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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.


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Bibliography / Reference

Collection of Pages - Last revised Date: October 18, 2019