Last week I wrote about proctalgia fugax, a condition that leads to rectal spasms and sharp fleeting pain in the lower rectum or anus, often described as excruciating and agonizing. Proctalgia fugax actually means anal pain of unknown cause but I am seriously questioning this definition because as you’ll see below there are a number of possible root causes!
I have experienced this horrible pain and was not willing to use medications. Instead, because I could find no other solutions, I experimented with sublingual GABA during an episode and then figured out how to prevent a spasm at the first hint of pain. You can read all the details on this blog: How GABA eases agonizing rectal pain and spasms in under 2 minutes
I promised to share part 2 with some root causes and other solutions but this article has grown because of all the wonderful feedback on the above blog. I’ve gathered some of it here as additional resources.
What is the pain like?
Here are some additional descriptions of the pain (sharing here so others can relate and feel comforted that this is not something weird):
- horrible, shooting pain up the lower rectum/spine area
- I have had this issue since I was about 45 (I’m now 60) at least a few times per year. It lasts usually 15 to 30 minutes and is extremely painful.
- I have had this pretty much all my life. More common with my period and the spasm lasts for close to 1/2 hour or so. Very deep aching pain.
- It stops me in my tracks. The pain is so bad sometimes I can’t breathe. It’s scary.
For some people the fear of having a spasm when out and about is extremely traumatic:
It seems no one in the mainstream medical field is concerned about it. It may be physically harmless but I know many people on other forums who live in constant fear of an attack – especially publicly. It is far from psychologically harmless.
I loved all the feedback: pleased to find out there is a name for it and feel comforted to know you’re not alone. Many have been worried and embarrassed to ask for help. And across the board you are all very interested in experimenting with GABA (or theanine or taurine) to see if it helps reduce or eliminate the spasms in the moment.
This GABA approach is a good one because it helps ease the pain and spasms and because stress is a common underlying factor.
Positive feedback about GABA helping
I am pleased to get some positive feedback that GABA is helping:
I used to get these right before my period – hormonally related for me. Interestingly, I have been taking Pharmagaba to help me sleep better and to help me relax…noticed that I haven’t had one of these “butt cramps” as I call them, in months.
And this wonderful result from someone else:
There were times I literally had to sleep in the tub for 5 hours at a time and keep refilling it hot water. Most excruciating pain I’ve ever had and I’ve birthed a child naturally! I’m taking GABA for other reasons and after reading this (facebook post), I realize I haven’t had this since!
Concerns about using GABA
A few of you had concerns about using GABA – for example: GABA causes palpitations for me but I will seriously consider trying it.
I wouldn’t use GABA if it causes palpitations or I would at least experiment with super small amounts. I mentioned I’ve used up to 500mg – for many people this is too much and even 100mg may help. Taurine may be an option too. If you can’t tolerate GABA or taurine the next section covers some other options and how to address some of the possible root causes.
And someone shared that when she took GABA in the past for anxiety it really seemed to make her more anxious:
Since I did not have the expected result for anxiety, I wonder if it would not be the best choice for me in this situation either . . . I would like to use something which works quickly, so the sublingual option would have been appealing. I have used l-theanine with good results (for anxiety) and have never tried taurine before.
I would not recommend GABA for someone who gets more anxious with it. When something does work, like theanine, I’d go with that approach. Or I would consider a very small dose of GABA and build up slowly.
There are some common patterns
When looking at common patterns many who responded on the GABA blog:
- Have had a hysterectomy, vaginal prolapsing and/or abdominal surgeries like repair of a large umbilical hernia (but not everyone)
- Have IBS and digestive issues, as well as food sensitivities
- Identify with stress being a factor and relate to feeling “irritable, perfectionistic, meticulous, obsessional, tense, and anxious.” As I mentioned above, GABA addresses the spasms and also relieves some of the stress and tension. And by addressing low serotonin with tryptophan this eases the worry, irritability and perfectionism
- Observe spasms during ovulation and/or when menstruating. GABA and tryptophan help with hormone balancing too
Medications for relief
Many find relief with medications but side-effects always need to be considered and it makes the most sense to get to the root causes and address them. Here are some mentioned:
- Benzodiazepines: I would dissolve a tab under my tongue and it would help the pain within a few minutes. As I would expect benzodiazepines to help but open up another whole can of worms – with tolerance (and needing higher doses), addiction and withdrawal).
- Naproxen (an NSAID) has side-effects as does a medication like Cyclobenzaprine (a muscle relaxer)
Addressing tight pelvic floor muscles and stress
We always want to get to the root causes of an issue and that is the most logical step. I reached out to the practitioners in my community to ask them how they help their clients and patients with this and what approaches they have used to end the spasm and pain. My colleague, Jessica Drummond, nutritionist and physical therapist, and an expert on female pelvic pain and women’s health, shares this advice:
For women with proctalgia fugax, the acute rectal spasm can come at any time unexpectedly. Usually, this is a sign that your pelvic floor muscles are tight and need to be relaxed. Avoid doing Kegel exercises, and see a physical therapist who is a pelvic floor specialist in order to release the muscles of your pelvic floor.
Additionally, it’s important to be sure that you’re finding time each day to fully relax, breathe deeply, and receive support from your family or friends. Often women with pelvic floor muscle spasm feel stressed or a lack of safety in their lives and bodies. So, working with a skilled professional to address your stress is key.
Lorraine shared these wonderful results with her pelvic floor therapy (on the GABA blog) and how much it’s been helping her:
Anxiety or stressful times was a huge trigger (I am still pretty type A) and I finally learned one reason among many that stress triggers it. My naturopathic doctor sent me to see the ‘guru’ in pelvic floor therapy–Caroline Allen in Ottawa. I suffered for years with anxiety and did not realize that I was still constantly holding my tummy in as an old habit to stress even now that I have overcome my anxiety disorder. She taught me how to relax the core which was a challenge at first and required much conscious thought–those muscles had many years of training to stay tight. I was also breathing incorrectly and she showed me that when our breathing is incorrect, our diaphragm is tight and then it pulls up and tightens the entire pelvic floor. I can often prevent or significantly decrease the severity of an attack by reminding myself to relax certain key muscles and breathing into the pelvic floor.
Gluten sensitivity, other food sensitivities and functional imbalances
Jessica also shares what can worsen pelvic floor function:
You may have nutrient deficiencies or [gluten or other] food sensitivities that can worsen your pelvic floor muscle function. And, if you have IBS or constipation that should be addressed by a nutrition professional who specializes in digestive or pelvic health.
Here is some of the feedback I received on the GABA blog, observing links to gluten sensitivity, other food sensitivities and functional imbalances:
- Gluten sensitivity
- I found that once I eliminated gluten from my diet, this almost eliminated the problem.
- Other food sensitivities – keeping a food-stress-spasm log will help you figure this out
- We have found a sensitivity to corn, coconut, and nightshades and eating these brings on an attack. I suspect gluten as well but don’t always get an attack the way corn will
- Food too high in phytic acid is a huge trigger for me…I avoid nuts like the plague
- I do have gluten intolerance, and have been gluten free since 2009. I also stay away from dairy, all grains, and eggs. Recently I went off of all nightshades and on a lectin free diet. I haven’t seen any difference yet, and it has been over a month, but then again I haven’t had a spasm lately either. Not sure if that is a coincidence or not.
- I have discovered that the following foods bring it on the next day: gluten, onions, citrus, especially orange juice, and black tea. Staying away from these foods has made a huge difference, but I still get episodes, which makes me think there’s another trigger I haven’t discovered
- Any functional imbalance
- I’ve recently been seeing a new naturopathic doctor who addressed SIBO, hormone imbalance as well as a stubborn parasite. My attacks most often occurred in correlation with constipation, digestive upset and ovulation pain (I had low zinc and low progesterone). Addressing all three factors has helped.
Other possible factors that should be considered: low magnesium, low potassium, low serotonin, low vitamin D, low zinc and dehydration, and look at drug-induced nutrient depletions from the BCP, fluroquinolones and proton pump inhibitors.
Jessica provides a comprehensive overview in this article: Physical Therapy and Nutrition: A Powerful Combination To Heal Pelvic Pain. It’s written for health professionals but is an excellent overview for anyone.
Some other possible solutions
I received so much wonderful feedback on the GABA blog that I’ve gathered these other possible solutions into a list:
- Skullcap and valerian for mild symptoms
- Designs for Health Gastromend, a product that is healing for entire GI tract helps in 15 minutes. Drinking Aloe juice may be helping
- Sitting on the toilet and pushing down like with a bowel movement [this doesn’t feel good when I do it] or sitting on my foot to apply upward pressure before the spasm gets to deep will generally shorten the duration. I have found that stretching and holding the stretch for a few minutes will ease the intensity and duration of the spasm.
- Nothing seems to help me except for a really hot heating pad. It usually takes about 20 minutes or a little longer for the spasms to go away
Squats, reflexology and downward dog for immediate relief
I also received these solutions that provide immediate relief while you’re figuring out and addressing the bigger root causes:
- My gastroenterogist recommended going into a deep squat when the spasm starts. I tried and it worked!
- I rub the inner ankle area (above the bone) in an upward motion – both sides. I rub as hard as I can. It takes a few minutes of rubbing but the pain reduces almost immediately. I went to a foot reflexologist and she said that this area relates to the rectum. [I found this reflexology chart and assume you rub the area marked “Rectum and Anus”]
- Downward dog yoga pose
I appreciate all the wonderful feedback on the GABA blog and the opportunity to share this so more of us get answers more quickly! Too often we think it’s just us but I encourage seeking solutions no matter what weird quirks we think we have!
I have one more article to share on the topic so stay tuned for part 3 with an exercise that strengthens the pelvic area and reverses rectal spasms.
Feel free to share what’s worked for you, what your possible triggers are and if GABA or any of these approaches resonate with you.
Sitting in a tub filled a few inches with really hot water provides immediate relief for me. I’ve tried using a hot washcloth or a warm water splash but nothing works except the immersion by sitting in hot water. Fortunately (or not as it has disrupted my sleep on many nights) my occasional attacks wake me in the middle of the night so that I am able to use this never-fail remedy. Has this worked for others? Could the correct remedy for this pain vary according to the cause?
Also I do know that brewed coffee that contains remnants of the coffee grounds is a trigger for me so I avoid that.
Good to know about GABA to try in case this ever happens in public or while on the road.
Kat
Thanks for sharing and yes there are varied root causes and solutions.
It’s good to avoid those triggers
Hi. What would be recommended for us here in the Uk as GABA isn’t available here.
Linda
I have had success with taurine too. Theanine may be an option too.
I also experience this and I think it is related to my period.
I place something warm on my pelvic area and it really helps, in a few minutes I start to feel much better. I boil water in a pan and place the pan on a towel on my pelvic area. If Im not home I use a glass with hot water but it takes more time.
Emma
Thanks for sharing. Period issues can be due to low progesterone and hence low GABA so addressing the root cause is always important. Having GABA on hand helps many of my clients who are not at home and out and about
My daughter is 13 years old and has a genetic disorder suffers from severe rectal spasms. I want to try the GABA for my daughter. Any suggestions on which ones to use. Should I use it daily? She gets the episodes Atleast twice a month.
Thank you!!
Suma
I’m sorry to hear. I find that if GABA levels are sufficient then they don’t occur so initially using GABA based on other symptoms (such as physical anxiety or tension, pain, insomnia) and doing a trial works well. And then using GABA in the midst of a spasm or when the person feels one coming on. For both I use a GABA only product opened or a powdered GABA. Here are some products I use https://www.everywomanover29.com/blog/amino-acids-pyroluria-supplements/
Thank you for the article. I find dehydration is the main culprit. It can be triggered by stress and other factors but, drinking a glass or two of water immediately and passing a bowel movement works for me.
Chris
Thanks for sharing what works for you!
I have been recommending various exercises to relax the psoas muscle and pelvic floor muscles to my client to help with this issue, which definitely help in the long run. However, it’s great to have something like the GABA which works faster. I’ve had a client who has been suffering form rectal spasm for a few months and was experiencing a flare up recently (probably due to eating gluten around Christmas). She tried the GABA and said it worked very quickly for her. I’m so happy to have a new tool in my box to deal with this!
Genevieve
Thanks for sharing your client’s success with GABA and glad you have a new tool for this! It’s so effective and so quick!
And yes that gluten can lead to leaky gut, affect the microbiome and contribute nutritional deficiencies all causing low GABA levels.
May I ask how much helped your client and how quickly she saw results? Did the GABA also help with other signs of low GABA – physical anxiety, stress eating or drinking alcohol to relax, other pain or stiff/tense muscles and sleep issues?
A gastroenterologist advised me to get an asthma puffer (Ventolin) and take a few breaths at the first sign of pain. Apparently the pelvic floor muscles relax with Ventolin. He said it was discovered by accident when someone had an asthma attack while suffering Proctalgia fugax.
I’ve had proctalgia fugax since my 20’s and still get the spasms occasionally at 58. I ate a LOT of breads back then and have cut way back so maybe that’s the culprit. I discovered downward dog when I connected that it feels like a cramp in my rectum. When I get a cramp in my foot or leg, I stretch that area so downward dog made sense and it works! Every time!
I have had this for years. Used yo be a quick stabbing pain that jast hamf a second. Has gotten worse and lasts a out 15 mins since 45. Tons of stress , dehydration and low potassium seems to impact. Eating lots of potassium , had attack that was much more mild in pain level. Drink V8 juice everyday. Drink water.
This is a welcomed blog for a totally embarrassing problem. Do you know if sitting on a too hard chair can also trigger it? Likewise, do you think the spasm can hurt the lower spine? I had a really bad spasm at the beginning of quarantine–usually I just get busy and exercise and shake it off. But I feel like I worried about it too much and now the stress and tension has graduated from the pelvic floor into my lower back. How do you get that tension out of your body? Thank you.
C
It’s possible that inactivity and sitting too long may have an impact, as can stress and tension. Muscle spasms in one area can trigger spasms elsewhere. I use GABA and the other approaches mentioned in this blog
thank you for the follow up–you mentioned sublingual GABA, do you have a brand you can recommend? great blog thank you
Could vaginismus also be connected to rectal spasms and tightening of the whole pelvic floor?
Marilyn
Yes absolutely and it’s worth considering everything mentioned in this blog.
Thank you so much for all the information. I have suffered with levator ani spasms/ cramps (horrific) since 2011 – just a few months after coccyx injury which has never healed. I used to get the spasms just every few months, but now I get about 4 episodes each month. They are the most excruciating, agnonizing, unbearable pain – mine goes from no pain to 10/10 pain in seconds – completely debilitating. I need ice and a hot water bottle & my tablets – usually I just fall to the floor (hands and knees) and grit my teeth and try to breathe to get through it. It is like one constant unbearable labour contraction – with no reprieve – it just goes on and on and on – relentless until it finally eases. Sometimes they are just a few minutes long, but often mine are 20 – 30 mins and my worst ever was 90 minutes of pure agony. I could hardly breathe during the one I had last week – it was terrifying. I rarely go out, but when I do I take my pills & an ice pack & a hot water bottle & some CBD oil. Mine happen day or night & have woken me from sleep. The tablets I usually use are Buscopan Cramps 10mg x 2 & Extra Anadin x 2 immediately on pain starting. I think they help after about 25 – 30 minutes but it’s too long to wait for relief. I have used codeine 30mg as well. And amitriptyline 10mg. I need something which acts quicker. I have ordered the GABA to try – I really hope it will help me. I am so scared of this happening so often. I have been seeing a pelvic floor therapist, and some yoga positions sometimes help – one is deep squat with feet flat. Another is ‘happy baby’ yoga pose – lay on back with legs in air and hands holding ankles. Basically I get in all sorts of positions trying to find a way out of the intense pain. (I would also advise to avoid doing Kegels to tighten pelvic floor – this causes me to have spasm.) I wish everybody here good luck in finding relief from this horrible condition.
Jacquetta
Thanks for sharing what has worked for you. Love the ‘happy baby’ yoga pose! How quickly does that help? Keep us posted on the GABA and how it works.
Interesting to hear the coccyx injury connection. I broke my coxxyx many years ago. I wonder how common this is in folks with this issue.
Thank you so much for this blog. I have had this for many years now and have tried to figure out what it was but never knew what to search for. I had an episode last night and decided to search anal muscle spasm this morning and your blog came up. I think I’ve only ever searched for anal pain and never came up with anything that sounded like what I was experiencing. It’s embarrassing to talk about so I’ve never talked to anyone about it. Are the lozenges what are recommended to take during an episode? Or are they more for maintenance to be taken daily?
Leigh
You are welcome and I can relate as I felt the same way! There is no one-size fits all – some folks do well with GABA Calm sublinguals and some with a GABA only product (product examples here https://www.everywomanover29.com/blog/amino-acids-pyroluria-supplements/) and some folks take it as needed or ongoing to get levels up for prevention. I’m in favor of the latter.
If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/store/aafsbook.html
Please do keep us posted on how it goes
Hello and thank you to everyone for their stories related to rectal spasms. I have a bit of a crazy story of my own. I started getting these types of spasms back in the early 90s however I managed them as best as possible. I may get them once or twice a year, however I had one in February of 2017 and not only did I pass out from the pain, I actually had a detached retinal (eye) and became blind for 3 months due to the nature and severity of the pain of that spasm.
I have the standard supplies (all mentioned within the blog) on my night stand for those moments in the middle of the night when I feel something coming on or in the midst of one. The various solutions that people have provided are wonderful and the GABA information is fantastic news given the anxiety associated with my history and the possibility of it to reoccur again! I have since bought some of the GABA is at my bed side if I need it in the future. I can’t thank you enough for the insight.
John
Gosh sorry to hear and glad to hear you now have GABA on hand. Keep us posted and do consider addressing low GABA before it happens if the anxiety is the low GABA type of physical anxiety.
If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/store/aafsbook.html
Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.
Hello I am so happy to have found this. When I mentioned to my doctor this pain that appears during the sleep from time to time in the rectum, that is so strong and wakes me up it did not seem to ring any bell. I had a collonoscopy as I have genetic factors in this area and was diagnosed with irritable bowel syndrome. But this pain came back last night and so I stumbled upon this. I will most definately try GABA. And am so happy to have found an explanation about this. Thanks so much for sharing this!