Main diagnostic categories for chronic anal pain: An overview
| Diagnostic category | Diagnosis or syndrome | Assumed etiology | Main symptoms | Examination findings |
|---|---|---|---|---|
| Local anorectal conditions | Fissure, perianal sepsis, tumor, ulcers, thrombosed hemorrohoids, severe proctitis | Specific to disorder | Common symptoms: Bleeding, discharge, lump, pruritis ani | Overt findings (may require EUA) |
| Functional anorectal conditions | Proctalgia fugax | Unknown | Short-lasting (seconds or minutes) sharp deep rectal stabbing or cramping. No radiation. No anorectal pain between episodes | No findings |
| Levator ani syndrome | Pelvic floor muscle tension or spasm | Chronic (> 30 minutes) dull rectal ache or pressure sensation. Radiation to buttock, vagina, thigh. Other functional diagnoses common (eg, IBS, FDD, fibromyalgia) | Tender puborectalis, replicates pain (usually left side) | |
| Unspecified functional anorectal pain | Unknown | Chronic (> 30 minutes) dull rectal ache or pressure sensation. Other functional diagnoses very common (eg, IBS, FDD, fibromyalgia) | No findings | |
| Neuropathic pain syndromes | Coccygodynia | Coccyx trauma leading to peripheral sensitisation | Perineal pain triggered by sitting | Tender on pressure or manipulation of coccyx |
| Pudendal neuralgia | Pudendal nerve entrapment: peripherally generated or neuropathic pain | Unilateral perineal pain with paresthesia. Worse on sitting. Nantes criteria2 | Pain on transvaginal pressure on ischial spine | |
| Phantom rectum syndrome | Neuropathic pain (deafferentation) | Specific to disorder | Specific to disorder | |
| Paroxysmal extreme pain disorder | Neuropathic pain (genetic) | Specific to disorder | Specific to disorder |
EUA = examination under anesthesia; FDD = functional defecation disorder; IBS = irritable bowel syndrome