Chronic Idiopathic Anal Pain. Results of a Diagnostic-Therapeutic Protocol in a Colorectal Referral Unit

Armañanzas, Laura; Arroyo, Antonio; Ruíz-Tóvar, Jaime; López, Alberto; Santos, Jair; Moya, Pedro; Gómez, María Amparo; Candela, Fernando; Calpena, Rafael

doi:10.1016/j.cireng.2013.09.029

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…Likewise, similar results were reported by Atkin et al albeit in a very small series (n = 3), with a median reduction in pain scores of 5.75 [median (pre-SNM) = 7.75 vs. median (post-SNM) = 2.0] [27]. Armañanzas et al report a similarly small series (n = 3) with a median reduction in pain scores of 4.6 [median (pre-SNM) = 7.75 vs. median (post-SNM) = 2.0] [33].…”

Section: Resultsmentioning

confidence: 99%

“…The study with the longest follow-up, performed by Park et al , reported a mean reduction of 2.2 points at 12 months [mean (pre-EGS) = 7 vs. mean (12 months post-EGS) = 4] [32]. Notably, the highest magnitude of effect was reported in the smallest series by Armañanzas et al (n = 8; mean difference = 4.7) [33]. Meanwhile, mean reductions in pain scores following injection of Botox ranged from 0.3 (in a study administering up to 100 IU Botox) to 2 (in a study administering up to 200 IU Botox) [5,30].…”

Section: Resultsmentioning

confidence: 99%

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Optimal management of functional anorectal pain: a systematic review and network meta-analysis

Byrnes

Sahebally

McCawley

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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Functional anorectal is idiopathic and characterised by severe and potentially intractable anorectal pain. The current review aims to appraise available evidence for the management of functional anorectal pain and synthesise reported outcomes using network meta-analysis. PubMed, CENTRAL and Web of Science databases were searched for studies investigating treatments for functional anorectal pain. The primary outcome was clinical improvement of symptoms and the secondary outcome was pain scores reported during follow-up. A Bayesian network meta-analysis of interventions was performed. A total of 1538 patients were included from 27 studies. Intramuscular injection of triamcinolone, sacral neuromodulation (SNM) and biofeedback were most likely to be associated with improvement in symptoms [SUCRA (triamcinolone) = 0.79; SUCRA (SNM) = 0.74; SUCRA (Biofeedback) = 0.61]. Electrogalvanic stimulation (EGS), injection of botulinum toxin A and topical glyceryl trinitrate (GTN) were less likely to produce clinical improvement [SUCRA (EGS) = 0.53; SUCRA (Botox) = 0.30; SUCRA (GTN) = 0.27]. SNM and biofeedback were associated with the largest reductions in pain scores [mean difference, range (SNM) = 4.6-8.2; (Biofeedback) = 4.6-6]. As biofeedback is noninvasive and may address underlying pathophysiology, it is a reasonable first-line choice in patients with high resting pressures or defecation symptoms. In patients with normal resting pressures, SNM or EGS are additional options. Although SNM is more likely to produce a meaningful response compared to EGS, EGS is noninvasive and has less morbidity. Whilst triamcinolone injection is associated with symptomatic clinical improvement, the magnitude of pain reduction is less.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Optimal management of functional anorectal pain: a systematic review and network meta-analysis

Byrnes

Sahebally

McCawley

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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“…No single treatment has been reported to be consistently effective in all patients with chronic proctalgia, and management can be a frustrating endeavour for both patients and physicians [1,20]. Firstly, patients should be reassured that the pain is of benign origin to allay fears of more sinister pathology [9,17]. No data are available on the impact of simple reassurance, but education and counselling are often incorporated as a component of treatment [1, 12••].…”

Section: Conservative Measuresmentioning

confidence: 99%

“…Most patients with proctalgia fugax fail to seek medical advice as the episodes of pain are infrequent, of short duration and spontaneously resolve [7•, 17, 18]. For those who do, simple reassurance and avoidance of trigger events, if any, are the first line treatments commonly provided [17,18,40]. This approach is likely to be effective in patients with mild symptoms, but it may be perceived as a bridging approach to delay more invasive options in the disabled sufferer.…”

Section: Managementmentioning

confidence: 99%

“…Unfortunately, there are only a few case series and a single RCT which guide management of these patients [40,41]. Warm sitz baths, warm tap water enemas and digital anal dilatation are often suggested as simple interventions to achieve rapid sphincter relaxation [17,18,40]. Oral calcium channel blockers (diltiazem) and topical nitroglycerin ointment which have been shown to decrease anal sphincter pressure have both been reported to be effective in small case series [7•, 17].…”

Section: Managementmentioning

confidence: 99%

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Proctalgia Syndromes: Update in Diagnosis and Management

Carrington

Popa

Chiarioni

2020

Curr Gastroenterol Rep

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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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Descending perineum syndrome: a review of the presentation, diagnosis, and management

Chaudhry

Tarnay

2016

Int Urogynecol J

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Chronic Idiopathic Anal Pain. Results of a Diagnostic-Therapeutic Protocol in a Colorectal Referral Unit

Cited by 5 publications

References 20 publications

Optimal management of functional anorectal pain: a systematic review and network meta-analysis

Optimal management of functional anorectal pain: a systematic review and network meta-analysis

Proctalgia Syndromes: Update in Diagnosis and Management

Descending perineum syndrome: a review of the presentation, diagnosis, and management

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