Manometric and radiologic investigations and biofeedback treatment of chronic idiopathic anal pain

Abstract

In 12 patients suffering from chronic idiopathic anal pain, the rectosphincteric function was studied using manometric and x-ray techniques. The results of manometric investigations were compared with those obtained in 12 healthy volunteers. In all patients, the resting pressure in the anal canal was significantly higher than in control subjects. In 10 patients, defecography revealed abnormalities of the pelvic muscles. We treated the patients by using biofeedback techniques, consisting of voluntary modifications of the state of contraction of the external sphincter. In all cases, pain disappeared after a mean of eight biofeedback training sessions. When noxious manifestations had disappeared, manometry showed a significant decrease in the anal canal resting pressure. Our results indicate 1) that chronic idiopathic anal pain is associated with abnormal anorectal manometric profiles, probably resulting from a dysfunctioning of the striated external anal sphincter, and 2) that biofeedback training is an effective treatment for chronic idiopathic anal pain.

Is Sacral Nerve Stimulation an Effective Treatment for Chronic Idiopathic Anal Pain?

“…4 The etiology of chronic idiopathic anal pain remains to be fully elucidated. Many authors 5,6 have suggested that higher resting and straining anal musculature pressures or perineal spasm may cause local ischemia and the accumulation of metabolites, inducing pain (''pain-cycle theory''). 7 However, these findings cannot be demonstrated in all patients.…”

High-Resolution Anorectal Manometry - New Insights in the Diagnostic Assessment of Functional Anorectal Disorders

“…With regard to levator ani syndrome, several reports using conventional manometry indicate higher anal sphincter pressures as well as typical manometric patterns of DD. Improvement of symptoms with biofeedback therapy supports the validity of these observations [58][59][60]. Currently, no data exist on the role of HR-ARM in the assessment of functional anorectal pain, and it remains to be investigated if results seen on conventional manometry are transferable to HR-ARM.…”

“…Symptoms usually last 30 min or longer and digital rectal examination reveals tenderness during traction on the puborectalis. Unspecified functional anorectal pain is defined by the same criteria as the levator ani syndrome with the exception that there is no local pain during digital rectal examination on traction of the puborectalis [1,58]. In contrast to the levator ani syndrome, proctalgia fugax is defined as recurrent but inconsistent episodes of gnawing, aching, or cramping rectal pain not associated with defecation over 3 months.…”

Transtornos anorretais

“…A fisiopatologia é nebulosa, mas em grande parte há sensibilidade aumentada à palpação dos músculos pélvicos e esta síndrome crônica pode refletir uma hiperalgesia visceral e/ou aumento da tensão do músculo pélvico (11) . Alguns pacientes com síndrome de elevador do ânus podem ter pressão anal aumentada (12) . Finalmente, há uma forte associação entre dor pélvica crônica e sofrimento psicossocial em vários domínios (por exemplo, depressão e ansiedade, somatização e comportamento obsessivo-compulsivo) (13) .…”