Proctagia Fugax - a pain in the derriere!

What is PF?
Proctalgia means pain around the back passage area (anus/rectum) and/or, for some women, into the vagina.  It's most often a central spasm + pain and less often appears on one side more than the other.
Fugax is a Latin word meaning fugitive or fleeting, so it's a pain in your anus/vagina that's like a spasm and is short lived……a squeeze and gone or a deeply unpleasant clench that can hold on for a 2 - 20 minutes.
Pain can appear frequently over a few weeks, each time lasting only seconds or minutes or appear rarely and only during specific actions/activities. It is a sudden, cramping, severe pain that may make you feel nauseous and quite awful. It may wake you up in the night.  If the spasm builds and becomes difficult to release (feeling "locked in"), you may have aching for up to a day afterward leaving you with a tired + tender anus/vagina that makes lengthy sitting uncomfortable and release for toileting and intimacy unpleasant. About 1 in 5 people have PF, so this is worth attending to! 
 
A specialist once told me "you just have to live with it".   If you've been told that, read on.
This isn't because doctors don't know about PF, but reflects that they can't test it or see/palpate it, because you're not usually in their office when it clamps on.  Then it passes, so it's not really a huge or impactful medical issue, but it IS a functional issue that has had very little attention…..until now.  Your doctor can rule out other problems that may cause similar symptoms, so please mention these anal/vaginal spasms to them! 
Then find a pelvic physio to assess your pelvic floor.  You can begin by reading onward and seeing if this story and these suggestions help you to reduce the frequency and intensity of your PF, then help you bid PF goodbye!
 
It is treatable, manageable and you can stop it from coming on. 
This requires attention - when you have PF, take stock of your life, activities, rest, stress, food etc. at the time.
Ask yourself what was going on just before or within the last ½ day?  Jot it down on the calendar or in your in notes on your phone.  Next time you experience PF, write it down again.  Pay attention to your triggers.
Shared problems may include:  IBS or an IBD?  Bloat?  Abdomino-phrenic Dyssynergia?  Overactive pelvic floor? Urge/urge incontinence for your bladder?  Overactive bladder (pee too often)?  Pain with sex?  Sluggish/painful bowel release)?  Hemorrhoids?  This pesky list reflects pelvic diagnoses that also occur with an overactive, hypertonic or hyperrecruited pelvic muscle system. 
 
Find your Triggers.
There are numerous triggers for PF including sexual activity, stress (+++) of all varieties and blends, grief, constipation, bowel movements, during/right before periods, sport activity like speed walking/running/interval work/hill work, gymnastics, basketball, sudden start/stop sports like softball or baseball …….although the PF can occur without a trigger. 
Increased stress (physical, emotional, relationship or a blend thereof) is most commonly implicated due to our very human tendency to protect ourselves by "holding on" when stressed.  We do this by butt gripping, pelvic floor clenching and tensing our lower abdominals (especially the Transversus Abdominus muscle just above your pubic bones).  Some of these muscles share attachments with your anus (external anal sphincter) and your vaginal walls (too many amazing muscles to list) and they all share the same electrical circuits (neuromotor or nerve to muscle communication).  Nerves (and muscles) that wire together, fire together.
 
Notice onset (like an aura with a migraine).
Some people describe a sensation of lifting or tightening of their pelvic floor or a very mild ache in their deep buttock or anus prior to the onset of PF…..notice it and begin emergency measures immediately.  You can learn to stop PF from coming on to a full clamp.
 
Immediately apply emergency management measures!
You need to release a spasm, so think of PF like a foot or calf cramp….it takes work + calm + time + skill.  Begin by taking deep, pelvic-diaphragmatic breaths, inhaling fully for a slow count of 4, then releasing it with big (Dizzy Gillespie playing the trumpet) cheeks or a deep bear growl or a long, slow, groany groan.  If you're near a toilet, sitting on the toilet seat (not the lid) with your feet planted on the floor and your elbows on you knees ("reading the newspaper on the floor position") can be helpful for 2 reasons:  you're used to releasing your pelvic floor on the toilet (habit) and the toilet seat is built to open up your pelvis (that sinking down in the middle).  It's a good tool!  Imagining release (motor imaging) of your pelvis, anus, vagina, buttocks, low belly and hips helps, so picture it while releasing with your mind.  Go to your Savasana or meditation or beach or post-run feeling in your mind.  Positions that might help:  squat (on your own or with your sacrum on the wall for support or at the wall or with a yoga block or low stool under your buttocks), hinging at the hips with your palms or elbows on your thighs, wide kneed child's pose or happy baby.  In all these positions, release your anus and vagina, especially on a deep and low in-breath with back pressure outbreath (big cheeks or bear or deep groan) so that you find ways that you (when you're not in spasm or pain) can release, release, release.

Do some prevention movement, breath practices and stress management daily.
Ask your pelvic physio to help you learn to turn OFF your pelvic floor and lower abdominals; we call this downtraining or quieting.  Do this practice every day for 2 weeks, then continue on most days, reminding your lower muscles, the centre of your deep core, that activation is OK but release is brilliant too!  Learn to do pelvic diaphragmatic, 4 part, back pressured out breath (big cheeks, bear or groan) or Dirga breaths as part of your "release your body and mind" practices each day.  You don't always breathe this way but it helps you to know when to use this technique for the right moment (toileting, sex, birthing, PF).  Never grip your buttocks nor hold your tummy in - these are really unhelpful habits.  You're beautiful as you are and gripping/holding doesn't help.  Learn where "your body keeps the score" - find those spots in your own body where you "hold on" and notice when you're feeling the urge to protect, get stressed out or overwhelmed and learn to release them.  Responding fully with a calm body to stress without being stressed out is a wonderful thing.  Make squatting and/or happy baby and/or child's pose or leaning forward with your hands/elbows on your thighs a stretch that you include in your day, especially before/after situations that often trigger you.  And breathe deeply and fully into the stretch, feeling the release and enjoying the moment.
 
Joanne Gailius, BSR, PT+OT, Physiotherapist
(Pelvic, Women's Health and Oncology)
C Lower - 1204 NW Blvd.     Creston, BC     Ph  250-254-3494   Fax  1-855-655-5281   [email protected]