PAROXYSMAL ANAL HYPERKINESIA - A CHARACTERISTIC FEATURE OF PROCTALGIAFUGAX

Background and Aims-Proctalgia fugax is a common problem, yet its path ophysiology is poorly understood. The objective was to characterise co lorectal disturbances in a paraplegic patient with a 10 year history o f proctalgia fugax that began two years after an attack of transverse myelitis. Methods-Standard anorectal manometry and prolonged 33 hour a mbulatory colonic manometry at six sites in the colon were performed t ogether with myoelectrical recording of the anus. Provocative tests de signed to simulate psychological and physical stress and two types of meals were included. Results-Anorectal manometry showed normal interna l sphincter tone and normal rectoanal inhibitory reflex but an inabili ty to squeeze or to bear down or to expel a simulated stool. Rectal se nsation (up to 360 ml inflation) was absent. Pudendal nerve latency wa s prolonged (4.5 ms (normal <2.2 ms). During colonic manometry, the pa tient 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 freq uency (5-50/min) anal myoelectrical activity, particularly after stres s tests, meals, and at night. The myoelectrical disturbance only occur red with proctalgia. Intermittently, 16 bursts of 3 cycles/min phasic rectal contractions were seen, but only six were associated with proct algia. Colonic motility was reduced compared with normal subjects. Con clusions-The temporal association between a high amplitude, high frequ ency myoelectrical activity of the anal sphincter, and the occurrence of proctalgia suggests that paroxysmal hyperkinesis of the anus may ca use proctalgia fugax.