Treatment of Chronic Pelvic Pain Syndrome with Recurrent Episodes of Pain Localised to the Anus or Lower Rectum
This protocol covers the specific presentation in which a patient experiences recurrent, brief episodes of anal or lower rectal pain with no pain between attacks — a pattern that has been present for at least three months.
Clinical Scenario
Recurrent episodes of pain localised to the anus or lower rectum, each lasting from several seconds to minutes, with complete absence of anorectal pain between episodes, present for at least 3 months. This pattern corresponds to primary intermittent chronic anal pain syndrome (proctalgia fugax).
Treatment Approach — Partial Overview
The protocol centres on an inhaled beta-2 adrenergic agonist used at the time of symptomatic episodes. The full regimen, including how and when to use it, is available in the structured protocol below.
Treatment goal: Reduction in duration and severity of anorectal pain episodes.
References
Primary intermittent chronic anal pain syndrome (proctalgia fugax) consists of all the following diagnostic criteria, which should be present for three months: recurrent episodes of pain localised to the anus or lower rectum; episodes last from several seconds to minutes; and there is no anorectal pain between episodes.
Offer inhaled salbutamol in intermittent chronic primary anal pain syndrome.
Inhaled β-2 adrenergic agonist salbutamol was effective in an RCT in patients with frequent symptoms and shortened pain duration.
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