I wanted to write this for the version of me from a few years ago, who was lying awake terrified and searching the internet at 3am.
If you get a sudden, savage cramping pain deep inside — one that tears you out of sleep, sometimes right out of a dream, peaks for a few minutes, then lifts as suddenly as it came and leaves absolutely no trace behind — you are not going mad, and you’re very likely not dealing with anything sinister. There’s a name for it: proctalgia fugax. It means, roughly, “fleeting rectal pain,” and it’s a muscle spasm rather than any kind of damage.
The reason I’m posting is that the fear did more harm to me than the pain ever did. I was certain it was something serious for years, partly because every test came back normal and partly because I couldn’t bring myself to describe it to a doctor. So if nothing else: it’s real, it’s recognised, and you’re not the only one. Not even close — the estimates are genuinely high, it’s just that almost nobody talks about it.
A few things I worked out, mostly the hard way:
In the moment, the instinct to jump up, tense against it, or sit on the toilet and push is the wrong one — that’s when people faint, and straining can make it worse. What helped me was the opposite: lie down, knees up, and soften everything. Long slow breaths out (I count a short breath in and a much longer breath out) settled it faster than anything. Warmth helps too.
Between episodes, the biggest pattern I found was that mine clustered on days I’d been dehydrated or had been sitting for hours. Fixing my water intake and getting up more often quietly cut how often it happened.
The caveat that matters: it’s only “proctalgia fugax” once the other things are ruled out. Bleeding, fever, a lump, weight loss, or a pain that stays rather than coming and going — none of those are this, and they’re worth getting looked at properly. Please don’t let a forum post (mine included) talk you out of seeing someone if something feels off.
Mostly I just want to normalise it for whoever’s reading this at 3am the way I used to. Ask me anything — I’ve been living with it a long time, and I’m very happy to share what I’ve learned.
I compiled all my learnings and experiences in a blog post: Proctalgia Fugax: Symptoms, Causes, Relief & Treatment