ABSTRACT
This chapter deals with the epidemiology, aetiology, diagnosis and management of these chronic perineal pain syndromes, with the significant addition of the post-proctectomy pain syndrome. Pudendal neuralgia refers to a chronic perineal pain syndrome due to entrapment and injury of the pudendal nerve in its muscolo-osteo-aponeurotic tunnel between the sacrotuberal and sacrospinal ligaments in the absence of organic diseases that may explain symptoms. Patients with severe and frequently recurring proctalgia fugax symptoms are likely to consult for a surgical procedure in an effort to solve the problem. No single treatment has been reported to be consistently effective in chronic proctalgia, and management can be a frustrating endeavour for both patients and physicians. Patients with proctalgia fugax are usually asymptomatic during consultation, and diagnosis relies heavily on eliciting a detailed clinical history. Diagnosis of coccygodynia relies heavily on the history and clinical exam. Coccygodynia may be of idiopathic origin or secondary to lumbar disc degeneration.
