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Proctalgia Syndromes: Update in Diagnosis and Management

  • Large Intestine (R Chokshi , Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Functional anorectal pain syndromes are a neglected yet often disabling clinical entity resulting in significant economic and psychological burden to the patient. The aim of this review is to update the practicing gastroenterologist/coloproctologist on the diagnosis and management of these complicated disorders.

Recent Findings

The updated Rome foundation diagnostic criteria (Rome IV) for functional anorectal pain subgroups chronic proctalgia (levator ani syndrome and unspecified functional anorectal pain) and acute proctalgia (proctalgia fugax) on the basis of symptom duration and digital rectal examination findings. Chronic proctalgia is thought to be secondary to paradoxical pelvic floor contraction in many patients and biofeedback to improve the defecation effort has proven effective for over 90% in the short term. Unfortunately, management of proctalgia fugax remains challenging and treatment outcomes modest at best.

Summary

A number of therapies to relax the pelvic floor may be employed to improve symptoms in functional anorectal pain syndromes; however, only biofeedback to improve defaecatory dynamics in patients with levator ani syndrome has proven effectiveness in a randomized setting. Further investigation of treatment approaches in proctalgia fugax is required.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, St Vincent’s University Hospital, University College Dublin, Dublin, Ireland

    Emma Victoria Carrington

  2. 2nd Medical Department, “Iuliu Hatieganu”, University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Stefan-Lucian Popa

  3. Division of Gastroenterology and Hepatology & UNC Centre for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Giuseppe Chiarioni

  4. Division of Gastroenterology of the University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy

    Giuseppe Chiarioni

Authors
  1. Emma Victoria Carrington
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  2. Stefan-Lucian Popa
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  3. Giuseppe Chiarioni
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Correspondence to Giuseppe Chiarioni.

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Competing Interests

Dr. Carrington has received consultancy fees for teaching from Laborie. Dr. Popa has no conflict of interest to declare. Dr. Chiarioni is a member of the Anorectal Committee of the Rome Foundation.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards and international/national/institutional guidelines).

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Carrington, E.V., Popa, SL. & Chiarioni, G. Proctalgia Syndromes: Update in Diagnosis and Management. Curr Gastroenterol Rep 22, 35 (2020). https://doi.org/10.1007/s11894-020-00768-0

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