title: Should anorectal ultrasonography be included as a diagnostic tool for chronic anal pain?
abstract: OBJECTIVE
  To assess the efficiency of endorectal ultrasound (ERUS) in the study of chronic idiopathic anal pain (CIAP).
  
  
  METHODS
  This is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz) was used.
  
  
  RESULTS
  One patient could not tolerate the examination. In 8 patients (20% of cases) alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women) internal anal sphincter (IAS) hypertrophy, and in 5 patients (4 women and 1 man) a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman).
  
  
  CONCLUSIONS
  ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.
authors.affiliation: Service of Gastroenterology, University Hospital Virgen Macarena, Sevilla, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: García-Montes
authors.forename: Federico
authors.initials: F
authors.lastname: Argüelles-Arias
authors.forename: S
authors.initials: S
authors.lastname: Jiménez-Contreras
authors.forename: S
authors.initials: S
authors.lastname: Sánchez-Gey
authors.forename: F
authors.initials: F
authors.lastname: Pellicer-Bautista
authors.forename: J M
authors.initials: JM
authors.lastname: Herrerías-Gutiérrez
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000293:injuries / Q000473:pathology; D001004:Anus Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D002908:Chronic Disease; D003113:Colonoscopy; D051517:Digital Rectal Examination; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000191:economics / Q000523:psychology