Rome IV Diagnostic Criteria for Functional Anorectal Pain
Use in patients with chronic, recurrent anorectal pain lasting >30 minutes that is often worse with sitting than standing or lying down, often described as a vague, dull ache, or pressure high in rectum.
Digital rectal exam:
Levator Ani Syndrome: tenderness on palpation of pelvic floor or vagina.
Pain during posterior traction of puborectalis.
Pain often asymmetric, more often on left side (but not universally).
Posterior massage may elicit characteristic discomfort.
Unspecified Functional Anorectal Pain:
NO pain during posterior traction of puborectalis.
Do NOT use in patients with:
Anorectal or pelvic floor structural pathology explaining symptoms.
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- Justin Brandler, MD
- Max J. Schmulson W., MD