ABSTRACT
The chief complaint of anorectal pain is often approached with trepidation by the colorectal surgeon since the physical examination is often unremarkable with no obvious cause for this very troublesome complaint. The goal of imaging is to exclude pelvic masses or neurologic causes of anorectal pain. Once primary pelvic and anorectal abnormalities have been excluded, three patterns of pain exist: proctalgia fugax, levator syndrome, and pudendal neuropathy. Proctalgia fugax is defined by recurrent episodes of sudden and severe anorectal pain; the pain disappears completely between attacks. Several medications have been used for the treatment of anorectal pain. Injection of botulinum toxin may benefit patients by treating muscle dystonia in the anorectal area. An effective approach to the complaint of anorectal pain is composed of a variety of factors; however, realistic expectations from both the patient and the physician are crucial. There is a sufficient body of literature regarding pudendal neuropathy to distinguish it as a separate category of anorectal pain.
