Main diagnostic categories for chronic anal pain: An overview

Diagnostic categoryDiagnosis or syndromeAssumed etiologyMain symptomsExamination findings
Local anorectal conditionsFissure, perianal sepsis, tumor, ulcers, thrombosed hemorrohoids, severe proctitisSpecific to disorderCommon symptoms: Bleeding, discharge, lump, pruritis aniOvert findings (may require EUA)
Functional anorectal conditionsProctalgia fugaxUnknownShort-lasting (seconds or minutes) sharp deep rectal stabbing or cramping. No radiation. No anorectal pain between episodesNo findings
Levator ani syndromePelvic floor muscle tension or spasmChronic (> 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 painUnknownChronic (> 30 minutes) dull rectal ache or pressure sensation. Other functional diagnoses very common (eg, IBS, FDD, fibromyalgia)No findings
Neuropathic pain syndromesCoccygodyniaCoccyx trauma leading to peripheral sensitisationPerineal pain triggered by sittingTender on pressure or manipulation of coccyx
Pudendal neuralgiaPudendal nerve entrapment: peripherally generated or neuropathic painUnilateral perineal pain with paresthesia.
Worse on sitting. Nantes criteria2
Pain on transvaginal pressure on ischial spine
Phantom rectum syndromeNeuropathic pain (deafferentation)Specific to disorderSpecific to disorder
Paroxysmal extreme pain disorderNeuropathic pain (genetic)Specific to disorderSpecific to disorder
  • EUA = examination under anesthesia; FDD = functional defecation disorder; IBS = irritable bowel syndrome