What Is 'Restless Anal Syndrome' and How Is It Related to COVID-19, Exactly?

Rest assured, you don't have to start panicking just yet.

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If it seems like every day you're reading headlines about new and potentially scary COVID-19 side effects, you might not want to hear the latest story coming from a coronavirus patient in Japan. The male patient has been suffering from something called "restless anal syndrome" after contracting the virus. But before you panic, know that this seemingly rare after-effect has only been reported in this singular patient thus far, and a gastroenterologist is here to explain why there's truly no need to worry just yet.

Here's the scoop: A recent report published in the peer-reviewed journal BMC Infectious Diseases detailed the case of a 77-year-old man who was hospitalized for 21 days with COVID-19. After being discharged, however, he began to experience "restless, deep anal discomfort" between his anus and genitals, and an incessant feeling of the need to poop, according to the case report. (ICYDK, there are lots of reasons you might have an itchy butt or genital itching.)

It seems that physical activity helped relieve the patient's spasms, according to the case report, but when he was at rest, he felt discomfort similar to restless leg syndrome, a condition characterized by an irresistible or unpleasant urge to move your legs that typically peaks in the late afternoon or evening hours when you're trying to relax, rest, and sleep. The National Institute of Neurological Disorders and Stroke notes that while restless leg syndrome is classified as a sleep disorder (since it often disrupts sleep and causes daytime exhaustion) and a movement disorder, it's perhaps best classified as a "neurological sensory disorder" since it's the brain sending signals and triggering movement.

This patient in particular reported symptoms post-COVID that were markedly similar to RLS (including insomnia, anxiety, and restlessness/discomfort, with relief during exercise), just around his anus — something the case report noted as a first-of-its-kind occurrence. After 10 months of treatment, the patient is improving, thanks to a daily dose of clonazepam (a sedative), which helps relax his anal muscles. The case report has suggested that what the patient experienced is a potential neurological side effect of COVID-19.

So, is this yet another potentially worrying effect of COVID-19 to stress about? According to New York-based gastroenterologist Samantha Nazareth, M.D., F.A.C.G., there's next to no reason to panic. (Read more: Can't Sleep? 6 Weird Reasons You're Still Awake)

How Common Is 'Restless Anal Syndrome?'

Rest assured, notes Dr. Nazareth, that "this specific condition of restless anal syndrome as a variant of restless legs syndrome is rare."

"The patient needs to have these specific features: symptoms worsening with rest and in the evening, symptoms improved with exercise, and the urge to move. While anal pain (as described in this case report) as a sole symptom is something I do see in clinical practice, all of these features together with anal discomfort is rare," she tells Shape.

Dr. Nazareth also reiterates that this is "the first reported case in the scientific literature and it was one patient. More patient cases will need to be reported to determine if there is a strong association between this condition and COVID-19," she adds. (

What Could Have Caused His Restless Anal Syndrome?

In an effort to determine if this patient's symptoms were a direct result of his COVID-19 diagnosis, doctors did a colonoscopy; it revealed that the patient had internal hemorrhoids, a very common condition that causes swollen veins inside the anus and rectum. However, the hemorrhoids didn't explain his restless anal syndrome symptoms, nor is it clear whether or not they're linked to COVID-19.

Before diagnosing him with restless anal syndrome, doctors ruled out all other colorectal conditions (other than hemorrhoids)."In this case report, all other colorectal conditions (other than hemorrhoids) were ruled out," she says. "Hemorrhoids do not trigger restless anal syndrome. Since there has been only one COVID-19 patient reported to have this condition, I would put this in the bucket of being very rare at this time."

Still, health experts are learning new things about the novel coronavirus all the time, and Dr. Nazareth points out that there are reports linking RLS to COVID-19. Further, there are other potentially lingering side effects linked to COVID, including fatigue, change in taste or smell, or chest and stomach pain according to the Centers for Disease Control and Prevention.

"The typical digestion-related effects seen in COVID-19 patients are loss of appetite, diarrhea, nausea, vomiting, and/or abdominal pain/discomfort," says Dr. Nazareth. "Many diverse neurological effects have been reported with and following COVID-19, such as confusion, loss of taste, encephalitis (a condition characterized by brain swelling), cerebrovascular disease (stroke), and Guillain-Barré syndrome, a condition in which your immune system attacks your body's nerve cells, potentially leading to muscle weakness and/or paralysis." (

The TL;DR here: Continue doing all you can to protect yourself and your loved ones from getting COVID-19, which means masking up in public, frequently washing your hands, and, of course, getting your COVID-19 booster shot as soon as you're eligible. But you can take a deep breath knowing that restless anal syndrome likely isn't another COVID symptom that'll keep you up at night.

The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it's possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.

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