Painful Butt Cramps? Here's What Your Body's Trying to Tell You

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Talk about a pain in the butt.
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Imagine that one moment you're just sitting at your desk or watching TV contently and suddenly you're gripped by a pretty intense pain…in your anus. It leaves you in agony for a few minutes and just as quickly as it came on, it leaves again.

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What you may have just experienced was proctalgia fugax, which is a type of severe rectal pain. (I should know — it's happened to me before. ​In my sleep.​ I thought I was dying, and then I was fine again. And totally confused. My body just acted as if nothing had happened. So, I laid in bed frantically Googling at 1 a.m. Only when I learned about proctalgia fugax did I start to feel better.)

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Here's what's going on: "Proctalgia fugax often happens when the smooth muscle in the anal canal spasms like crazy," gastroenterologist Supriya Rao, MD, tells LIVESTRONG.com.

It's not common, affecting just 5 to 10 percent of the population, Dr. Rao says, but the number could be higher. "Only 20 percent of patients who experience it tell their physician. That may be out of embarrassment or because it doesn't happen often enough," she says.

Each episode of this rectal pain lasts between a couple seconds to a few minutes and is fairly infrequent, happening five or fewer times in a year for most patients. In between bouts, you're totally fine.

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What Causes Proctalgia Fugax?

While experts generally know who experiences this kind of painful anal spasm — adults of any age, more often in people assigned female at birth — it's not clear yet ​why​ it's happening.

"There are several suggested triggers, but there's not one true obvious trigger," Dr. Rao says.

The suggested triggers include:

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  • Stress or anxiety
  • Constipation
  • Sex
  • Having your period

Proctalgia fugax may also be associated with IBS, notes a March 2013 article in the Canadian Medical Association Journal (​CMAJ​). And sometimes there's a compression of the pudendal nerve (a main nerve in your pelvis) that leads to these symptoms, Dr. Rao says.

Other times, though, it just seems to happen at random, the ​CMAJ​ article authors note.

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How to Find Relief

As for the fix, there's one powerful thing to keep in mind: The pain is fleeting. It will go away.

"If proctalgia fugax happens infrequently, most physicians would reassure their patients and explain what's going on, but no specific treatment is needed," Dr. Rao says.

In general, treating proctalgia fugax is challenging, notes a June 2020 review in Current Gastroenterology Reports. Of course, that doesn't mean you have to just grit your teeth through it. There are some things you can do to ease the pain, especially if it's occurring regularly.

Here's what to try, says Dr. Rao:

  1. Sitz baths:​ This is when you soak the anal area by sitting in a few inches of warm water. If you don't have a bathtub or have trouble getting in and out of it, you can try a plastic sitz bath seat that attaches to your toilet ($23.75, Amazon). Aim to soak two to three times a day for 10 to 15 minutes each, per the Mayo Clinic.
  2. Epsom salt baths:​ Adding Epsom salts to your soak may be beneficial because these salts are rich in minerals like magnesium that have muscle-relaxing properties.
  3. Prescription topical antispasmodics:​ These can be applied when symptoms start, to decrease pressure in the area. Your doctor can prescribe these.
  4. Biofeedback therapy:​ This type of therapy is often used in pelvic floor physical therapy and may help retrain these muscles to relax. Talk to your doctor about getting a referral for physical therapy.

You can also try to figure out what's triggering these painful episodes and work from there. If bowel movements (or a lack thereof) are to blame, try treating constipation by eating more fiber, drinking more water and getting daily exercise.

If stress is the culprit, get more zen in your life via daily meditation, deep-breathing exercises or other stress-busting methods.

It's completely normal to be shy about bringing up anal pain at the doctor's office — it's not exactly a comfortable topic to discuss. But it's important. "Being honest with your doctor can help you, so you don't have to suffer in silence," Dr. Rao says.

Pro tip: It might be helpful to say that you read a story about proctalgia fugax and use that as a jumping off point to talk about your symptoms.

When to See a Doctor (and What to Expect)

If proctalgia fugax is happening to you frequently (every few days or weekly) and it's enough to disrupt your quality of life, then you may want to make an appointment with your doctor.

There are many steps required to get a diagnosis, Dr. Rao says. For instance, you have to have recurrent episodes of pain in your rectum that are not related to having a bowel movement. These symptoms had to have happened within the last three months, with the first symptom starting six months ago.

In addition, your MD will rule out other potential causes of anal pain, such as anal fissures or hemorrhoids. A pelvic exam is needed to rule out pelvic inflammatory disorder, and you'll need a colonoscopy, too. Once these find that everything is normal, then your doctor can diagnose you with proctalgia fugax.

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Is This an Emergency?

If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911. If you think you may have COVID-19, use the CDC’s Coronavirus Self-Checker.
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