COVID may cause 'restless anal syndrome' - report

A patient in Japan seems to have developed the condition due to COVID-19, according to initial findings.

 Scanning electron microscope image shows SARS-CoV-2, also known as novel coronavirus (photo credit: U.S. NIAID-RML/Handout via REUTERS)
Scanning electron microscope image shows SARS-CoV-2, also known as novel coronavirus
(photo credit: U.S. NIAID-RML/Handout via REUTERS)

Scientists in Japan have reported a case in which a patient seems to have developed "restless anal syndrome" after suffering from COVID-19, with initial findings indicating that the syndrome may be related to the coronavirus, according to a case report published last week in the BMC Infectious Diseases journal.

The scientists reported that the patient, age 77, experienced insomnia and anxiety while infected with the virus and, several weeks after discharge, began to experience restless, deep anal discomfort.

The patient experienced an urge to move which worsened with rest and improved with exercise and worsened in the evening in the anal region. A colonoscopy revealed internal hemorrhoids. 

While it is still unclear how COVID-19 causes neurological symptoms, a number of cases of neurological issues, including Guillain-Barré syndrome, "brain fog" and tingling among other issues, have been linked to coronavirus infections since the start of the pandemic.

Restless anal syndrome is a variant of restless leg syndrome (RLS), which has also been linked to a small number of COVID-19 cases. This is the first case report to link restless anal syndrome to the disease caused by the novel coronavirus.

 Shaare Zedek hospital team members wearing safety gear as they work in the Coronavirus ward of Shaare Zedek hospital in Jerusalem on September 23, 2021. (credit: YONATAN SINDEL/FLASH90) Shaare Zedek hospital team members wearing safety gear as they work in the Coronavirus ward of Shaare Zedek hospital in Jerusalem on September 23, 2021. (credit: YONATAN SINDEL/FLASH90)

The 77-year-old patient, categorized as a mild COVID-19 case, was admitted to Tokyo Medical University Hospital with a sore throat, cough and low-grade fever and treated for mild pneumonia, insomnia and anxiety. Although his respiratory function returned to normal 21 days after he was admitted, insomnia and anxiety remained.

Several weeks after discharge, he began to experience anal discomfort despite never experiencing such discomfort before he was affected by COVID-19. Exercise relieved his symptoms while resting worsened them. 

The scientists diagnosed the patient with restless anal syndrome after determining that his symptoms matched the criteria and failing to observe any other cause for the syndrome. No bladder or rectal disturbance or erectile dysfunction was found in the patient. Neurological tests found no abnormalities and the patient had no family history of RLS or periodic limb movements.

The patient's symptoms were alleviated after being treated every day with 1.5 mg of Clonazepam, a medication used to treat seizure disorders and panic disorders.

The scientists stressed that the long-term neuropsychiatric effects of COVID-19 are not yet fully understood and it is still unclear how the novel coronavirus causes these effects. They called for long-term monitoring of such effects in order to gain a fuller understanding of the mechanisms behind them, adding that COVID-19-related RLS or RLS variants may be underdiagnosed.

Since the middle of last year, researchers have found that even some patients who were only mildly affected by the virus suffered neurological complications ranging from brain inflammation and delirium to nerve damage and stroke.