Perianal Pain

Understanding Perianal Pain

Perianal pain is characterised by pain present in the anal, rectal or genital region, that may be associated with a sense of fullness or heaviness in the rectum, incomplete rectal evacuation or pain with defecating. 

  • Pain or altered sensation in the region of the anus, rectum or genitals
  • Pain or altered sensation during or after defecation
  • Unsatisfactory bowel emptying
  • Pain that is often triggered by sitting

The cause of perianal pain is often multifactorial and may include

  • Genetic predisposition
  • Previous surgery in the pelvic region
  • Injuries sustained during childbirth 
  • Excessive straining to defecate
  • Chronic constipation or diarrhea
  • Injury to the tailbone (coccyx)
  • Pelvic floor muscle tension myalgia
  • Pudendal neuralgia
  • Coccyx pain
  • Emotional distress or prolonged stressed levels
  • History of trauma

The first step in diagnosis of perianal pain is a thorough history and physical examination. Further evaluation to confirm diagnosis may include:

  • Defecating MRI
  • Colonoscopy
  • Functional assessment of the muscles in the anorectum via digital rectal examination

Treatment of perianal pain often includes input from a multidisciplinary team. Common treatment options may include;

  • Pelvic floor muscle (PFM) relaxation  
  • Optimising defecation technique including your toileting position, use of abdominal and pelvic floor muscles, and passive support/splinting if prolapse is relevant for you
  • Adjunctive therapies utilising biofeedback (ultrasound, EMG & Rectal Balloon therapy). Biofeedback has been demonstrated to be an effective, first-line intervention for dyssynergia
  • Stool manipulation through changes to dietary fibre, fluid intake, and laxatives.
  • Lifestyle modifications including physical activity, weight loss, stress management, sleep hygiene, and overall relaxation
  • Botox therapy
  • Surgical procedures to address structural deficits, where conservative approaches have failed.