Abstract
PURPOSE: This study was undertaken to analyze whether intra-anal ultrasound examination, anorectal physiologic evaluation, and histopathologic examination in patients with chronic idiopathic anal pain presented any common features and whether the results of different treatment modalities correlated with these findings. METHODS: Eighteen patients who met the criteria for chronic idiopathic anal pain were studied. All had an intra-anal ultrasound examination and a complete anorectal physiologic evaluation. In a selected group of patients, ultrasound-guided biopsy samples were taken from pathological areas in the internal and external sphincter. Treatment consisted of analgesics only in four patients, 0.2 percent nitroglycerin ointment in four, and ultrasound injection of botulin (botulinum toxin, Botox®) into the intersphincteric space in nine. Two patients, including one who was previously treated with botulin, ultimately had a colostomy. RESULTS: Four patients were managed satisfactorily on analgesic treatment under the guidance of the hospital's pain clinic. Nitroglycerin ointment resulted in temporary pain relief in one of four patients. Injection of botulin resulted in a permanent improvement in four patients, a temporary improvement in one patient, and no effect in four patients. Two patients had a colostomy, resulting in complete pain relief. The effect or lack of effect of nitroglycerin ointment and botulin was not related to changes in anal pressure. CONCLUSION: Chronic idiopathic anal pain is a condition of unknown origin for which no proven therapy exists. As in other syndromes based on muscular dystonia, some patients may benefit from injection of botulin.
Similar content being viewed by others
References
Keighley MR, Williams NS. Surgery of the anus, rectum and colon. London: WB Saunders, 1993:753–9.
Christiansen J. Chronic idiopathic anal pain. Eur J Surg 1998;164:83–8.
Swash M. Chronic perineal pain. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor. London: Butterworth, 1985:388–92.
Todd IP. Clinical evaluation of the pelvic floor. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor. London: Butterworth, 1985:187–8.
Hussain SM, Stoker J, Shouten WR, Hop WC, Laméris JS. Fistula in ano: endoanal sonography versus endoanal MR imaging in classification. Radiology 1996;200:475–81.
Nielsen MB, Pedersen JF, Hauge C, Rasmussen OØ, Christiansen J. Endosonography of the anal sphincter: finding in healthy volunteers. AJR Am J Roentgenol 1991;157:1199–202.
Pedersen IK, Christiansen J. A study of the physiological variation in anal manometry. Br J Surg 1989;76:69–70.
Rasmussen OØ, Christiansen J. Physiology and pathophysiology of anal function. Scand J Gastroenterol Suppl 1996;126:169–74.
Skomorowska E, Henrichsen S, Christiansen J, Hegedüs V. Videodefaecography combined with measurement of the anorectal angle and of perineal descent. Acta Radiol 1987;28:559–62.
Alstrup N, Rønholt C, Fu C, Rasmussen O, Sørensen M, Christiansen J. Viscous fluid expulsion in the evaluation of the constipated patient. Dis Colon Rectum 1997;40:580–4.
Nielsen MB, Rasmussen OØ, Pedersen JF, Christiansen J. Risk of sphincter damage and anal incontinence after anal dilatation for fissure-in-ano: an endosonographic study. Dis Colon Rectum 1993;36:677–80.
Grimaud J-C, Bouvier M, Naudy B, Guien C, Salducci J. Manometric and radiologic investigations and biofeedback treatment of chronic idiopathic anal pain. Dis Colon Rectum 1991;34:690–5.
Neill ME, Swash M. Chronic perianal pain: an unsolved problem. J R Soc Med 1982;75:96–101.
Hallan RI, Williams NS, Melling J, Waldron DJ, Womack NR, Morrison JF. Treatment of anismus in intractable constipation with botulinum A toxin. Lancet 1988;2:714–7.
Lund JN, Scholefield JH. Aetiology and treatment of anal fissure. Br J Surg 1996;83:1335–44.
Author information
Authors and Affiliations
About this article
Cite this article
Christiansen, J., Bruun, E., Skjoldbye, B. et al. Chronic idiopathic anal pain. Dis Colon Rectum 44, 661–665 (2001). https://doi.org/10.1007/BF02234562
Issue Date:
DOI: https://doi.org/10.1007/BF02234562