Anorectal pain (proctalgia) has been described in association with a variety of organic conditions but also occurs under circumstances in which organic disorders are absent and the pathophysiology is uncertain. The two most common functional disorders are levator ani syndrome and proctalgia fugax. These disorders are distinguished clinically on the basis of duration of painful episodes, frequency, and characteristics. Levator ani syndrome must be distinguished from other disorders of chronic anorectal rectal pain, such as coccygodynia, rare genetic syndromes of familial rectal pain, tumors of the pelvis or cauda equina, endometriosis, and other gynecologic causes of chronic pain. The literature concerning this area has been mostly descriptive and anecdotal, and therapeutic modalities have not been examined rigorously. This is a group of disorders in which patients often are disabled, and many physicians possess little information concerning evaluation and management of these patients.