What causes chronic idiopathic perineal pain?

Colorectal Dis. 2011 Sep;13(9):1035-9. doi: 10.1111/j.1463-1318.2010.02422.x.


Aim: Chronic idiopathic perineal pain is poorly understood. Underlying structural abnormalities have been clinically suspected but rarely demonstrated objectively. The condition has been frequently considered to be a psychological disorder. We aimed to evaluate how commonly a structural explanation for such pain symptoms is present.

Method: Patients seen in a pelvic floor clinic with severe chronic functional anorectal pain that was classified as chronic idiopathic perineal pain (study group) were prospectively registered in a pelvic floor database and underwent pelvic floor work up (defaecating proctography, anorectal physiology and anal ultrasound +/- rectal examination under anaesthetic). A control group was formed by patients with obstructed defaecation, with or without faecal incontinence, with advanced posterior compartment prolapse.

Results: Of 59 patients with chronic idiopathic perineal pain [80% women; mean age 53 (range, 22-84) years], representing 5% of all pelvic floor presentations, 33 (56%) had chronic idiopathic perineal pain alone and 26 (44%) had chronic idiopathic perineal pain with obstructed defaecation. Thirty-five (59%) had an underlying high-grade internal rectal prolapse (73% with chronic idiopathic perineal pain + obstructed defaecation vs 48% with chronic idiopathic perineal pain alone; P < 0.05). Anorectal pain was present in 50% of 543 controls with advanced posterior compartment prolapse.

Conclusion: High-grade internal rectal prolapse commonly underlies chronic idiopathic perineal pain, particularly when obstructed defaecation is present. Chronic anorectal pain is a common, under-recognized subsidiary symptom in patients with advanced posterior compartment prolapse presenting primarily with obstructed defaecation or faecal incontinence.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anal Canal / physiopathology
  • Chronic Pain / etiology*
  • Chronic Pain / physiopathology
  • Defecation*
  • Defecography
  • Fecal Incontinence / complications
  • Fecal Incontinence / diagnosis
  • Fecal Incontinence / physiopathology
  • Female
  • Humans
  • Male
  • Manometry
  • Middle Aged
  • Perineum / physiopathology
  • Rectal Prolapse / complications
  • Rectal Prolapse / diagnosis*
  • Rectal Prolapse / physiopathology
  • Young Adult