Restless anal syndrome is an extremely rare condition that may occur after COVID-19. There has been only one reported case to date. It causes the urge to move and deep anal discomfort that does not improve with bowel movements.

Restless anal syndrome shares similarities with restless legs syndrome (RLS), as it causes an urgent need to move that only improves with exercise. Symptoms may worsen at night or when resting.

So far, there is one report of a person experiencing restless anal syndrome after COVID-19.

This article looks at restless anal syndrome and its symptoms. It also explores symptoms of COVID-19 that are more common.

Coronavirus data

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub for the most recent information on COVID-19.

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Restless anal syndrome is an extremely rare variant of RLS that may occur after a COVID-19 infection. So far, there has been one report of a person developing the condition.

Reported case

In 2021, the journal BioMed Central Infectious Diseases published a case report of a 77-year-old Japanese male who developed unusual symptoms following a COVID-19 infection.

Treatment with antiviral and anti-inflammatory medications resolved his respiratory symptoms, but he was still experiencing insomnia and anxiety.

Symptom development

Several weeks after discharge from the healthcare facility, the person also began to experience deep, restless anal discomfort, which did not improve with bowel movements.

Symptoms worsened with rest and in the evening but improved with exercise. The person had not experienced restless anal syndrome before having COVID-19.

Doctors carried out a colonoscopy, which showed internal hemorrhoids, but no found other issues with the bladder or rectum. Neurological examinations found no explanation for the restless anal discomfort.

Treatment with clonazepam, a sedative, helped relieve the symptoms.

Connection with RLS

The condition in this case affected the anal area but shared similarities with RLS, so doctors named it “restless anal syndrome,” a variant of RLS that developed following COVID-19.

RLS occurs due to a problem with the central nervous system (CNS), which can affect movement and sensation.

The case study suggests that restless anal syndrome may occur if the SARS-CoV-2 virus, which causes COVID-19, spreads to the CNS and affects the nerves.

Learn more about RLS here.

According to the case study, symptoms of restless anal syndrome include:

  • anxiety
  • insomnia
  • a feeling of restless, deep anal discomfort, which does not improve with bowel movements
  • feeling an urgent need to move

Symptoms appeared to worsen in the evening or when resting and improved with exercise.

The National Institutes of Health (NIH) states that RLS is a neurological disorder that begins in the brain. Symptoms affect movement and sleep.

RLS causes uncomfortable leg sensations and the urgent need to move the legs. People may feel a throbbing, aching, itching, or crawling sensation. Walking or moving the legs usually relieves the sensations temporarily.

Symptoms may occur in the late afternoon or evening and worsen at night, which can cause sleep disturbances. Symptoms may also worsen when resting or during long periods of inactivity.

In many cases, there is no known cause for RLS. However, it may occur due to the following:

Similarities and differences

Both conditions cause the urge to move, with symptoms appearing to worsen with rest and in the evening and improving with exercise.

Both conditions may occur due to improper functioning of the CNS. However, restless anal syndrome may only occur as a variation of RLS after COVID-19.

The fact that there has only been one case study reporting restless anal syndrome suggests it may be an extremely rare side effect of COVID-19.

RLS and COVID-19

A person may be more likely to experience RLS with COVID-19 rather than restless anal syndrome, although this still seems rare.

A 2021 study of sleep dysfunction in people after COVID-19 infection found that in 572 people who received hospital treatment for COVID-19, 3.9% experienced RLS.

A 2021 case study also reported RLS in one person after COVID-19 infection. According to research from 2020, sleep complaints may affect around 12.6% of people with a COVID-19 infection, and 1.7% may experience complaints that overlap with RLS criteria.

RLS may occur after COVID-19 due to how the immune response affects the CNS.

The 2021 case study concludes that although sleep disturbances are common with COVID-19, RLS is uncommon.

Long-lasting COVID-19 symptoms

Another 2021 study found that the most common long lasting symptoms of COVID-19 are:

Learn more about the symptoms of COVID-19 here.

If a person has symptoms of COVID-19, they will need to take a test. After a positive test, people will need to:

  • isolate and wear a mask to protect others
  • inform people with whom they have had recent contact
  • monitor symptoms and seek medical help if they worsen
  • contact a doctor if they are at higher risk of severe infection

People can contact a doctor about any severe or concerning COVID-19 symptoms. It is best to call 911 if a person experiences any of the following:

If people experience symptoms of restless anal syndrome following a COVID-19 infection, they can contact a doctor and explain their symptoms.

The doctor may take a medical history and perform a physical examination or tests to find the underlying cause and suggest treatment.

There is little information on restless anal syndrome, as only one case study currently exists.

In that case, the person received treatment with 1.5 milligrams per day of a benzodiazepine drug called clonazepam. This effectively relieved anal discomfort and restlessness symptoms, which continued to improve 10 months after starting treatment.

Like all benzodiazepines, clonazepam can be habit-forming, and doctors do not recommend it for long-term use.

Restless anal syndrome is a rare variation of RLS that may occur after a COVID-19 infection. It shares similarities with RLS but affects the anal area rather than the legs.

Symptoms include a deep, restless anal discomfort and the urge to move, which does not improve with bowel movements. Symptoms may worsen at night and with rest and improve with exercise. In the one case report of restless anal syndrome, treatment with a sedative was effective.

If people have symptoms of restless anal syndrome following a COVID-19 infection, they can contact a doctor for a diagnosis.