Chronic anal pain
Treatment varies according to etiology, for example for anal fissure, abscess, fistula and hemorrhoids both medical and surgical therapy can be attempted, depending on the cases.
Regarding coccygodynia, a complete evaluation with the orthopedic consultant is performed. If there are no issues are coming up from this side, then local infiltrations can be performed with good results. If there is a suspect that chronic prostatitis is present, the patient is referred to our urologist, likewise if the doctor is thinking about pelvic endometriosis, a consult with our expect gynecologist is suggested.
Rectal ischemia is more common in the elderly population, in this case anal canal is not touched by the surgeon and all efforts are done in order to diagnose which blood vessels are involved (for example CT scan) and ameliorate local and general blood supply.
Puborectalis syndrome and pudendal chronic neuralgia can be diagnosed only after a careful visit with palpation of the levator ani and the different trigger points. Then, if necessary, nerve conduction studies can be performed in order to confirm the diagnosis. Then, biofeedback and pelvic floor rehabilitation are offered and can guarantee very good results. In very selected cases, direct infiltration with local anesthetics and corticosteroids are performed directly on the nerve.