Proctalgia Fugax. And lots of blood.

Proctalgia Fugax is an occasional but nasty pain in the bottom, specifically involving the muscles around the anus. It happens without much prior warning, and its incidence is unpredictable. I get an attack of it maybe three or four times a year.

It is suddenly there. The pain builds up gradually but inexorably. I usually have time to lie down, get comfortable, and then ride it out, perhaps in a semi-foetal position on the top of my bed, under a warm blanket.

The pain will get worse, then subside. It feels like cramp, but whereas I can alleviate cramp in my foot, there's nothing I can do about this except try to relax. If I can, I try to think of something much, much nicer than this overwhelming pain - or just think of nothing at all. It reaches a climax, then fades. I sometimes stay awake to experience that release from pain, as if I were emerging at last from the grip of a dark dream. But as often as not, I fall asleep, waking refreshed, the pain completely gone. Either way, I'm able to resume what I was doing as if nothing had happened. Months may pass before it all happens again.

I had an attack last week, on 27th November around 4.00am, when I would probably have woken up anyway to go to the loo, as I often do in the night. But I had the impression that I had just come out of a dream that had tensed me up. Who knows what worries the subconscious mind explores at night! I went to the toilet; but that wasn't why I was in pain. It got worse, and I felt hot and unsteady. I should have stayed seated, or perhaps slid down to the floor and curled up. Instead I formed the notion that a cold flannel would be soothing, and I got to my feet. A mistake!

The next thing I knew, I was lying on the floor looking up at an unfamiliar sight. Two ceilings and a door frame. It took me a while to work out that I was half in, half out of the bathroom. I wasn't cold, and I felt comfortable enough. All the pain in my bottom had gone. There was no pain anywhere. I must be all right again. But why was I like this, on the floor? I couldn't remember how I got there. Then I propped myself up on my left elbow, and saw that my head had been lying in a pool of blood. It was at that point that I realised I had fainted from the pain, hit my head on the bathroom door frame, and gashed the back of my head.

Here's the 'crime scene', a few minutes later.

I felt no shock or giddiness. I felt normal. I was capable of doing practical, sensible things. My first thought was that I had better record all this in case the doctor needed pictures of the injury, and where I had ended up. So I went into the bedroom (I could walk normally), got my phone, and took that shot above. Then I directed the camera lens onto myself. Ugh, what a mess. The hair on the left side of my head was dripping with blood. Drops were now going all over the place.

Everything you might expect from a head wound. I told myself it wasn't as bad as it looked, and I guessed that I had suffered a bad cut, but no more. I spent the next half hour cleaning myself up, putting towels and nightie into cold water to soak, then dealing with that pool of blood on the bathroom floor, and all the individual drops of blood that were scattered around. Remarkably, that initial trip to my bedroom to fetch my phone had deposited only one spot of blood, on my freshly-washed quilt cover, which I now saturated in cold water until it disappeared.

None of this blood had congealed. That told me that I couldn't have been unconscious for long. I half-dried my hair, and made myself a cup of tea. It was high time I stopped doing things and rested. It was still dark, not yet 5.00am. I made a second cup of tea, got comfortable in one of my reclining chairs in the lounge, with a quilt over me for extra warmth, and attempted to sleep. I didn't drop off, but just resting there with my feet up and eyes closed must have helped. 7.00am arrived, the central heating came on, and I got up to have my usual frugal breakfast and morning pills. I felt OK. Not completely normal, of course, but coping and fully able to think.

So the next step. How bad was the damage? There was still no pain; the wound felt sore to the touch, that was all. I needed to see it, but I couldn't study the back of my head directly. So I contrived a photo (using one of the bedroom mirrors), and zoomed into that to view the cleaned-up wound. It looked disturbingly bloody, but not life-threatening. I could smile, sort of.

Was this something that needed a doctor's eye? I decided that a medical opinion from a doctor or nurse was well justified. I consulted the NHS website, which pointed me towards the nearest A&E. Really? Going to A&E would certainly mean a long wait for treatment, when what I really wanted was a rapid assessment at the local surgery, hopefully with advice to simply go home, take some paracetamol if necessary, and rest up. So at 10.00am I set off for the surgery. I was perfectly fit to walk, though (for once) not keen on driving. It wasn't far. It was, however, pouring down with rain. No problemo. I was wearing my new green Seasalt raincoat, with that hood. I'd be all right. 

Predictably, the lady on reception told me that they were fully booked that day. Anticipating this, I showed her a couple of those gory photos. Within ten minutes I was seeing a doctor. He had a quick look. In his opinion, this was a job for A&E - with stitches likely. And as soon as possible. I mustn't drive myself to the Hospital. Could I ask a friend or neighbour to take me? I could.

Well, I next called on friends Jo and Clive, turning up at their door 'looking like a drowned water rat' Jo said, as the rain had got worse, although in truth I was still dry and snug under the dripping exterior. Coffee, toast, and (inevitably) a cry on Jo's shoulder. The shock was just getting to me. Then we set off to the local hospital, The Princess Royal Hospital at Haywards Heath. Jo stayed with me all afternoon, and was a complete star. And gave me a lovely evening meal once back, with Clive driving me home by 8.30pm. I am so lucky to have friends like this.

I had a lot of tests, including an ECG, at A&E. All indicated normal reflexes, normal fine control of movements, normal blood pressure, pulse and heartbeat, no vision problems, no unusual deafness or aches, and no fluid seepage from nose or ears. In other words, no sign of concussion or other complications. The scalp wound was a simple cut about two inches long, and suitable for gluing after further cleansing. They had to snip my hair somewhat, to keep it away from the glueline. Enough to make my hair stylist Morgan wince when I dropped by a couple of days ago to show her. But it will all grow back in time. And no stitches! I didn't mind glue.

Here's a shot taken that evening at Jo and Clive's, which shows the wound tended and freshly-glued:

Any other damage? Well, I must have hit the bathroom floor with my left side, because my left hip and thigh felt bruised, although no skin marks have actually developed. And the muscles in my neck feel stiff. All that will pass. 

In the first few days after my fall, I definitely felt shaken up. I looked normal, though. Here are shots of myself taken only two days after the fall, before and during a birthday lunch. I was perhaps less animated than usual, but that was all:

I faded a bit later on; but next day I was fine again for an afternoon walk around Sheffield Park. Surely I look chipper enough.

I even got up into the attic, to fetch down my ceramic Christmas Tree. I always get it out and plug it in on 1st December. My gesture towards Christmas! 

So the fall and the head wound have certainly shaken me up, but I haven't been laid low. A week has gone by. I now feel able to cope with most things perfectly well, although I still tire a bit after two hours, and wouldn't yet want to travel far, not out of Sussex anyway. But that sense of fatigue will pass too. 

By the way, I haven't relied purely on self-diagnosis when considering the reason for the bottom pain, and fainting from it. I saw my usual doctor today, to discuss the matter. She confirmed it was indeed a classic case of Proctalgia Fugax. And she agreed that I'm already doing most of the things I could try to ward off anal muscle pain: a diet with plenty of vegetables, fruit and fibre in it, to avoid any straining on the loo; activities involving mild exercise, to tone and relax tense muscles; and cultivating an anxiety-free frame of mind. 

She did however recommend three other things: 

# I could try pelvic floor exercises. 

# I should also make a point of not getting over-heated at night, which dilated blood vessels near the skin and reduced blood pressure (i.e. I need to pay attention to duvet-warmth management). 

# Nor should I get to my feet too fast from a long period of sitting or lying-down, which might make me feel slightly dizzy.

Can do - will do. I don't want to wake up in a pool of blood ever again!