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Giuseppe Chiarioni - One of the best experts on this subject based on the ideXlab platform.
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Proctalgia Syndromes: Update in Diagnosis and Management
Current Gastroenterology Reports, 2020Co-Authors: Emma Victoria Carrington, Stefan-lucian Popa, Giuseppe ChiarioniAbstract:Purpose of Review Functional anorectal pain syndromes are a neglected yet often disabling clinical entity resulting in significant economic and psychological burden to the patient. The aim of this review is to update the practicing gastroenterologist/coloproctologist on the diagnosis and management of these complicated disorders. Recent Findings The updated Rome foundation diagnostic criteria (Rome IV) for functional anorectal pain subgroups chronic Proctalgia (levator ani syndrome and unspecified functional anorectal pain) and acute Proctalgia (Proctalgia Fugax) on the basis of symptom duration and digital rectal examination findings. Chronic Proctalgia is thought to be secondary to paradoxical pelvic floor contraction in many patients and biofeedback to improve the defecation effort has proven effective for over 90% in the short term. Unfortunately, management of Proctalgia Fugax remains challenging and treatment outcomes modest at best. Summary A number of therapies to relax the pelvic floor may be employed to improve symptoms in functional anorectal pain syndromes; however, only biofeedback to improve defaecatory dynamics in patients with levator ani syndrome has proven effectiveness in a randomized setting. Further investigation of treatment approaches in Proctalgia Fugax is required.
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Proctalgia Syndromes: Update in Diagnosis and Management
Current gastroenterology reports, 2020Co-Authors: Emma Victoria Carrington, Stefan-lucian Popa, Giuseppe ChiarioniAbstract:Functional anorectal pain syndromes are a neglected yet often disabling clinical entity resulting in significant economic and psychological burden to the patient. The aim of this review is to update the practicing gastroenterologist/coloproctologist on the diagnosis and management of these complicated disorders. The updated Rome foundation diagnostic criteria (Rome IV) for functional anorectal pain subgroups chronic Proctalgia (levator ani syndrome and unspecified functional anorectal pain) and acute Proctalgia (Proctalgia Fugax) on the basis of symptom duration and digital rectal examination findings. Chronic Proctalgia is thought to be secondary to paradoxical pelvic floor contraction in many patients and biofeedback to improve the defecation effort has proven effective for over 90% in the short term. Unfortunately, management of Proctalgia Fugax remains challenging and treatment outcomes modest at best. A number of therapies to relax the pelvic floor may be employed to improve symptoms in functional anorectal pain syndromes; however, only biofeedback to improve defaecatory dynamics in patients with levator ani syndrome has proven effectiveness in a randomized setting. Further investigation of treatment approaches in Proctalgia Fugax is required.
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Proctalgia and Other Anorectal Pain Syndromes
Anorectal Disorders, 2019Co-Authors: Giuseppe Chiarioni, Francesca CarestiatoAbstract:Abstract This chapter addresses the pathophysiology, diagnostic evaluation, and treatment of pelvic-pain syndromes: chronic Proctalgia (CP), Proctalgia Fugax, coccygodynia, and pudendal neuralgia. Chronic or recurrent pain in the anorectal area is a prevalent disorder affecting approximately 7% of the population and it is associated with impaired quality of life and a high economic burden. These pain syndromes are poorly understood with little evidence available to guide their diagnosis and treatment. However, a recently published randomized, controlled trial comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of CP has shown success rates of 85% for biofeedback when patients are selected based on evidence of tenderness of the levator ani muscle and outlet dysfunction, both of which are suggestive of striated muscle tension. Overly tense pelvic-floor muscles appear to be common to most of the pelvic pain syndromes, therefore similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic-pain disorders.
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Functional Anorectal Disorders.
Gastroenterology, 2016Co-Authors: Satish Sc Rao, Giuseppe Chiarioni, Adil E. Bharucha, Richelle Felt-bersma, Charles Knowles, Allison Malcolm, Arnold WaldAbstract:This report defines criteria and reviews the epidemiology, pathophysiology, and management of common anorectal disorders: fecal incontinence (FI), functional anorectal pain and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into three subtypes. In Proctalgia Fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome (LAS) and unspecified anorectal pain the pain lasts more than 30 minutes, but in LAS there is puborectalis tenderness. Functional defecation disorders are defined by >2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with >2 features of impaired evacuation i.e., abnormal evacuation pattern on manometry, abnormal balloon expulsion test or impaired rectal evacuation by imaging. It includes two subtypes; dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating LAS and defecatory disorders.
Satish Sc Rao - One of the best experts on this subject based on the ideXlab platform.
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Functional Anorectal Disorders.
Gastroenterology, 2016Co-Authors: Satish Sc Rao, Giuseppe Chiarioni, Adil E. Bharucha, Richelle Felt-bersma, Charles Knowles, Allison Malcolm, Arnold WaldAbstract:This report defines criteria and reviews the epidemiology, pathophysiology, and management of common anorectal disorders: fecal incontinence (FI), functional anorectal pain and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into three subtypes. In Proctalgia Fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome (LAS) and unspecified anorectal pain the pain lasts more than 30 minutes, but in LAS there is puborectalis tenderness. Functional defecation disorders are defined by >2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with >2 features of impaired evacuation i.e., abnormal evacuation pattern on manometry, abnormal balloon expulsion test or impaired rectal evacuation by imaging. It includes two subtypes; dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating LAS and defecatory disorders.
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Functional Anorectal Disorders
Gastroenterology, 2006Co-Authors: Adil E. Bharucha, Arnold Wald, P Enck, Satish Sc RaoAbstract:This report defines criteria for diagnosing functional anorectal disorders (ie, fecal incontinence, anorectal pain, and disorders of defecation). Functional fecal incontinence is defined as the uncontrolled passage of fecal material recurring for ≥3 months in an individual with a developmental age of ≥4 years that is associated with: (1) abnormal functioning of normally innervated and structurally intact muscles, and/or (2) no or minor abnormalities of sphincter structure and/or innervation insufficient to explain fecal incontinence, and/or (3) normal or disordered bowel habits (ie, fecal retention or diarrhea), and/or (4) psychological causes. However, conditions wherein structural and/or neurogenic abnormalities explain the symptom, or are part of a generalized process (eg, diabetic neuropathy) are not included within functional fecal incontinence. Functional fecal incontinence is a common, but underrecognized symptom, which is equally prevalent in men and women, and can often cause considerable distress. The clinical features are useful for guiding diagnostic testing and therapy. Functional anorectal pain syndromes include Proctalgia Fugax (fleeting pain) and chronic Proctalgia; chronic Proctalgia may be subdivided into levator ani syndrome and unspecified anorectal pain, which are defined by arbitrary clinical criteria. Functional defecation disorders are characterized by 2 or more symptoms of constipation, with ≥2 of the following features during defecation: impaired evacuation, inappropriate contraction of the pelvic floor muscles, and inadequate propulsive forces. Functional disorders of defecation may be amenable to pelvic floor retraining by biofeedback therapy (such as dyssynergic defecation).
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functional disorders of the anus and rectum
Gut, 1999Co-Authors: William E. Whitehead, Abigail I Wald, N E Diamant, P Enck, John H Pemberton, Satish Sc RaoAbstract:In this report the functional anorectal disorders, the etiology of which is currently unknown or related to the abnormal functioning of normally innervated and structurally intact muscles, are discussed. These disorders include functional fecal incontinence, functional anorectal pain, including levator ani syndrome and Proctalgia Fugax, and pelvic floor dyssynergia. The epidemiology of each disorder is defined and discussed, their pathophysiology is summarized and diagnostic approaches and treatment are suggested. Some suggestions for the direction of future research on these disorders are also given.
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Paroxysmal anal hyperkinesis: a characteristic feature of Proctalgia Fugax.
Gut, 1996Co-Authors: Satish Sc Rao, R. A. HatfieldAbstract: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 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.
Arnold Wald - One of the best experts on this subject based on the ideXlab platform.
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functional anorectal pain tenesmus
2018Co-Authors: Arnold WaldAbstract:There are many causes of anorectal pain. This section will focus on three patients in whom chronic or recurrent anorectal pain occurs in the absence of a biologic disease marker. Chronic anorectal pain disorders, Proctalgia Fugax, and idiopathic tenesmus are all categorized as functional pain disorders and can greatly impair quality of life.
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Functional Anorectal Pain/Tenesmus
Gastrointestinal Motility Disorders, 2017Co-Authors: Arnold WaldAbstract:There are many causes of anorectal pain. This section will focus on three patients in whom chronic or recurrent anorectal pain occurs in the absence of a biologic disease marker. Chronic anorectal pain disorders, Proctalgia Fugax, and idiopathic tenesmus are all categorized as functional pain disorders and can greatly impair quality of life.
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Functional Anorectal Disorders.
Gastroenterology, 2016Co-Authors: Satish Sc Rao, Giuseppe Chiarioni, Adil E. Bharucha, Richelle Felt-bersma, Charles Knowles, Allison Malcolm, Arnold WaldAbstract:This report defines criteria and reviews the epidemiology, pathophysiology, and management of common anorectal disorders: fecal incontinence (FI), functional anorectal pain and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into three subtypes. In Proctalgia Fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome (LAS) and unspecified anorectal pain the pain lasts more than 30 minutes, but in LAS there is puborectalis tenderness. Functional defecation disorders are defined by >2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with >2 features of impaired evacuation i.e., abnormal evacuation pattern on manometry, abnormal balloon expulsion test or impaired rectal evacuation by imaging. It includes two subtypes; dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating LAS and defecatory disorders.
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Functional Anorectal Disorders
Gastroenterology, 2006Co-Authors: Adil E. Bharucha, Arnold Wald, P Enck, Satish Sc RaoAbstract:This report defines criteria for diagnosing functional anorectal disorders (ie, fecal incontinence, anorectal pain, and disorders of defecation). Functional fecal incontinence is defined as the uncontrolled passage of fecal material recurring for ≥3 months in an individual with a developmental age of ≥4 years that is associated with: (1) abnormal functioning of normally innervated and structurally intact muscles, and/or (2) no or minor abnormalities of sphincter structure and/or innervation insufficient to explain fecal incontinence, and/or (3) normal or disordered bowel habits (ie, fecal retention or diarrhea), and/or (4) psychological causes. However, conditions wherein structural and/or neurogenic abnormalities explain the symptom, or are part of a generalized process (eg, diabetic neuropathy) are not included within functional fecal incontinence. Functional fecal incontinence is a common, but underrecognized symptom, which is equally prevalent in men and women, and can often cause considerable distress. The clinical features are useful for guiding diagnostic testing and therapy. Functional anorectal pain syndromes include Proctalgia Fugax (fleeting pain) and chronic Proctalgia; chronic Proctalgia may be subdivided into levator ani syndrome and unspecified anorectal pain, which are defined by arbitrary clinical criteria. Functional defecation disorders are characterized by 2 or more symptoms of constipation, with ≥2 of the following features during defecation: impaired evacuation, inappropriate contraction of the pelvic floor muscles, and inadequate propulsive forces. Functional disorders of defecation may be amenable to pelvic floor retraining by biofeedback therapy (such as dyssynergic defecation).
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Functional anorectal and pelvic pain.
Gastroenterology clinics of North America, 2001Co-Authors: Arnold WaldAbstract:Anorectal pain (Proctalgia) has been described in association with a variety of organic conditions but also occurs under circumstances in which organic disorders are absent and the pathophysiology is uncertain. The two most common functional disorders are levator ani syndrome and Proctalgia Fugax. These disorders are distinguished clinically on the basis of duration of painful episodes, frequency, and characteristics. Levator ani syndrome must be distinguished from other disorders of chronic anorectal rectal pain, such as coccygodynia, rare genetic syndromes of familial rectal pain, tumors of the pelvis or cauda equina, endometriosis, and other gynecologic causes of chronic pain. The literature concerning this area has been mostly descriptive and anecdotal, and therapeutic modalities have not been examined rigorously. This is a group of disorders in which patients often are disabled, and many physicians possess little information concerning evaluation and management of these patients.
Emma Victoria Carrington - One of the best experts on this subject based on the ideXlab platform.
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Proctalgia Syndromes: Update in Diagnosis and Management
Current Gastroenterology Reports, 2020Co-Authors: Emma Victoria Carrington, Stefan-lucian Popa, Giuseppe ChiarioniAbstract:Purpose of Review Functional anorectal pain syndromes are a neglected yet often disabling clinical entity resulting in significant economic and psychological burden to the patient. The aim of this review is to update the practicing gastroenterologist/coloproctologist on the diagnosis and management of these complicated disorders. Recent Findings The updated Rome foundation diagnostic criteria (Rome IV) for functional anorectal pain subgroups chronic Proctalgia (levator ani syndrome and unspecified functional anorectal pain) and acute Proctalgia (Proctalgia Fugax) on the basis of symptom duration and digital rectal examination findings. Chronic Proctalgia is thought to be secondary to paradoxical pelvic floor contraction in many patients and biofeedback to improve the defecation effort has proven effective for over 90% in the short term. Unfortunately, management of Proctalgia Fugax remains challenging and treatment outcomes modest at best. Summary A number of therapies to relax the pelvic floor may be employed to improve symptoms in functional anorectal pain syndromes; however, only biofeedback to improve defaecatory dynamics in patients with levator ani syndrome has proven effectiveness in a randomized setting. Further investigation of treatment approaches in Proctalgia Fugax is required.
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Proctalgia Syndromes: Update in Diagnosis and Management
Current gastroenterology reports, 2020Co-Authors: Emma Victoria Carrington, Stefan-lucian Popa, Giuseppe ChiarioniAbstract:Functional anorectal pain syndromes are a neglected yet often disabling clinical entity resulting in significant economic and psychological burden to the patient. The aim of this review is to update the practicing gastroenterologist/coloproctologist on the diagnosis and management of these complicated disorders. The updated Rome foundation diagnostic criteria (Rome IV) for functional anorectal pain subgroups chronic Proctalgia (levator ani syndrome and unspecified functional anorectal pain) and acute Proctalgia (Proctalgia Fugax) on the basis of symptom duration and digital rectal examination findings. Chronic Proctalgia is thought to be secondary to paradoxical pelvic floor contraction in many patients and biofeedback to improve the defecation effort has proven effective for over 90% in the short term. Unfortunately, management of Proctalgia Fugax remains challenging and treatment outcomes modest at best. A number of therapies to relax the pelvic floor may be employed to improve symptoms in functional anorectal pain syndromes; however, only biofeedback to improve defaecatory dynamics in patients with levator ani syndrome has proven effectiveness in a randomized setting. Further investigation of treatment approaches in Proctalgia Fugax is required.
Patrick Atienza - One of the best experts on this subject based on the ideXlab platform.
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Proctalgia Fugax: Demographic and Clinical Characteristics. What Every Doctor Should Know from a Prospective Study of 54 Patients
Diseases of the Colon & Rectum, 2007Co-Authors: Vincent Parades, Isabelle Etienney, Pierre Bauer, Milad Taouk, Patrick AtienzaAbstract:Purpose This prospective study was designed to describe a typical attack of Proctalgia Fugax. Methods Patients were recruited from May 2003 to June 2004. Whatever the reason for consultation, they were systematically asked: “Do you ever suffer intermittent and recurring anorectal pain lasting for at least three seconds?” If the answer was yes, they were interviewed with a questionnaire and had a proctologic examination. The criterion for Proctalgia Fugax was a positive answer with a negative examination. Results The study included 1,809 patients. Fifty-four of these patients (3 percent) had Proctalgia Fugax and 83 percent of them had never sought medical advice for this problem. The mean age was 51 (range, 18–87) years. Thirty-seven patients were females (69 percent). The onset of pain was sudden and without a trigger factor in 85 percent of cases. Attacks occurred in the daytime (33 percent) as well as at night (35 percent). The pain was described as cramping, spasm-like, or stabbing in 76 percent of cases. It did not radiate in 93 percent of cases. There were no concomitant symptoms in 81 percent of cases. Attacks stopped spontaneously in 67 percent of cases. The average duration was 15 minutes (range, 5 seconds to 90 minutes). The average annual number of attacks was 13 (range, 1–180). Conclusions Proctalgia Fugax affects twice as many females as males at approximately aged 50 years. Commonly the roughly once-monthly attack occurs as a sudden pain with no trigger factor, diurnally as often as nocturnally. The nonradiating cramp, spasm, or stabbing pain, without concomitant symptoms, is most severe on average after 15 minutes and declines spontaneously.
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Proctalgia Fugax: Demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients
Diseases of the colon and rectum, 2007Co-Authors: Vincent Parades, Isabelle Etienney, Pierre Bauer, Milad Taouk, Patrick AtienzaAbstract:Purpose:This prospective study was designed to describe a typical attack of Proctalgia Fugax.Methods:Patients were recruited from May 2003 to June 2004. Whatever the reason for consultation, they were systematically asked: “Do you ever suffer intermittent and recurring anorectal pain lasting for at