How is anal pain investigated?
When you visit your doctor, you will be asked questions about the pain you are experiencing. For example, how long it lasts, if it is related to opening your bowels, etc. The doctor will also want to know if you have other symptoms, in particular bleeding. Proctalgia fugax and levator ani syndrome do not cause any bleeding from your back passage.
The doctor will then need to examine you. You will be asked to lie on the couch, usually on your side, with your knees curled up towards your chest. The doctor will look at the outside of your anus first, looking for lumps, bumps, fissures and skin rashes. They will want to feel inside with a gloved finger, checking for lumps, tenderness and bleeding. They may look inside your anus and rectum with an instrument called a proctoscope. This is a short rigid see-through tube, which allows them to see the inside of just the lower few inches of your gut.
If further tests are needed, you may then be referred to a specialist, usually a gastroenterologist or colorectal surgeon. Further tests might be advised. This could include:
- A sigmoidoscopy. This is an examination with a camera on a longer tube, which can pass further up inside your gut.
- An ultrasound scan
- An MRI scan
- Anorectal manometry. This is a test used to measure the pressure of anal muscle contractions.
Not everybody needs all these tests. If you have occasional fleeting pains, no bleeding, and a normal examination, you are likely to have proctalgia fugax and will not need any more tests. If this is the case, you would be advised to return to see the doctor if anything changes (for example, if you get any bleeding, or if the pain becomes more persistent).
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- Jeyarajah S, Purkayastha S; Proctalgia fugax. CMAJ. 2013 Mar 19 185(5):417. doi: 10.1503/cmaj.101613. Epub 2012 Nov 26.
- Chiarioni G, Asteria C, Whitehead WE; Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options. World J Gastroenterol. 2011 Oct 28 17(40):4447-55. doi: 10.3748/wjg.v17.i40.4447.
- Guidelines on Chronic Pelvic Pain; European Association of Urology (2015)