There you are, casually minding your business when all of a sudden you feel a bolt of lightning shoot up your butt. Hopefully, you’re alone because the pain is strong enough to make you shriek, grimace, and grab onto your cheeks for dear life.

Turns out this “pain in the butt” is a legit medical phenomenon.

“That sharp, severe, fleeting pain that you’re feeling is called proctalgia fugax,” explains Dr. Carlton Thomas, M.D. a San Diego gastroenterologist, in a viral TikTok video.

Proctalgia fugax is a temporary muscle spasm in or around your anal cavity. It’s common, harmless, and usually goes away quickly. But that still doesn’t explain what the hell is happening down there. 

We know a thing or two about butt stuff, so read on to learn all about proctalgia fugax, what causes it, how to manage it, and when to worry about it.

What Is Proctalgia Fugax?

Proctalgia fugax is a rectal muscle spasm that causes a sharp, stabbing pain in your butt. The episodes can last between a few seconds to 20 minutes. “It’s basically caused by a spasm of the pelvic floor muscles or sphincter muscles around the anus,” explains Dr. Karen Tang, MD, a gynecologic surgeon.

The term is a combination of two Latin words: proctalgia (pain around the butthole) and fugax (fleeting or temporary)

Proctalgia fugax is pretty common. Up to 18% of people will experience it, according to the Canadian Medical Association Journal. It has a higher prevalence among women than men. It can occur at any age, but it’s rare before puberty. It mainly affects people between 30-60 years old.

Symptoms of Proctalgia Fugax

The main symptom of proctalgia fugax is a sudden, sharp pain in the rectum. Or as Dr. Thomas says, “It feels like lightning struck your butthole.”

As you can imagine, people on TikTok have described their experiences with PF with some hilarious, hyper-specific language.

“Thought I was getting poltergeisted in the a-hole one night”

“It feels like a toothpick pushing on your pelvis”

“I assumed it was my ex with the voodoo doll she totally doesn’t have.”

Episodes can occur without warning at any time throughout the day. However, a 2005 study found that proctalgia fugax was more common at night.

What Causes Proctalgia Fugax?

Proctalgia fugax happens when your internal anal sphincter muscles spasm or cramp up. This can trigger pain from your pudendal nerve, which runs from your lower spine through your pelvic floor muscles to your genitals. 

Your anal canal is a complex area with lots of muscles and nerves, so it’s hard to pinpoint exactly why this happens. The main theory is that your butthole can randomly spasm, just like other muscles. Other possible causes of proctalgia fugax proposed by researchers include: 

• Anxiety or stress
• Constipation
• Defecation
• Menstruation
• Irritable bowel syndrome (IBS)
• Sexual activity
• Hypertrophy of the sphincter
• Sclerotherapy (an injection for hemorrhoids or after a hysterectomy)

For a doctor to officially determine proctalgia fugax is causing your anal pain, they have to rule out other medical conditions like hemorrhoids, anal fissures, anal abscesses, and neuropathy. Unlike proctalgia fugax, these are more serious causes of anal pain that require medical attention.

Proctalgia Fugax vs. Levator Ani Syndrome

While proctalgia fugax involves short, random spells of pain in your butt, there’s a different condition that causes longer-lasting anal pain: levator ani syndrome. This is an aching pain that lasts longer than 20 minutes and can radiate to your hips and back.

Unlike proctalgia fugax—which is nerve pain—levator ani syndrome involves the levator ani muscle, which is located in the pelvis. Until 2016, levator ani syndrome was thought to be a form of chronic proctalgia, but that’s no longer the case.

Is Proctalgia Fugax Dangerous?

“Proctalgia fugax is totally benign,” says Dr. Thomas. “Nothing to worry about.” It may feel like a bee just stung the inside of your bum, but it doesn’t mean you’ve been stricken by some rare butt disease.

If you’re having persistent pain that happens every day or lasts longer than 20 minutes, you should contact your healthcare provider. This could be a sign of levator ani syndrome.

Severe proctalgia fugax gets more complicated if you’re a woman. (Dudes, feel free to skip this next part).

“Really bad rectal pain can also be a sign of endometriosis,” explains Dr. Tang, referring to a painful tissue disorder. “A common place for endometriosis to grow is between the uterus and the rectum. So if you’re having really severe pain with your period or things like diarrhea, constipation, pain with bowel movements, or pain with sex…talk to your gynecologist about those.”

Treatment Options for Proctalgia Fugax

Since proctalgia is so random and only lasts a few minutes, most doctors don’t offer a detailed plan to prevent or treat it. Translation: tough it out. 

“The episodes of pain are so brief and infrequent that treatment is impractical,” note Mayo Clinic researchers in a 2017 study.

However, if you have frequent episodes or you’re desperate to relieve the pain, you can try these techniques:

• Muscle relaxants such as diltiazem and glyceryl nitrate
• A sitz bath, which is basically soaking your butt in warm water
• Pelvic diaphragm breathing to relax your pelvic floor muscles

Show Your Butt Some Love

The anus is arguably the most reviled region of the body, right up there with the gooch. That’s understandable: buttholes are stinky, sensitive, and hairy. But that doesn’t mean it should be neglected.

Most people don’t think twice about their a-hole. They sit on it all day, wipe it with glorified sandpaper, then wonder why issues arise. Fortunately, you can prevent all sorts of booty probs with the Quit Toilet Paper Starter Kit.

Our flushable wipes are infused with aloe and vitamin E to soothe your sensitive sides. They may not be able to cure proctalgia fugax, but at least you’ll feel fresh in the grips of pain.