Dr. Anicet Puigdollers Perez is a coloproctologist and belongs to Top Doctors, Spain’s elite circle of top doctors. As an expert in anal pain, he will explain the details of this treatment.
What do we understand by anal pain?
Pain is not a disease, pain is a symptom, and anal-rectal pain is the symptom for which about 50% of the patients who come to a proctology office consult. The patient suffers pain in the anal region and this can be located in the anus itself or inside the rectum, and it is sometimes difficult for the patient to make this distinction. Other times the pain is around the anus, in the peria-nal region. The characteristics and intensity of pain vary logically depending on the cause and a factor no less important as is the threshold of perception of each individual, not all perceive pain in the same way or express it in the same way and less in a region such as the delicate anal as pain coexist with factors such as shame or modesty.
What can cause anal pain?
There are many processes that can trigger this symptom. There are organic causes due to a specific anatomical lesion and non-specific causes of difficult diagnosis that give rise to what we call functional pain.
How do you arrive at a diagnosis?
It is curious because anal pain is usually associated with hemorrhoids on the part of the patient who suffers from it, although no one is unaware that the issue is more complex than all this. First of all, it must be said that hemorrhoids play little role in the issue of pain because if they are not complicated they do not usually generate a very important pain. When the pain is accompanied by obvious physical alterations there are no diagnostic doubts, a hemorrhoidal thrombosis, a perianal access are clear examples of rapid treatment. The problem arises in the absence of an obvious physical lesion, it is then when a good interrogation of the patient and a thorough proctological examination help us. For example, if the pain starts with bowel movements and increases after bowel movements for hours, we should think of an anal fissure even if we cannot see it. There are also complementary explorations and in proctology we have the advantage of working with the terminal portion of the digestive tract, therefore open to the exterior and allowing easy access to endoscopic, ultrasound or functional explorations.
What are functional pains?
They are a type of pain that does not respond to any obvious anatomical cause, we will have ruled out, therefore, physical injury in the patient. They are difficult to diagnose. Functional ano-rectal pain is divided into 2 groups depending on the duration of the symptom. We speak of chronic proctalgia when the pain lasts more than 20 minutes and we speak of fleeting proctalgia when it evolves into peaks of pain ranging from seconds to a few minutes.
How is functional ano-rectal pain treated?
Treatment must always be individualized. Although these pains may be related to psychological factors, it should not be assumed from the outset that this is the origin of the pain. Certainly, conventional analgesia is often ineffective. Postural treatments, peri-anal massages and even sitz baths can provide considerable relief for these patients. With respect to pharmacological treatments, muscle relaxants and tricyclic antidepressants are used, among others. An interesting treatment is the re-education of the anal and pelvic floor musculature by means of bio-feedback techniques, which allows to achieve a good sphincter relaxation and a correct defecatory maneuver and all this will contribute to the improvement of these patients. In recent years, neuro-modulation of sacral roots or through stimulation of the posterior tibial nerve have shown encouraging results.