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.
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.
Loss of bladder control is referred to as urinary incontinence. Urinary incontinence occurs if the bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax. Women experience urinary incontinence twice as often as men. Various factors like pregnancy and childbirth, menopause and the structure of the female urinary tract account for this difference.
Causes of urinary incontinence
Drinking a lot of fluid or any other beverages in a short period of time increases the amount of urine in the bladder which results in urinary incontinence. Alcohol causes the bladder to fill quickly and triggers an urgent and uncontrollable urination. Alcohol also temporarily impairs the ability to recognize the need to urinate and act in a timely manner.
Sedatives such as sleeping pills can interfere with your ability to control bladder function. Water pills like diuretics, muscle relaxants and antidepressants can cause an increase in urinary incontinence. High blood pressure drugs, heart medications and cold medicines also affect the urinary bladder function.
Urinary tract infection can cause bladder irritation and even incontinence. Consuming foods and beverages that irritate your bladder like carbonated drinks, tea and coffee may cause episodes of urge incontinence.
Tackling urinary incontinence
Exercises help to strengthen pelvic floor muscles and sphincter muscles. Electrical stimulation is used to reduce stress incontinence and urge incontinence. Hormones such as estrogen cause muscles involves in urination to function normally. Surgery is suggested to alleviate incontinence only after other methods and treatments have failed.
Myotonia Congenita is a neuromuscular genetic disease that involves progressive muscle stiffness and enlargement. This rare disorder is characterized by bouts of sustained muscle stiffness or Myotonia. The resultant muscle tensing can range from mild to severe. Myotonia Congenita occurs due to mutation of the CLCNI gene. This gene is critical in the functioning of the skeletal muscles. Therefore the mutation leads to bouts of muscle weakness. Abnormal muscle enlargement or hypertrophy is noticed in persons suffering Myotonia, even in children.
Myotonia can affect muscles in any part of the body. In some it can affect the limbs. Some persons experience difficulty in swallowing or inability to relax their muscles quickly after contraction. Other symptoms include shortness of breath at the beginning of exercise.
Thomsen disease: In this form of the disorder, the symptoms manifest early in infancy. The main characteristic symptom of Thomsen disease is muscle stiffness or even muscle weakness after a bout of strenuous exercise. Even stress, fatigue or cold can act as triggers. The symptoms become noticeable in 2-3 years. Limbs and eyelid muscles are often affected. Thomsen disease is transmitted as an autosomal dominant trait.
Becker disease: This form of the disorder typically occurs later in life. The symptoms of Becker disease are noticed between 4-12 years. In Becker Myotonia, there is severe muscle stiffness which can often lead to mild muscle atrophy. Some medications such as beta blockers, diuretics and muscle relaxants can trigger Becker disease symptoms. Becker disease is inherited as an autosomal recessive trait.
An Electromyography is done to test the electrical activity within the muscles. Muscle biopsy is performed to check for absence of 2B fibers. CK blood test is done to check for elevated creatine kinase levels.
Myotonia Congenita Treatment
In the absence of a cure for Myotonia Congenita, a holistic approach encompassing lifestyle changes, physical therapy, and avoiding triggers is effective. Termed as the warm-up phenomenon, for most people regular exercise has been effective to relax the stiff muscles. Healthcare providers suggest making lifestyle modifications such as avoiding certain situations and physical therapy even before prescribing medications. Rehabilitative therapy to improve muscle function and relaxation techniques to reduce stress and mental discomfort which may worsen the disorder is also recommended.
Only when all these are insufficient, medications such as quinine and anticonvulsant drug such as phenytoin are prescribed. Children diagnosed with the disorder should have regular consultation with pediatric neurologist to understand and manage the disorder with the least disturbance during the growing years. Custom designed exercises, selecting suitable games and sports, avoiding foods that trigger lets children work around the symptoms and have a quality life.
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Bibliography / Reference
Collection of Pages - Last revised Date: January 20, 2020