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Two recent studies described a temporal association between a high-amplitude and high-frequency myoelectrical activity of the anal sphincter and the occurrence of proctalgia, which suggest that paroxysmal hyperkinesis of the anus may cause proctalgia fugax. We describe a single case of proctalgia fugax responding to anal sphincter injection of Clostridium botulinum type A toxin. The presumed aetiology of proctalgia fugax is discussed and the possible mechanism of action of botulinum toxin (BTX) in this condition is outlined. Botulinum A toxin seems to be a promising treatment for patients with proctalgia fugax, and further trials appear to be worthwhile for this condition, which has been described as incurable.

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Causes of secondary anal stenosis that have been reported include trauma, Crohns disease, tuberculosis, actinomycosis, lymphogranuloma, Bowens disease, Pagets disease, epidermoid carcinoma, and actinic causes [1]. We report here an unusual case of anal stenosis caused by extensive anal leukoplakia, which (so far as we are aware) is the first such case to be reported.