Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment

Eur J Gastroenterol Hepatol. 2011 Jan;23(1):2-7. doi: 10.1097/MEG.0b013e32834164f6.

Abstract

Chronic perineal pain is the anorectal and perineal pain without underlying organic disease, anorectal or endopelvic, which has been excluded by careful physical examination, radiological and endoscopic investigations. A variety of neuromuscular disorders of the pelvic floor lead to the different pathological conditions such as anorectal incontinence, urinary incontinence and constipation of obstructed defecation, sexual dysfunction and pain syndromes. The most common functional disorders of the pelvic floor muscles, accompanied by perineal pain are levator ani syndrome, proctalgia fugax, myofascial syndrome and coccygodynia. In the diagnosis of these syndromes, contributing to a thorough history, physical examination, selected specialized investigations and the exclusion of organic disease with proctalgia is carried out. Accurate diagnosis of the syndromes helps in choosing an appropriate treatment and in avoiding unnecessary and ineffective surgical procedures, which often are performed in an attempt to alleviate the patient's symptoms.

Publication types

  • Review

MeSH terms

  • Anus Diseases / diagnosis*
  • Anus Diseases / physiopathology*
  • Anus Diseases / therapy
  • Chronic Disease
  • Constipation / diagnosis
  • Constipation / physiopathology
  • Constipation / therapy
  • Fecal Incontinence / diagnosis
  • Fecal Incontinence / physiopathology
  • Fecal Incontinence / therapy
  • Female
  • Humans
  • Male
  • Myofascial Pain Syndromes / diagnosis
  • Myofascial Pain Syndromes / physiopathology
  • Myofascial Pain Syndromes / therapy
  • Neuralgia* / diagnosis
  • Neuralgia* / physiopathology
  • Neuralgia* / therapy
  • Pain / diagnosis
  • Pain / physiopathology
  • Pain Management
  • Sacrococcygeal Region / physiopathology
  • Urinary Incontinence / diagnosis
  • Urinary Incontinence / physiopathology
  • Urinary Incontinence / therapy

Supplementary concepts

  • Levator syndrome