Review ArticlesChronic perineal pain current pathophysiological aspects, diagnostic approaches and treatmentAndromanakos, Nikolaos P.a; Kouraklis, Grigoriosb; Alkiviadis, Kostakisb Author Information aDepartment of General Surgery, ‘Polykliniki’ Athens General Hospital bSecond Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, Athens, Greece Correspondence to Nikolaos P. Andromanakos, MD, Department of General Surgery, ‘Polykliniki’ Athens General Hospital, 10A Glafkis Street, Halandri 15232, Athens, Greece Tel: +30 6945890453; fax: +30 2132044105; e-mail: [email protected] Received July 8, 2010 Accepted October 11, 2010 European Journal of Gastroenterology & Hepatology 23(1):p 2-7, January 2011. | DOI: 10.1097/MEG.0b013e32834164f6 Buy Metrics Abstract Chronic perineal pain is the anorectal and perineal pain without underlying organic disease, anorectal or endopelvic, which has been excluded by careful physical examination, radiological and endoscopic investigations. A variety of neuromuscular disorders of the pelvic floor lead to the different pathological conditions such as anorectal incontinence, urinary incontinence and constipation of obstructed defecation, sexual dysfunction and pain syndromes. The most common functional disorders of the pelvic floor muscles, accompanied by perineal pain are levator ani syndrome, proctalgia fugax, myofascial syndrome and coccygodynia. In the diagnosis of these syndromes, contributing to a thorough history, physical examination, selected specialized investigations and the exclusion of organic disease with proctalgia is carried out. Accurate diagnosis of the syndromes helps in choosing an appropriate treatment and in avoiding unnecessary and ineffective surgical procedures, which often are performed in an attempt to alleviate the patient's symptoms. © 2011 Lippincott Williams & Wilkins, Inc.