Paroxysmal anal hyperkinesis: A characteristic feature of proctalgia fugax

Satish Sanku Chander Rao, R. A. Hatfield

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background and Aims - Proctalgia fugax is a common problem, yet its pathophysiology is poorly understood. The objective was to characterise colorectal disturbances in a paraplegic patient with a 10 year history of proctalgia fugax that began two years after an attack of transverse myelitis. Methods - Standard anorectal manometry and prolonged 33 hour ambulatory colonic manometry at six sites in the colon were performed together with myoelectrical recording of the anus. Provocative tests designed to simulate psychological and physical stress and two types of meals were included. Results - Anorectal manometry showed normal internal sphincter tone and normal rectoanal inhibitory reflex but an inability to squeeze or to bear down or to expel a simulated stool. Rectal sensation (up to 360 ml inflation) was absent. Pudendal nerve latency was prolonged (4.5 ms (normal < 2.2 ms). During colonic manometry, the patient reported 27 episodes of pain, of which 23 (85%) were associated with bursts (1-60 min) of a high amplitude (0.5 to >3.2 mv), high frequency (5-50/min) anal myoelectrical activity, particularly after stress tests, meals, and at night. The myoelectrical disturbance only occurred with proctalgia. Intermittently, 16 bursts of 3 cycles/min phasic rectal contractions were seen, but only six were associated with proctalgia. Colonic motility was reduced compared with normal subjects. Conclusions - The temporal association between a high amplitude, high frequency myoelectrical activity of the anal sphincter, and the occurrence of proctalgia suggests that paroxysmal hyperkinesis of the anus may cause proctalgia fugax.

Original languageEnglish (US)
Pages (from-to)609-612
Number of pages4
JournalGut
Volume39
Issue number4
DOIs
StatePublished - Jan 1 1996

Fingerprint

Hyperkinesis
Manometry
Anal Canal
Meals
Transverse Myelitis
Pudendal Nerve
Economic Inflation
Exercise Test
Psychological Stress
Reflex
Colon

Keywords

  • Colon motility
  • Manometry
  • Pathophysiology
  • Proctalgia fugax

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Paroxysmal anal hyperkinesis : A characteristic feature of proctalgia fugax. / Rao, Satish Sanku Chander; Hatfield, R. A.

In: Gut, Vol. 39, No. 4, 01.01.1996, p. 609-612.

Research output: Contribution to journalArticle

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