Pelvic Pain Associated with a Coloproctologic Etiology

Abstract

Pelvic pain is the most common form of pain experienced by people and one of the most frequent reasons inducing patients to seek medical attention. Many conditions are related to anorectal pain: inflammatory disease; functional disease; pelvic tumors; post operative complications. In inflammatory bowel disease (IBD) patients experience visceral pain secondary to hyperalgesia and allodynia. Hyperalgesia is a peculiarity of patients with active ulcerative colitis (UC), while hypoalgesia is typical of patients with quiescent or mild UC and Crohn’s disease (CD). Inflammatory pelvic diseases such as prostatitis or interstitial cystitis can cause recto-anal pain, also. “Functional” disorders such as levator ani syndrome, proctalgia fugax, coccygodynia and Alcock’s canal syndrome evoke severe anal pain and affect the quality of life of patients. Irritable bowel syndrome (IBS) patients complain of pelvic pain, although there are no structural lesions underlying this symptom. The central nervous system plays a major role in the pathophysiology of IBS, also. Anorectal tumours commonly cause pain. Radiotherapy has been demonstrated to be an useful mean to improve pelvic pain significantly. Sexually transmitted infections can cause proctitis. The most common symptom of infectious proctitis is anorectal pain. Gonorrhoea, chlamydia, herpes simplex virus and syphilis are the commonest causative infectious agents. Specific therapy is ideal but not always feasible. Bowel endometriosis causes a wide variety of symptoms, which range from rectal bleeding to pelvic pain on defecation. Haemorrhoids, anal fissures and anal absceses are the most common proctological diseases associated with anal pain. Chronic proctalgia has been also described after many surgical procedures such as PPH and STARR. In summary, pelvic pain involves many visceral organs. Accuracy in collecting medical informations and in phyisical examination is fundamental. Pelvic pain should be approached by a multidisciplinary team in order to reach the best results in diagnosis and treatments.