Chronic Anorectal Pain

What is chronic anorectal pain?
Anorectal pain is commonly associated with ODS (about 50%). Less commonly (5%) patients complain of isolated anorectal pain. Its symptoms can be relatively non-specific and varied and it can sometimes be difficult to treat.

What cause chronic anorectal pain?
There are many causes of anorectal pain. Some people will have specific causes such as an anal fissure or abscess. Others might have a pelvic floor problem such as anismus, prolapse or an enterocoele. Nerve entrapment is a rare cause. Sometimes, no obvious cause for the symptoms is found and this is called “proctalgia fugax” or chronic idiopathic anal pain. The pain these patients feel is real but treatment, in the absence of a “structural” cause, is mainly symptomatic.

What symptoms do patients get?
The nature of the pain varies between patients and may give a clue to its cause.

What test will I need?
After an examination, tests will usually involve anorectal physiology and endoanal ultrasound. A proctogram and transit study is also often performed to check for any evidence of internal or external prolapse or an enterocoele. We may suggest investigations to rule out a back problem.

Which treatments might be offered?
Anal fissures or an abscess are relatively easily treated. If there is evidence of a prolapse or enterocoele, then your surgeon will be able to advise you on the likelihood of surgery improving your symptoms. If you have proctalgia fugax or chronic idiopathic anal pain, then treatment may be mainly symptomatic and your surgeon may suggest you try pelvic floor exercise or biofeedback. Sometimes we suggest you see a chronic pain specialist.