Dear Dr. Roach: I just read your column from R.A., about rectal pain. I believe what he is talking about is proctalgia fugax. I have had this condition for many years. It's not serious, but can be very painful. It is severe episodic rectal and sacral coccygeal pain caused by muscle cramping. The cause is unknown. It occurs spontaneously, usually at night, but can occur at any time. It can last from a few seconds to 20 minutes or more. Since the pain is spasms and severe, the key is to stop it as soon as possible.

Sitting on a baseball right away will help, but sitting on anything hard, even a tennis ball, will help. I keep one in my car at all times. The best way to control the pain is a microwave hot pack. When that is applied soon after the pain starts, it is usually relieved within 5-10 minutes. I had this for many years before mentioning it to my doctor, and then he told me the actual medical name for this.


Dear D.D.: I thank you and the many other readers who wrote in. Although proctalgia fugax is very common, few people report it to their doctors. It is thought to be due to muscle spasm, but nerve compression is another hypothesis. My medical sources emphasize making sure there isn't another cause for pain, such as a fissure, inflammatory bowel disease or, as one reader mentioned, prostate cancer.

Dear Dr. Roach: I am 90 — yes, 90 — and I'm in full control of my faculties. My heart doctor changed my blood pessure pill to diltiazem in increasing doses. It now takes me four hours to become normal after taking the medicine. I'm like a zombie. Any suggestions?

Dear H.B.: Explain to your heart doctor as clearly as you did for me the symptoms this pill causes. Tell the doctor you can't tolerate it. He or she has a vast number of blood pressure medicines to choose from, but don't stop the medicine on your own. This is something that is easily remedied.

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