Makindo Medical Notes

🩺 Proctalgia = pain localised to the rectum or anal region. It may be acute, chronic, or intermittent. Causes range from functional (muscle spasm) to organic (fissures, abscesses, malignancy) and even referred pain from pelvic or neurological sources.

⚡ Causes

• Functional Causes:
  • ⚡ Proctalgia fugax → brief, sharp episodes lasting seconds–minutes
  • 🪑 Levator ani syndrome → chronic dull rectal pain from pelvic floor spasm
• Organic Causes:
  • 💥 Haemorrhoids (internal/external)
  • 🔪 Anal fissure
  • 🦠 Perianal abscess or fistula-in-ano
  • ⬇️ Rectal prolapse
  • 🔥 Inflammatory bowel disease (Crohn’s, UC)
  • 🎗️ Anorectal cancer
  • 🧫 Infections (STIs, proctitis)
  • 🚨 Foreign bodies
• Referred Pain:
  • ♀️ Pelvic inflammatory disease
  • 🧑‍⚕️ Urological conditions (e.g., prostatitis, bladder pain syndrome)
  • 🦴 Sciatica

🩺 Clinical Presentation

• Sudden or chronic rectal pain
• Pain during or after defecation
• Associated features:
  • 💉 Rectal bleeding
  • 🚽 Tenesmus (feeling of incomplete emptying)
  • Constipation or diarrhoea
  • Discharge, swelling, or fever
• History of pelvic floor dysfunction or prior anorectal surgery

🔬 Investigations

• Clinical Examination:
  • Inspection → fissures, haemorrhoids, discharge
  • DRE → tenderness, masses, muscle spasm
• Imaging & Tests:
  • Anoscopy/proctoscopy → fissures, haemorrhoids
  • Flexible sigmoidoscopy/colonoscopy → malignancy, IBD
  • Pelvic MRI/CT → abscess, fistula, deeper pathology
  • Stool culture & microscopy → infection
  • Bloods → FBC, CRP, ESR (inflammation, infection)

💊 Management

• Functional:
  • Proctalgia fugax → reassurance, warm baths, muscle relaxants, inhaled salbutamol (for severe)
  • Levator ani syndrome → pelvic floor physiotherapy, biofeedback, diazepam (occasionally used)
• Organic:
  • Anal fissure → topical nitrates, calcium channel blockers, botulinum toxin
  • Haemorrhoids → conservative (fibre, sitz baths), banding or surgery
  • Abscess/fistula → incision, drainage ± antibiotics
  • IBD → refer to gastroenterology for disease-specific therapy
  • Cancer → MDT oncology pathway
  • Other anorectal causes → manage per condition
• Referred Pain:
  • Treat underlying disorder (e.g., prostatitis, gynaecological infection)

⚠️ Complications

• Chronic rectal pain → ↓ quality of life
• Pelvic floor dysfunction
• Spreading sepsis (perianal, pelvic)

🛡️ Prevention

• Good anorectal hygiene
• High-fibre diet + hydration → prevent constipation
• Early treatment of fissures, haemorrhoids, infections
• Pelvic floor exercises for functional syndromes