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Functional anorectal pain falls within the broader category of chronic pelvi-perineal pain. Such pain is characterized by a normal clinical examination with non-specific imaging. The physiopathological mechanisms behind this pain are poorly understood but are likely multifactorial, involving both triggering and perpetuating factors. The overuse of additional examinations is harmful. Many treatments have been attempted, but no precise algorithm exists. It is reasonable to begin with the least invasive treatments, combining physiotherapy, osteopathy, and posterior tibial neurostimulation. More invasive treatments may be considered in well-selected patients. In the future, advancements will allow for a better understanding of this still vague spectrum of symptoms and causes and enable more personalized treatments.