title: Chronic idiopathic anal pain. Results of a diagnostic-therapeutic protocol in a colorectal referral unit.
abstract: BACKGROUND
  Chronic idiopathic anal pain (CIAP) remains a diagnosis of exclusion. Its study and management still lack a standardized protocol. The aim of this study is to evaluate the results obtained with the diagnostic-therapeutic protocol established in our service.
  
  
  METHODS
  We performed a retrospective study of patients diagnosed with CIAP at the Colorectal Unit of the General University Hospital of Elche, between 2005 and 2011.
  
  
  RESULTS
  We evaluated 57 patients with a diagnosis of chronic anal pain for functional anorectal disease (FAD). After the application of our diagnostic protocol, final diagnosis of chronic anal pain (CAP) was achieved in 43 cases (75%), including 22 cases of descending perineum syndrome, 12 of proctalgia fugax, 2 of pudendal neuritis and 7 of coccydynia. In 14 patients exclusion diagnosis of CIAP was established. Among the therapies used on patients with CIAP, biofeedback combined with conservative measures improved symptoms in 43% of the cases. Sacral nerve stimulation was assessed in patients who did not respond to other treatments.
  
  
  CONCLUSIONS
  Through proper anamnesis, physical examination and complementary tests, a specific diagnosis of the cause of CAP by FAD can be achieved, reducing exclusion diagnosis of CIAP to 25% of cases. Conservative measures combined with biofeedback achieved an improvement in pain in more than 40% of the cases of CIAP in our study. Sacral nerve stimulation can be considered as a treatment option in refractory cases.
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital General Universitario de Elche, Elche, España. Electronic address: laura.armananzas@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Armañanzas
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital General Universitario de Elche, Elche, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Arroyo
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital General Universitario de Elche, Elche, España.
authors.forename: Jaime
authors.initials: J
authors.lastname: Ruiz-Tovar
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital General Universitario de Elche, Elche, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: López
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital General Universitario de Elche, Elche, España.
authors.forename: Jair
authors.initials: J
authors.lastname: Santos
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital General Universitario de Elche, Elche, España.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moya
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital General Universitario de Elche, Elche, España.
authors.forename: María Amparo
authors.initials: MA
authors.lastname: Gómez
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital General Universitario de Elche, Elche, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: Candela
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital General Universitario de Elche, Elche, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003108:Colonic Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D012017:Referral and Consultation; D012189:Retrospective Studies; D055815:Young Adult
keywords: Biofeedback; Chronic anal pain; Chronic idiopathic anal pain; Criterios Roma III; Dolor anal crónico; Dolor anal crónico idiopático; Functional anorectal disorders; Proctalgia; Rome III Criteria; Trastornos funcionales anorrectales