Levator Ani Syndrome

Levator ani syndrome also known as levator ani spasm, refers to pain and discomfort in the rectum caused by spasms in the levator muscles that surround the anus. Patients with Levator ani syndrome often complain of a pain associated with rectal pressure that gets worse on sitting or lying down. The pain is almost always dull and constant with a sensation of tightness and fullness in the rectal region. In few cases, the pain may not be constant, but recurrent at frequent intervals lasting up to 20 minutes. Prevalence of Levator ani syndrome is five times higher in women than men. Proctalgia fugax refers to the 'anal pain without known cause'. Here the episodes of pain are very brief and occur rather infrequently.

Diagnosis

When the patient develops rectal pain, firstly the doctor would want to rule out any disease related to organs surrounding the anal canal and pelvic floor. Sometimes an endoscopy is done to investigate the cause of the pain. Patient with Levator Ani Syndrome experiences severe tenderness on palpation of the pubo-rectalis muscle and this forms the basis for diagnosing the levator ani syndrome. In case of Levator ani syndrome, the patient also undergoes posterior traction of the puborectalis muscle during rectal examination.

There is constant rectal, vaginal or perineum pressure. Defection becomes difficult. The symptoms are often aggravated by emotional stress. Muscular tension, injury or surgery can also lead to this condition. Childbirth injury, pelvic infection, lumbar disc surgery or sexually related injuries can lead to levator ani syndrome.

Treatment of Levator Ani Syndrome

Levator ani syndrome is usually resolved through the following steps:

1. Sitting on a doughnut shaped pillow to reduce the pressure.

2. Anti inflammatory drugs and muscle relaxants.

3. Application of perianal lidocaine jelly ointments.

4. Apart from medication and special tools, levator ani syndrome is also treated with physical therapy which includes digital massage of levator muscle, pelvic floor strengthening exercises , pelvic floor relaxation techniques.

5. Hot sitz bath also helps in alleviating the pain and anal pressure.

6. Levator ani syndrome is also treated using Electrogalvanic stimulation (EGS) and Biofeedback training. However recent studies reveal that Biofeedback is far more effective than EGS in treating Levator Ani Syndrome.

Pelvic Floor Dysfunction

The cause for pelvic pain is often difficult to diagnose. Tissues around the pelvic organs might suffer increased or reduced sensitivity or irritation leading to pain in the area. Pelvic floor disorders can manifest as urinary incontinence or fecal incontinence. Typical pelvic disorders include interstitial cystitis, pelvic inflammatory disease or digestive disorders such as diverticulitis and colitis. Cystitis, irritable bowel syndrome, pelvic congestion and Vulvovaginitis> are other pelvic conditions that lead to pelvic pain. Infections, pregnancy and childbirth, incorrect posture, trauma or surgery can lead to pain in the pelvic area.

Symptoms in Women

• Frequent urination with incomplete sensation
  
• Pelvic pain
  
• The feeling of incomplete bowel movement
  
• Vaginal or rectal prolapse (sagging of the vagina or rectum)
  
• Rectocele (protrusion of the rectum into the vagina)
  
• Cystocele ( herniation of the bladder into the vagina)
  
• Enterocele (a herniation of the intestine into the vagina)
  
• Sigmoidocele (a herniation of the sigmoid colon into the vagina)

Symptoms in Men:

• Urgency and frequency in urination
  
• Pain in testes and pain on ejaculation
  
• Reduced urinary flow
  
• Levator Ani Syndrome (pressure and pain in the sacrum)
  
• Constipation or strain during bowel movement

For constipation, low dose muscle relaxants are prescribed. Lifestyle changes in diet and physical activity are recommended. Rectal prolapse and rectocele may be treated through surgery. Cold laser involving a process wherein low-intensity laser light is applied to the tissue easing the pain and inflammation.