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How to address rectal spasms with GABA, pelvic floor work, gluten removal and squats

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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:

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:

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.

How GABA eases agonizing rectal pain and spasms in under 2 minutes

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Proctalgia fugax is described as a condition that leads to rectal spasms and sharp fleeting pain in the lower rectum or anus. In some people it can be more than fleeting and is often described as excruciating and agonizing.  

This paper describing proctalgia fugax shares how this pain can

recur over weeks, is localized to the anus or lower rectum, and can last from seconds to several minutes with no pain between episodes. There is no diurnal variation. There are numerous precipitants [preceding factors] including sexual activity, stress, constipation, defecation and menstruation, although the condition can occur without a trigger.

Although the cause of proctalgia fugax is unclear, spasm of the anal sphincter is commonly implicated. The condition may be more likely to occur after sclerotherapy for hemorrhoids and vaginal hysterectomy. There are also associations with other functional pathologies, such as irritable bowel syndrome and anxiety.

My story

I have experienced this awful anal sphincter spasm and pain myself so I want to shine some light on this condition and offer the simplest and most effective solution: oral and sublingual GABA. It works to completely eliminate the pain in 1-2 minutes! And it can also be used to prevent a full-on spasm if you catch it in advance. More about this below.

Let me first share my story so you can relate to the pain. I started to experience this a few years ago. It was right after my aunt died from rectal cancer and my immediate thought was that I was dying of cancer. That’s how bad the pain was. It’s like nothing I’ve ever experienced and I’ve had some pretty bad pain experiences: shingles, a tick bite headache, ice-pick headaches from a neck injury and poking my eye on a tree-branch while hiking.

For me, since it initially used to happen during the night, it felt like I was in bad dream and was lying somewhere injured and in agony. I would half wake-up moaning in pain, not quite grasping how the pain I was feeling could be so bad. Then I would come fully awake and feel the need to bear down (as in needing to have a bowel movement) but this would actually make it worse.

How do others describe the pain?

When I shared this paper on facebook one woman said her rectal pain and spasms last 20-30 minutes and is bad a childbirth.

Someone else shared that her husband “complained of feeling like a knitting needle was being driven through his anus.”

What do I think my triggers are?

I have not had sclerotherapy for hemorrhoids or a vaginal hysterectomy. I do have a history of anxiety and panic attacks (in my late 30s) and do have IBS/SIBO right now and I suspect that both low GABA and IBS/SIBO are my biggest root causes. I no longer have any anxiety but since I respond so well to GABA I assume my GABA levels are not optimal (likely due to the SIBO). I suspect exposure to hidden sources of gluten could also be a factor, and this could also affect my GABA levels.

Medications or heating pads as a solution?

I didn’t ever consider the conventional approaches which include: botox, benzodiazepines, SSRIs, Gabapentin, lidocaine, oral diltiazem, topical glyceryl nitrate, nerve blocks or salbutamol.

A warm bath has been reported to help but I was looking for a 1-2 minute fix (and less if possible). Once you’ve experienced this pain you’ll understand that you not imagine running a bath in the midst of a spasm and waiting to get in it.

Heating pads do also work but can take 20 minutes to take effect and that is simply too long for most people.

The first solution for in-the-moment relief (takes 2 to 12 minutes)

After the first episode I started searching online and because I didn’t know it was called proctalgia fugax I searched for “rectal cramp”, “rectal spasm”, “anal cramp” and came across forums with hundreds of women asking about it and describing their pain.

But no-one really had a solution and many had seen their doctors without much success. The best solution that many people use is 30-60 seconds of finger pressure (with the finger wrapped in toilet paper) in the anal sphincter during a spasm. Sometimes this is needed for up to 2-3 mins and sometimes doing this 2 or 3 times a few minutes apart is needed. Think about how you put pressure on a calf muscle spasm to stop the cramps. This works well but the agony can last for the entire 2 to 12 minutes (depending on how many times it has to be done).  Adding a small amount of arnica cream onto the toilet paper seems to helps too.  

How common is it?

It took more searching and reading and then I discovered what it was called. Once I found a name for it and started looking into I was surprised to see how common it is:

The prevalence of proctalgia fugax in the general population may be as high as 8%–18%. Many patients present to primary health care physicians and often do not require further consultation because the symptoms are fleeting. This condition is more common among women than among men, and usually affects patients between 30 and 60 years of age.

Although it’s more common among women I worked with a male client who experienced this. During one of his episodes, the pain was SO bad he actually passed out and hit his head on the bathroom floor.

The best solution for almost-immediate relief (takes 1 minute)

I know that GABA works amazing well for physical anxiety and stiff and tense muscles and I decided to try GABA in the midst of a spasm. It worked amazingly well and within 1 minute the terrible pain started to ease. It does need to be taken sublingually and I have found that 250mg to 500mg opened onto my tongue works best for me.

Each person would need to find the ideal amount for their needs but at night this should be a reasonable amount. During the day this could be too much and make you sleepy or too relaxed.

I’ve also used a combination of sublingual GABA and theanine with similar results.

I know GABA isn’t readily available everywhere so I did an experiment with taurine and found I needed more (at least 1000 mg) and it did take longer (2-3 minutes) to get relief, but it did work.

THE immediate solution for preventing the spasm

But I have now gotten to the point where I can nip it in the bud and prevent the spasm altogether – by taking sublingual GABA at the very first hint of an ache or twinge. I’ve been fortunate that when this does happen (about once a month and sometimes every 2 months) it’s around 8-11pm.

The long-term solutions for getting to the root cause/s?

We always want to get to the root cause of an issue and that is the next 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. I will be sharing some of their solutions and how to get to some of the root causes in part 2.

UPDATE: Here is part 2 – How to address rectal spasms with GABA, pelvic floor work, gluten removal and squats

I’d love your feedback!

I’d love your feedback so I can learn what works, so we can all learn from each other and so others get answers quicker than I did.

Have you ever experienced this rectal pain and spasms? And what has worked for you?

I’d love to know if it is more common after sclerotherapy for hemorrhoids and vaginal hysterectomy? Have you had either? Or any surgery in the abdominal area?

Do you also have IBS/SIBO?  What about celiac disease or gluten sensitivity?

Do you currently have anxiety or mood issues or have a history of anxiety or mood issues?  How many low GABA and low serotonin symptoms do you have – here is the questionnaire  (a paper from 1965 mentions that patients with proctalgia fugax have been described as irritable, perfectionistic, meticulous, obsessional, tense, and anxious)

If you’ve tried GABA or these other approaches (or decide to try them) please come back and share.  Too many people don’t know about this and it needs to change!