Ano-rectal neuralgia consists of pain in the ano-rectal region without any underlying organic proctological disease. Classically, three major clinical groups are defined, although associated, successive and intermediary forms may also exist. Proctalgia fugax is the most distinctive condition, consisting of brief episodes of nocturnal pain recurring at very variable intervals. In coccygodynia, the pain is postural and reproduced by pressure and mobilisation of the coccyx. The other forms of ano-rectal pain are grouped under the heading ano-rectal neuralgia or neurosis, which are characterised by the imprecision and the variability of the symptoms described. The pathogenesis of these forms of pain is unknown. Psychiatric elements are generally involved in these conditions, especially in the third clinical group. The treatment suffers from this uncertainty about the pathogenesis. The patient should be reassured by means of the least aggressive proctological procedures.