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Proctalgia Fugax: Medical Terminology Explained · This Is Why with Dr. Busti

• 0:00
  SPEAKER_00: All right, well, welcome to this episode on medical terminology, where I'm going to ensure that we all understand the medical term Proctalgia Fujax and how it is used appropriately as healthcare professionals.
• 0:13
  SPEAKER_00: I'm Dr.
• 0:14
  SPEAKER_00: Busai and welcome to This Is Why, a show dedicated to helping healthcare professionals understand the why behind what we do and what we talk about in everyday clinical practice.
• 0:25
  SPEAKER_00: So let's start with the term itself because, as always, the name is going to do more work than what we think.
• 0:34
  SPEAKER_00: Proctalgia Fujax.
• 0:36
  SPEAKER_00: Let's break down its origin and etymology, and it's also first introduction in the literature.
• 0:43
  SPEAKER_00: Okay, now procto refers to the rectum or anus.
• 0:50
  SPEAKER_00: Algae means pain.
• 0:52
  SPEAKER_00: Okay, and then fujax means quickly fleeting or transient in nature.
• 0:59
  SPEAKER_00: Okay, now this is a similar word that fujax that's used in amaurosis fujax, which is a temporary painless loss of vision in one or both eyes.
• 1:12
  SPEAKER_00: And that would be concerning for a stroke or TIA.
• 1:14
  SPEAKER_00: So we don't want to get that one confused.
• 1:16
  SPEAKER_00: Okay?
• 1:17
  SPEAKER_00: All right, now let's go further.
• 1:19
  SPEAKER_00: Proctalgia, okay, without the word Fujax.
• 1:23
  SPEAKER_00: Well, that was recorded in the English literature as early as the 1800s.
• 1:28
  SPEAKER_00: A clinical description can also be traced back to A.
• 1:31
  SPEAKER_00: S.
• 1:32
  SPEAKER_00: Myrtle in 1883, which is often cited as an early description of episodic anal rectal pain.
• 1:41
  SPEAKER_00: However, the term Proctalgia Fujax was introduced and formalized by Thesson in an article published in the Lancet in August of 1935.
• 1:52
  SPEAKER_00: And that was an article titled Proctalgia Fujax, a little known form of pain in the rectum.
• 2:00
  SPEAKER_00: Okay.
• 2:00
  SPEAKER_00: So right from the beginning, the term is telling you the story.
• 2:05
  SPEAKER_00: This is fleeting rectal pain, or said another way, a pain in the butt.
• 2:12
  SPEAKER_00: Okay.
• 2:13
  SPEAKER_00: Now why does that matter?
• 2:15
  SPEAKER_00: Because in clinical medicine, the duration of symptoms guides your differential diagnosis.
• 2:22
  SPEAKER_00: Think about it this way.
• 2:24
  SPEAKER_00: If the patient tells you that you have they have anal rectal pain that lasts a few seconds to minutes and then completely disappears, well, that's much different of a clinical problem than pain that lasts for hours or constant.
• 2:41
  SPEAKER_00: So the name is not just descriptive, it is actually diagnostic reasoning embedded in the language.
• 2:48
  SPEAKER_00: Now let's take this one step further and talk about how this concept developed historically.
• 2:55
  SPEAKER_00: Proctalgial fujax has been grouped under what we used to call functional anal rectal disorders, meaning that the patient has real symptoms, but we do not find a clear structural or biochemical cause on routine exam or testing.
• 3:11
  SPEAKER_00: And historically, clinicians thought this was likely related to spasm of the internal anal sphincter or the pelvic floor muscles.
• 3:22
  SPEAKER_00: And with that, I want to point to a diagram and kind of help us to wrap our minds around the anatomy so that when we're talking to a patient, we can visualize sort of that area, and that might guide us a little bit to what's going on.
• 3:39
  SPEAKER_00: So this is a coronal view, which is a cut from top to bottom and looking straight in this direction.
• 3:47
  SPEAKER_00: Okay.
• 3:48
  SPEAKER_00: And what you see is the rectal and uh rectum and the anus here in the opening.
• 3:54
  SPEAKER_00: We have the internal sphincter over here, and then of course the external sphincter on the outside or external.
• 4:04
  SPEAKER_00: And that's controlling and keeping that tone and tension so that we don't just leak things out.
• 4:11
  SPEAKER_00: Okay.
• 4:11
  SPEAKER_00: Obviously, those muscles have to relax and reposition themselves.
• 4:16
  SPEAKER_00: And so if you follow these muscles up further, there's another group of muscles kind of anchoring and pulling.
• 4:23
  SPEAKER_00: That is called the levator ani muscles.
• 4:26
  SPEAKER_00: And that that group of muscles is more extensive and helps to do a lot of things, not only control defecation, but also is involved in pelvic floor support, helps with also micturation or urination, it helps also involved in sexual intercourse and activity, and also during pregnancy for support.
• 4:48
  SPEAKER_00: So there's a lot of network of muscles and what they do to coordinate this controlled response.
• 4:55
  SPEAKER_00: Now, looking at this coronal view, you also see examples of some hemorrhoids that are internal and external.
• 5:05
  SPEAKER_00: Okay.
• 5:06
  SPEAKER_00: And this type of recognition, you may not be able to see internal hemorrhoids unless you do an analektal exam.
• 5:15
  SPEAKER_00: But those can cause pain for patients, no different than obviously the external ones can.
• 5:19
  SPEAKER_00: And there's a lot of other things that can cause pain in this area, but understanding the basic anatomy is important.
• 5:25
  SPEAKER_00: Now let's look at a sagittal view, okay?
• 5:30
  SPEAKER_00: So on the left hand side is the sagittal view of the female anatomy, the right side over here is the male anatomy.
• 5:38
  SPEAKER_00: And when you get down again, look at the sagittal view of the of the rectum, you see those internal and external uh sphincters, but you also see the network of a lot of other muscles all throughout here.
• 5:51
  SPEAKER_00: Now, again, it's a sagittal view, so it's from cutting through this way and looking from the side.
• 5:56
  SPEAKER_00: Alright.
• 5:57
  SPEAKER_00: So you always have to keep your orientation correct.
• 6:00
  SPEAKER_00: But when we when we learn anatomy, obviously you have to look at it in a three-dimensional, obviously, consideration of space.
• 6:08
  SPEAKER_00: But the levator ani muscles, which are further up, are necessary for obviously that pelvic floor.
• 6:16
  SPEAKER_00: And there's a lot of pelvic floor dysfunction and things that go.
• 6:19
  SPEAKER_00: And that even goes back to the treatment, which we'll talk about here in a minute.
• 6:23
  SPEAKER_00: Now, what controls and innervates the muscles in these areas here?
• 6:28
  SPEAKER_00: Well, you can see an extension or cross-section here of the sagittal view of part of the spine, right?
• 6:36
  SPEAKER_00: The lumbar sacral spine.
• 6:37
  SPEAKER_00: And that's where remember those nerves come off.
• 6:40
  SPEAKER_00: And so patients who have traumatic injury to their low lumbar and sacral spine, or have compression on the nerves from disc disease, disc herniation, or they have an abscess or something else, right, then the compression or damage of those nerves will affect the control of the muscles in this area.
• 7:01
  SPEAKER_00: And that's why patients with significant lower back problems can eventually develop things like caudic quinice syndrome and things like that, where they lose control of their bowel bladder, they have urinary retention, they lose sensation, all those things which can be considered a medical emergency.
• 7:18
  SPEAKER_00: Okay?
• 7:19
  SPEAKER_00: Now, the real issue here is that we still do not have a, we have a single, we do not have a clear defined mechanism for what is causing that anal rectal pain or proctalgial fujax.
• 7:33
  SPEAKER_00: So in the modern terminology, we simply have shifted uh shifted away from simply calling it functional and and how we classify it under now a disorders that relate to the brain-gut interaction, which we know has been growing in our understanding.
• 7:48
  SPEAKER_00: So the question becomes: what does that actually mean for the patient sitting in front of you?
• 7:53
  SPEAKER_00: It means that the symptoms are real, the physiology is complex, and the interaction between the central nervous system and the gastrointestinal tract is likely playing a central role because everything looks normal.
• 8:07
  SPEAKER_00: So now let's connect that to the diagnosis because this is where clinicians get in trouble.
• 8:14
  SPEAKER_00: Okay, if they have shortcuts for their reasoning.
• 8:17
  SPEAKER_00: Proctalgial fujax is a, listen, diagnosis of exclusion.
• 8:23
  SPEAKER_00: That means before you confidently label somebody with that, you need to think about reasonably to rule out other structural causes and reasons for anal rectal pain.
• 8:33
  SPEAKER_00: Okay, what are we talking about?
• 8:34
  SPEAKER_00: Well, things like anal fissures that actually can bleed, a tear, internal, external hemorrhoids, which we saw in the image, perianal abscess, okay, infection, malignancy, inflammatory conditions, things like proctitis that we see in things like inflammatory bowel disorder or ulcerative colitis, okay, and even objects.
• 9:00
  SPEAKER_00: Yes, I said objects.
• 9:03
  SPEAKER_00: So why does this matter?
• 9:05
  SPEAKER_00: Okay?
• 9:06
  SPEAKER_00: Well, because those conditions require very different management strategy, and missing them has real consequences, especially the malignancy.
• 9:14
  SPEAKER_00: Now, once those are excluded, the clinical picture of poctalgiafugex becomes much clearer.
• 9:20
  SPEAKER_00: These are sudden, severe episodes of anal rectal pain that lasts seconds to minutes and sometimes may be 20 to 30 minutes.
• 9:29
  SPEAKER_00: But then they completely resolve, right?
• 9:31
  SPEAKER_00: And in between those episodes, the patient is typically asymptomatic, and that last point is actually really important.
• 9:38
  SPEAKER_00: There's no ongoing pain, there's no persistent discomfort, and they have a normal exam.
• 9:42
  SPEAKER_00: Okay?
• 9:43
  SPEAKER_00: Now let's compare this to a closely related term, okay, because this is where clinical reason can your clinical reasoning needs to get a little sharper.
• 9:52
  SPEAKER_00: Levator anine syndrome, right?
• 9:55
  SPEAKER_00: So I remember I pointed out that muscle and I mentioned it earlier, but that's also involved in anal rectal pain.
• 10:02
  SPEAKER_00: Okay, but that time course is different.
• 10:05
  SPEAKER_00: Levator AI syndrome tends to produce more prolonged, dully, dull ache pressure that can last hours and even longer.
• 10:15
  SPEAKER_00: So again, the duration becomes one of your differentiators.
• 10:22
  SPEAKER_00: Short fleeting episodes point you towards proctalgia fugex.
• 10:26
  SPEAKER_00: Longer persistent pain pushes you in another direction.
• 10:30
  SPEAKER_00: Now let's shift gears slightly and talk about how this concept shows up outside of medicine because this is where we can make it more relatable, especially to patients, right?
• 10:40
  SPEAKER_00: You're not likely going to hear the phrase proctalgia fugex.
• 10:45
  SPEAKER_00: Although I do have some close friends who love medical terms and like to use them to throw off their friends and try to impress them with their knowledge, okay?
• 10:55
  SPEAKER_00: But in everyday conversation, you're not gonna hear that, okay?
• 10:58
  SPEAKER_00: But you will absolutely hear people describe something as a pain in the butt, okay?
• 11:03
  SPEAKER_00: And while that phrase is often used metaphorically to describe annoyance or inconvenience, it actually loosely mirrors the idea of something that is bothersome, sometimes sudden, and disruptive.
• 11:18
  SPEAKER_00: Now, obviously, this is not a clinical description, but it helps to anchor the concept in language people already understand.
• 11:28
  SPEAKER_00: Sometimes making that connection helps learners remember, right, the underlying idea.
• 11:34
  SPEAKER_00: So, what can be done for it, right?
• 11:37
  SPEAKER_00: Well, there's things that have been shown to help: warm sits baths, relaxation techniques, or both, improving bowel habits to prevent constipation, the initiation or consideration of that pelvic floor physical therapy with biofeedback.
• 11:53
  SPEAKER_00: Again, remember that brain-gut interaction.
• 11:56
  SPEAKER_00: And then there's also things like medications, inhaled albuterol, a beta 2 agonist that's known to relax muscle, topical sphincter relaxants, like 0.2 to 0.4% GTN uh ointment, or a calcium channel blocker to relax that muscle, 2% deltizam cream, or in refractory cases, Botox, where, yes, injections are actually made into the internal anal sphincter to basically relax or semi-paralyze them, right?
• 12:31
  SPEAKER_00: Now, and that's the real issue, isn't it?
• 12:33
  SPEAKER_00: Medical terminology is not just vocabulary, it's a tool for thinking about the underlying problem.
• 12:38
  SPEAKER_00: It helps us to organize information, to recognize patterns, and make better decisions for the patients in front of you.
• 12:45
  SPEAKER_00: So the next time you hear the term proctalgial fujax, don't just think of it as a complicated phrase.
• 12:51
  SPEAKER_00: Think of it as a concise clinical story of fleeting rectal pain, diagnosis of exclusion, pattern of recognition driven by that duration or time course.
• 13:02
  SPEAKER_00: And most importantly, a concept that helps you translate symptoms into meaningful clinical reasoning.
• 13:08
  SPEAKER_00: And that is exactly why understanding terminology at this level matters.
• 13:14
  SPEAKER_00: Thank you so much for joining me on this episode of This Is Why with Dr.
• 13:18
  SPEAKER_00: Busai.
• 13:18
  SPEAKER_00: We'll see you next time.