Key Concepts

• Irritable bowel syndrome (IBS) is defined by the Rome IV criteria and divided into three subtypes (diarrhea-predominant (IBS-D); constipation-predominant (IBS-C); mixed bowel habits (IBS-M)) defined by stool form. The diagnosis is one of exclusion.
• Surgery for IBS is not indicated, but patients with IBS frequently have undergone one or more surgical procedures in an attempt to alleviate chronic pain.
• Treatment of IBS depends on the subtype.
• There are three subtypes of chronic anal pain defined by Rome IV criteria: levator ani syndrome, unspecified functional anorectal pain, and proctalgia fugax. These subtypes are distinguished by differences in the duration of pain and the presence or absence of anorectal tenderness.
• Coccygodynia is defined as pain or discomfort at or around the coccyx and may be related to trauma, but also an idiopathic variant exists.
• Pudendal neuralgia produces knifelike pain in the anus, vagina, or perineum. It is felt to be produced from pudendal nerve entrapment in Alcock’s canal or in the infrapiriformis canal.