Anorectal and perineal pain: new pathophysiological hypothesis.

Anorectal and perineal pain has been described in association with a variety of organic conditions but can also occur under circumstances in which organic disorders are absent and pathophysiology is uncertain. The three most common functional disorders causing anorectal and perineal pain are levator ani syndrome, coccygodynia and proctalgia fugax; Alcock's canal syndrome is also responsible for pain in these areas. We review current concepts about these disorders and the approach to diagnosis and management, and offer a provocative interpretation of the role of psychological factors.