News and Analysis

‘Restless Anal Syndrome’: New Study Finds Potential Side-Effect Of Contracting COVID-19
Woman hand holding her bottom because having Abdominal pain and Hemorrhoids, Health care concept.
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Scientists in Japan have reported a case in which a patient “seems to have developed ‘restless anal syndrome’ after suffering from COVID-19,”  according to a new report.

Initial findings indicate “that the syndrome may be related to the coronavirus, according to a case report published last week in the BMC Infectious Diseases journal,” The Jerusalem Post reported.

“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,” said the report. “Exercise relieved his symptoms while resting worsened them.”

Restless anal syndrome is akin to restless leg syndrome (RLS), another malady that has 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,” said the Post.

Here’s what the BMC Infectious Diseases journal wrote:


Coronavirus disease 2019 (COVID-19) has a broad spectrum from respiratory and nasopharyngeal symptoms, cerebrovascular diseases, impaired consciousness, and skeletal muscle injury. Emerging evidence has indicated the neural spread of this novel coronavirus. Restless legs syndrome (RLS) is a common neurological, sensorimotor disorder, but highly under diagnosis disorder. Restless anal syndrome as restless legs syndrome variant associated with COVID-19 has been previously not published. We report a case presenting with restless anal syndrome following COVID-19.

Case presentation

Although a 77-year-old male with COVID-19 improved to normal respiratory function 21 days after admission and treatment of favipiravir 200 mg per day for 14 days and dexamethasone 6.6 mg per day for 5 days, the insomnia and anxiety symptoms remained. Several weeks after discharge, he gradually began to experience restless, deep anal discomfort, approximately 10 cm from the perineal region. The following features were observed in the anal region; urge to move is essential, with worsening with rest, improvement with exercise, and worsening at evening. Colonoscopy revealed internal haemorrhoids without other rectal lesions. Neurological findings including deep tendon reflex, perineum loss of sensory and spinal cord injury, revealed no abnormalities. Diabetes militias, kidney dysfunction and iron deficiency status were not confirmed. Family history of RLS and periodic limb movements were not observed. Clonazepam at 1.5 mg per day resulted in the alleviation restless anal discomfort.


We reported a case presenting with restless anal syndrome following affection of COVID-19 as restless legs syndrome variant. This case fulfilled 4 essential features of RLS, urge to move, worsening with rest, improvement with exercise, and worsening at evening. To date, no case of restless anal syndrome associated with COVID-19 has been previously published. This case report may reflect the associative impacts of COVID-19 on the neuropsychiatric state. The long-term outcomes of neuropsychiatric conditions should continue to be monitored.

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