I was hardly even 16 years old when I experienced my first episode. One minute I was standing in the center of my mother’s kitchen over a plate of store brand butter cookies, helping myself to a couple of generous gulps of orange juice, and the next minute I was a puddle of cold sweaty skin on the tan linoleum floor.
I had nearly blacked out due to the explosive, toe-curling pain that was rocketing up my backside in the form of some invisible, hateful lampoon. I cramped up in terror as I doubled over from what was the worst feeling I had ever felt before. I could only describe what happened in that dreadful minute-and-a-half as lightning striking me three times without any advanced warning. (Or in more graphic terms, it was like someone was forcibly attempting to drag my intestines out from between my butt cheeks.) What was particularly horrific was that the spasm-like pain seemed to originate in my rectum and ran up and down the inside of me sharply. When I finally caught my breath again and felt safe enough to move, I collected myself off the kitchen floor and staggered gingerly to the bathroom.
Needless to say, my appetite was gone and I was totally stunned out of my mind. My bum was sore and I was left to wonder the obvious question: What in the hell had just happened to me? I have always considered myself to have a high threshold for pain. I could usually suffer through even the worse bouts of menstrual cramps without the need for any pain relievers. I could weather terrific canker sores and endure strained muscles with little complaint. But I had unexpectedly met my match on that otherwise uneventful afternoon in June as I collapsed to my knees at the mercy of this sensation that literally immobilized me. Seeing as I was a few hours into having my period for that month, I half-suspected that it was probably some exaggerated (and hopefully, isolated) manifestation of my menstruation. Still, it was frightening to think that it could happen again.
Later that day, I tried to explain what I had felt to my mother, and while I looked for her face to ease into an expression of recognition at what I was describing in embarrassingly sparse details, she just stared blankly back at me.
“Hmm… So this pain ran up your back, you mean? Back pain isn’t unusual. I get that too…”
“Well, not actually my back… you know? I mean, it’s …well…coming from a lower region than that. Does that make sense, mom?”
“No…not really,” she said. “Take some Ibuprofen if you’re still hurting.”
“I’m not hurting anymore… That’s the thing about it mom; it came and it went.” I was only sore at this point.
“Well, it is that time of the month for you. So sometimes the body goes through all sorts of funky feelings. I’m sure it’s just cramps. Your pelvic muscles contracting like crazy and all…”
I wasn’t satisfied with that answer but I told myself she was likely right and became determined to put the incident as far behind me as possible — until the next day, when it happened again. This time I was reclining on the porch in a wicker chair with my ankles crossed, soaking in the beautiful summer rays on a perfect 84-degree Saturday afternoon. I had just about finished reading the Arts & Entertainment section of the newspaper when I heard my sister call for me from inside the house. “Coming! I bellowed back. I lowered both my feet over the side of the chair and popped up to a standing position. Lightning struck again. The same crippling pain as before shot up my anus with avengence. I buckled quickly, then grabbed feebly behind myself at my clenched butt cheeks. It was again the worst sensation of my entire life and my face and neck beaded over with sweat. I was dazed, lightheaded, and too weak to move for the next few minutes. My sister eventually found me still standing outside, posing like an aghast statute on my tippy toes, completely upright. I guess I thought the pain would simply pass through me quicker if I extended my whole body as straight as I could bring myself to.
That episode lasted about 45 seconds. I wish I could say it was the last I had to endure but here I am, penning this essay an exasperating 13 years later, with tears brimming in my eyes as a long-time sufferer of this nightmare. I’m afraid I can’t say the painful episodes went away after so many years or that I stumbled across some spectacular cure. There were, in fact, years of me grinning and bearing the pain from month to month, almost always around the same time. I can, however, say that it got better. And while I still experience these incidents (although a great deal more infrequently), as a 20-something woman, I am no longer a victim of proctalgia fugax as I was in my teen years.
Proctalgia fugax is a fairly common anorectal disorder that affects both men and women, with more prevalence in the latter sex. It’s characterized by intermittent spasmodic episodes of sharp, stabbing pain which is always limited to the anus or lower rectum and can last from mere seconds up to 20 minutes. Research estimates 4 to 18 percent of the general population has this disorder and the average sufferer is between 30 and 60 years of age. Consequently though, because of its highly intimate and embarrassing nature, many patients are hesitant to ask their doctor about the pain they expweriencerand remain undiagnosed.
I was resistant as well. I feared that my primary doctor would make the assumption that I was probably already sexually active at 16 and had recently engaged in anal sex for the first time, as the stereotype of the morally reckless, uber-promiscuous young Black female continues to live on. (This couldn’t be farther from the truth, however. When I had my first episode, I was an honest-to-goodness virgin who feared the wrath of my strict Baptist mother too much to even risk getting caught masturbating.) I wound up scouring through tons of women’s health forums online and finally found myself in the middle of a lengthy thread of comments from women of all ages responding to a middle-aged woman who was bemoaning her recent bouts of “spontaneous anal misery.” All of her symptoms and her colorful descriptions of the pain matched mine. I read through all of the posts following up to her original one and was quite shocked, and somewhat relieved, to know I wasn’t alone. Other women and young girls also suffered from what I had suffered from for over a decade. Several people who posted replies named the same culprit: proctalgia fugax.
I immediately turned to Google for anything I could find about this condition. Apparently, there is no known cause, but research indicates it’s a spasm of the internal anal sphincter muscle. The list of triggers includes stress, bad posture, menstruation, sexual activity, constipation, and passing stool. In my case, onset was restricted to either just before my menstruation or during it. It would occur outside in jarringly cold temperatures or on the toilet while I might have been in the middle of a bowel movement. It would happen if I stood up too quickly from a sitting position, or sat down too quickly from a standing position. Sometimes I could have an episode with no apparent trigger at all. Four months into my new career as a public safety dispatcher, I was sitting in the lounge room at my workplace just trying to wind down over my lunch hour. I started to feel a strangely warm, but awfully familiar, flush rise up between my legs. My whole body went absolutely motionless in dread. All of a sudden, I was very much aware of my surroundings. From the sticky sweet smell that hung thinly in the air of the room, to the mound of colorful blankets that laid like a log over the coworker sleeping on the couch parallel to me, to the bristly hairs of my lower arm scraping against my skin where it was draped over my wrist. I knew what was coming….the lightning. I willed it to go away, to leave me be. Not now. I pleaded with it. I’m at work. I can’t go through this at work. I’m not even alone. As though trying to mentally negotiate with the pain had ever worked before, I tensed up through shakily drawn breaths, my fists balled tightly in resistance, and braced for the impending impact. It wasn’t even my most severe attack, but the bag of vending machine popcorn I was eating out of did end up an unfortunate casualty with my right thigh bumping it over as I screeched in pain. In the aftermath, I must have looked like a frightened cat, my body curling up and my head crunching up into my chest. I remember the sleeping coworker bouncing upward in shock, his eyes and mouth saucer-wide, as he searched my panicked face for an explanation. “Sorry. I had a …uh, bad spasm.” It was all I could come up with.
In my teenaged years, I dealt with my episodes by choosing to not really deal with them at all. I hid away in my room, buried myself beneath my bedsheets, and usually slept most of the day away. I only emerged from my bedroom long enough for lunch and dinner and to take a shower. My mother didn’t make much of an effort to get me to confide the extent of my menstrual woes to her. She figured I would prefer not to talk about it. I wanted nothing more than for her to pry this once in my life; to ask the right questions that would open the door I could walk through. I wanted to explain why I was always so miserable and whiny during that time of the month. She never quite understood though.
As a 29-year-old adult now, the episodes happen with a great deal less frequency, and less fervor too. I’ve learned that beginning and ending my days with a warm bath can do wonders for my temperamental anus. If it’s in the middle of the day, and I’m at work when that familiar uncomfortable sensation grips me, then I’ll retreat to the women’s lockers downstairs and help myself to a hot five-minute shower. I keep an electric heating pad in my desk to pull out for long work days. I’ve noticed that abstaining from caffeinated beverages and carbonated drinks during my menstruation also helps with the proctalgia fugax attacks and the stomach cramping as well.
I used to live as a victim of proctalgia fugax. I used to live at the mercy of the pain. That time of the month for me was a literal pain in my butt. Now I am no longer a victim. I am a survivor. I still live with it; most months in the year I’m free of it, but some months the pain comes back to haunt me. Yet, I have learned what it means to be confident in my own skin and to not punish myself for how others might judge me for something they can’t understand. The difference is that what was once a three-horned taloned monster that kept me alone and ashamed and in unbearable pain has been reduced to purely a pest in my closet. The lightning still strikes, but it’s nothing I cant handle.
Samantha Hawkins is an essayist, poet, and creative writer. She’s a frequent contributor to the blog, Black Superwoman Chronicles, and has recently published a guest column in the Atlanta Journal-Constitution.