An update of the systematic review of Barolith intestinal obstruction

to my early teens. Occasionally, the intense pain and agony had been so severe that I fainted. I tried several cures such as massage of the coccyx region, warm baths and rectally-administered laxatives, but was not able to reduce the frequency or intensity of the seizures. Finally, in pure desperation during one extremely painful episode, I showered and inserted a few deciliters of water at body temperature into the rectum. To my surprise the seizure stopped immediately. During subsequent defecation, only small lumps of faeces came out. In my years as a clinician, both as a general practitioner and as an infectious disease specialist, three patients have mentioned nightly episodes of anorectal pain. Extensive gastrointestinal investigation of the patients showed no pelvic and anorectal abnormality and the diagnosis became proctalgia fugax. Two of the patients had tried bulk pharmaceuticals, calcium channel blockers and benzodiazepines without any improvement in the frequency or intensity of the pain. One of my patients had also, in intensive despair, inserted water at body temperature anorectally. As with my experience described above, he had immediate relief of his pain. I recommended my patients to try this method whenever they had seizures. At follow-up appointments, the patients reported that the frequency of their seizures had not decreased, but that they were able to stop the attack by inserting a small amount of water anorectally. Even if the aetiology of this condition is not understood, my pragmatic view is that enema is a safe and reliable method which can be used after ruling out any organic cause. My personal view, after many ghastly hours, is that proctalgia fugax is started by a motor abnormality of the rectal smooth muscle, resulting from small lumps of faeces, and subsequently spreading to the rectal or pubococcygeal muscle apparatus. This nightmare can be brought to an end by using a small amount of water, either as a water enema or, in the worst case scenario, the shower, to dilate the ampulla and lower part of rectum.