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Levator Syndrome

by Parswa Ansari, MD

Levator syndrome is sporadic pain in the rectum caused by spasm of a muscle near the anus (the levator ani muscle).

Proctalgia fugax is fleeting pain in the rectum. Coccydynia is pain near the tailbone (coccyx). Both of these disorders are variations of levator syndrome.

The muscle spasm causes pain that typically is not related to defecation. The pain usually lasts less than 20 minutes. Pain may be brief and intense or a vague ache high in the rectum. It may occur spontaneously or with sitting and can waken a person from sleep. The pain may feel as if it would be relieved by the passage of gas or a bowel movement. In severe cases, the pain can persist for many hours and can recur frequently. A person may have undergone various unsuccessful rectal operations to relieve these symptoms.

Diagnosis

  • A doctor's examination

A doctor does a physical examination to rule out other painful rectal conditions (such as thrombosed hemorrhoids, fissures, or abscesses). The physical examination is often normal, but the muscle may be tender or tight. Occasionally, the pain is caused by low back or prostate disorders.

Treatment

  • Pain relievers and sitz baths

  • Physical therapy of the pelvis

The doctor explains that this condition is not life-threatening or severe. An episode may be relieved by the passage of gas or a bowel movement, by a sitz bath (see Hemorrhoids : Treatment), or by a mild pain reliever (such as aspirin). When the symptoms are more intense, people can undergo physical therapy of the pelvis. Therapy sometimes includes mild electrical stimulation of the area using a probe inserted into the anus, which may help stop muscle spasms.

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