I get rectal muscle spasms like every 20 secs for which if I retract my anal canal and sphincter it get relieved for a few moments. I take Meftal Spas and Nsaids to get rid of this every month. What can be the resons ?
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The pattern sounds most consistent with a pelvic-floor/anal sphincter spasm syndrome, such as proctalgia fugax or levator ani syndrome, but this cannot be diagnosed safely without an anorectal examination.
- Proctalgia fugax causes sudden, intense rectal/anal spasms that may recur in clusters and typically last seconds to minutes, sometimes up to about 30 minutes.
- Levator ani syndrome tends to cause a deeper dull pressure or ache, often triggered by sitting, bowel movements, constipation, or pelvic-floor tightening.
- Your temporary relief when you relax or pull/retract the area may fit a muscle-spasm mechanism, but do not forcefully manipulate or insert anything into the anal canal, as this can irritate tissue or worsen a fissure.
Other causes that should be ruled out include:
- Anal fissure, especially if pain is sharply worse during/after stool, with blood on tissue
- Constipation, straining, incomplete evacuation, or pelvic-floor dyssynergia
- Hemorrhoid thrombosis
- Perianal abscess/fistula, particularly if there is a tender lump, discharge, fever, or constant worsening pain
- Inflammatory bowel disease, infection, prostate/pelvic conditions, or, if symptoms track with periods, endometriosis
Functional rectal pain is diagnosed only after excluding fissure, hemorrhoids, abscess, inflammatory bowel disease, and other structural causes. Yamada's Textbook of Gastroenterology, p. 1504. Proctalgia fugax is described as an abrupt painful rectal spasm; levator ani syndrome is more often prolonged pressure related to pelvic floor contraction. ROSEN's Emergency Medicine, p. 1349.
What to do
- Arrange an appointment with a colorectal surgeon, gastroenterologist, or primary-care clinician. Since this occurs monthly and you are repeatedly self-treating, an exam is warranted. They may check for fissure/hemorrhoids and assess pelvic-floor muscle tenderness.
- Discuss pelvic-floor physiotherapy/biofeedback, especially if you strain, have constipation, or feel incompletely emptied. This is often more useful than repeatedly taking pain medicines for recurrent muscle spasm.
- During an episode, safer measures include a warm sitz bath, slow diaphragmatic breathing, avoiding straining, and keeping stools soft with fluids, dietary fiber, and, if needed, clinician-guided laxative use.
- Do not routinely rely on Meftal-Spas or other NSAIDs every month without medical advice. Meftal-Spas commonly contains mefenamic acid plus an antispasmodic, and recurrent NSAID use can cause gastritis, ulcer/bleeding, kidney injury, and may be unsafe with kidney disease, ulcers, blood thinners, or some other medicines. It may also mask an abscess or other cause needing treatment.
Seek urgent care today if
- fever, swelling, redness, pus, or a painful anal lump
- constant or rapidly escalating pain
- heavy rectal bleeding, black stools, dizziness/fainting
- inability to pass stool or urine
- unexplained weight loss, persistent change in bowel habit, or new symptoms after age 45 to 50.
The NHS anal-pain guidance also flags bleeding, fissure-like pain with bowel movements, and fever/discharge as reasons for clinical assessment.
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