Covid-infected Japanese man, 77, develops ‘restless anal syndrome’ that left him with constant urge to move (and going to the toilet didn’t help…)

• The man was treated in hospital for what medics say was a mild case of Covid
• He suffered ‘deep anal discomfort’ several weeks after being discharged 
• Medics say Covid’s impact on body’s nervous system is not yet fully understood

An elderly Japanese man developed ‘restless anal syndrome’ after catching Covid, in what doctors claim is a world first.

The unidentified 77-year-old was admitted to Tokyo Medical University Hospital after testing positive for Covid. 

Despite his age, he did not require any oxygen during his stay and managed to start breathing normally again 21 days after being admitted.

However a problem of another kind emerged several weeks after he was discharged.

The man began to suffer ‘deep anal discomfort’ about 10cm above his perineum, the region between the genitals and the anus. This gave him an ‘essential urge to move’, according to medics who treated him. 

Defecation did nothing to relieve the man’s discomfort, wrote Dr Itaru Nakamura who detailed the case in BMC Infectious Diseases. 

A 77 year old Japanese man developed restless anal syndrome as a result of catching Covid according to medics from Tokyo Medical University Hospital

But the man noticed that exercise such as walking, running or playing motion based video games alleviated his symptoms, while taking a rest and staying still made them worse. 

He also noticed the symptoms got worse towards the evening.

It is unclear how common restless anal syndrome is because the condition is barely mentioned in medical literature.

Medics who reported the case in Japan described it as deep anal discomfort, associated with an ‘essential’ urge to move.

The symptoms were made worse by resting and being sedentary, and particularly bad in the evenings.

However, they were alleviated by exercise.

Japanese doctors described restless anal syndrome as a variant of restless leg syndrome. 

Restless leg syndrome, also known as Willis-Ekbom disease, is a common condition affecting the nervous system. It is thought to affect up to one in 10 people.

It causes an overwhelming urge to move your legs along with an unpleasant crawling or creeping sensation.

Despite the name the sensation can also affect the arms, chest and face. 

What causes restless leg syndrome is in many cases unknown.

It can run in families, though this is not believed to be the case for the Japanese man. 

In some cases it can be caused by another medical condition. 

Treatment can range from lifestyle changes such as increasing exercise or medication depending on what is causing the problem.  

Dr Nakamura said a colonoscopy, where a thin flexible camera is inserted into the anus, revealed the man had internal haemorrhoids but no other rectal damage.

Testing the man’s nervous system also revealed no abnormalities. 

Dr Nakamura said the symptoms of ‘suffering’ in the anal region; the urge to move, the worsening with rest, improvement with exercise but worsening at evening, led medics to diagnose him with restless anal syndrome.

They classified this as a variant of the relatively common condition restless leg syndrome, and directly attributed it as being caused by his Covid infection.

Dr Nakamura said how Covid impacted patients’ nervous system was not fully understood a number of neurological conditions had been reported following infection.

These include delirium, confusion, psychosis, brain swelling, disruption to the brain’s blood supply, and a condition characterised by weakness and numbness in parts of the body called Guillain-Barre Syndrome.

A loss of taste and/or smell which are now famously associated with Covid, are also considered a neurological impact of the virus, Dr Nakamura said.   

Restless leg syndrome is a common neurological condition that causes an overwhelming irresistible urge to move the legs as well as unpleasant sensations in the limbs. 

Despite the name, the condition can also occur in other parts of the body such as arms, chest and face.

It is described as a sleep disorder due to the disruption it causes to people’s lives. 

In many cases the cause of restless leg syndrome is unknown, but it can run in families, though the Japanese man had no family history of the condition.  

While restless leg syndrome has been associated with a Covid infection on two occasions, both in women under the age of 50 in Pakistan and Egypt, Dr Nakamura said this was the first published case of the virus causing restless anal syndrome. 

The man was given a daily dose of 1.5mg of Clonazepam, a drug used to treat seizures and fits, which alleviated his symptoms.

Dr Nakamura said that man continues to improve after 10 months on the medication. 

Restless leg syndrome is thought to impact between 1 to 4 per cent of the Japanese population according to Dr Nakamura.

In the UK the restless leg syndrome is thought to affect one in ten people according to charity RLS-UK.

It it also thought 7 to 8 per cent of the US population also have the disease according to the Restless Legs Syndrome Foundation.

It is unclear how common the variant restless anal syndrome is.  

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