In the evaluation of anal pain, ultrasonography is useful in eliminating abscesses and fistulas as causes for acute pain. Intersphincteric abscesses are difficult to diagnose clinically but can easily be found with endoanal ultrasound. However, in a study of patients with chronic idiopathic anal pain, intra-anal ultrasound findings were abnormal (hyperechoic, hypoechoic, or thickened sphincters) in 12 patients.21 However, these structural findings were nonspecific relative to the etiology of the anal pain. Endoanal ultrasonography has been useful in the guidance of anal sphincter biopsies and botulinum injections into the inter-sphincteric space in the treatment of chronic anal pain, but otherwise has little to contribute in the evaluation of chronic anal pain.

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