Certain patients suffer from intense episodes of nighttime pain.

These episodes occur in the middle of the night and usually last 15 to 30 minutes.

The frequency is highly variable, ranging from one per month to one per year.

These episodes are caused by a spasm (a cramp) of the levator ani muscle, which is primarily responsible for continence and pelvic floor support. The reason for these episodes is unknown.

This particular type of pain is referred to as proctalgia fugax, which simply means short-term rectum pain.

Many treatments have been tried, without much success:

• Ointments and suppositories of all sorts
• Oral or respiratory medications
• Botox injections
• Lukewarm baths
• Anal finger dilation
• Relaxation exercises
• Breathing exercises
• And even psychotherapy!

Good hygiene can help you reduce these painful episodes, but there is currently no miracle cure. Your doctor or pharmacist can suggest treatments for pain.

Specifically for women

Another possible cause of discomfort and a common cause of itching in women is the presence of vaginal discharge.

This highly irritating discharge flows towards the perineum and the anus at nighttime. The result is irritation around the anus and the onset of pruritus, which is often worse at night. Moreover, unconscious scratching at night causes excoriations which then lead to the growth of infectious agents, especially fungi.

In this case, treatment consists of:

• reducing or eliminating vaginal secretions;
• treating the skin in case of infection—in this case, an antifungal and antibacterial cream will be prescribed;
• make a habit of washing after defecation and applying a skincare cream;
• eliminate irritants two or three weeks before: excess caffeine, red wine, tomato sauce and strong spices.

In the majority of cases, however, most discharge is physiological and varies in intensity depending on the individual’s menstrual cycle and on sexual activity. Antibiotic treatment is therefore useless in this case and can even be harmful since it may alter the normal bacterial flora of the vagina.

To avoid these problems, gentle washing with water only is encouraged. Drug stores sell vaginal syringes at a cost of about $10. At first, use every night, then once a week, before going to bed or after sex.

Although some practitioners do not recommend douching, the latter has been shown to be beneficial, except during pregnancy if used daily or if the individual uses products other than water.

Randomized field trial of vaginal douching, pelvic inflammatory disease and pregnancy
Kenneth J Rothman 1, Donnie P. Funch, Tanya Alfredson, Joanne Brady, Nancy A. Dreyer
https://pubmed.ncbi.nlm.nih.gov/12859036/