, might be more common than we think. That’s because not everyone tells their doctor about occasional anal pain — even if it’s severe. But if you do have this pain, it’s important to get it checked in case it’s something serious, like a tumor or inflammatory bowel disease. There’s no treatment for proctalgia fugax, but warm baths, over-the-counter pain relievers, and maybe stress relief, like meditation, might help relieve the pain while it’s happening. These episodes usually last only seconds but could even last up to half an hour.

How common is proctalgia fugax?

We don’t know exactly how many people have proctalgia fugax, especially if they only experience the pain for short periods very rarely. Experts say it could be that as many as 18% of people have the condition.

How long do episodes of proctalgia fugax last?

These episodes can be as short as a few seconds to a few minutes, but sometimes they can be as long as 30 minutes. If it lasts longer than that, then another issue may be causing the pain.

What can be mistaken for proctalgia fugax?

There are many possible causes of pain in the anal area. Some possible causes that could be mistaken for proctalgia fugax before a medical exam could be:

  • Anal fissures
  • Hemorrhoids
  • Anal abscesses
  • Infections
  • Tumors
  • Inflammatory bowel disease
  • Levator ani syndrome