title: What causes chronic idiopathic perineal pain?
abstract: OBJECTIVE
  Chronic idiopathic perineal pain is poorly understood. Underlying structural abnormalities have been clinically suspected but rarely demonstrated objectively. The condition has been frequently considered to be a psychological disorder. We aimed to evaluate how commonly a structural explanation for such pain symptoms is present.
  
  
  METHODS
  Patients seen in a pelvic floor clinic with severe chronic functional anorectal pain that was classified as chronic idiopathic perineal pain (study group) were prospectively registered in a pelvic floor database and underwent pelvic floor work up (defaecating proctography, anorectal physiology and anal ultrasound +/- rectal examination under anaesthetic). A control group was formed by patients with obstructed defaecation, with or without faecal incontinence, with advanced posterior compartment prolapse.
  
  
  RESULTS
  Of 59 patients with chronic idiopathic perineal pain [80% women; mean age 53 (range, 22-84) years], representing 5% of all pelvic floor presentations, 33 (56%) had chronic idiopathic perineal pain alone and 26 (44%) had chronic idiopathic perineal pain with obstructed defaecation. Thirty-five (59%) had an underlying high-grade internal rectal prolapse (73% with chronic idiopathic perineal pain + obstructed defaecation vs 48% with chronic idiopathic perineal pain alone; P < 0.05). Anorectal pain was present in 50% of 543 controls with advanced posterior compartment prolapse.
  
  
  CONCLUSIONS
  High-grade internal rectal prolapse commonly underlies chronic idiopathic perineal pain, particularly when obstructed defaecation is present. Chronic anorectal pain is a common, under-recognized subsidiary symptom in patients with advanced posterior compartment prolapse presenting primarily with obstructed defaecation or faecal incontinence.
authors.affiliation: Department of Colorectal Surgery, Pelvic Floor Centre, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hompes
authors.forename: O M
authors.initials: OM
authors.lastname: Jones
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
authors.forename: I
authors.initials: I
authors.lastname: Lindsey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology; D059350:Chronic Pain / Q000209:etiology* / Q000503:physiopathology; D003672:Defecation; D019841:Defecography; D005242:Fecal Incontinence / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010502:Perineum / Q000503:physiopathology; D012005:Rectal Prolapse / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult