(See also Evaluation of Anorectal Disorders Evaluation of Anorectal Disorders The anal canal begins at the anal verge and ends at the anorectal junction (pectinate line, mucocutaneous junction, dentate line), where there are 8 to 12 anal crypts and 5 to 8 papillae. The... read more .)
Proctalgia fugax (fleeting pain in the rectum) and coccydynia (pain in the coccygeal region) are variants of levator syndrome. Rectal spasm causes pain, typically unrelated to defecation, usually lasting < 20 minutes. The pain may be brief and intense or a vague ache high in the rectum. It may occur spontaneously or with sitting and can waken the patient 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 recur frequently. The patient may have undergone various rectal operations for these symptoms, with no benefit.
Physical examination can exclude other painful rectal conditions (eg, thrombosed hemorrhoids Hemorrhoids Hemorrhoids are dilated vessels of the hemorrhoidal plexus in the anal canal. Symptoms include irritation and bleeding. Thrombosed hemorrhoids are usually painful. Diagnosis is by inspection... read more , fissures Anal Fissure An anal fissure is an acute longitudinal tear or a chronic ovoid ulcer in the squamous epithelium of the anal canal. It causes severe pain, sometimes with bleeding, particularly with defecation... read more , abscesses Anorectal Abscess An anorectal abscess is a localized collection of pus in the perirectal spaces. Abscesses usually originate in an anal crypt. Symptoms are pain and swelling. Diagnosis is primarily by examination... read more ). Physical examination is often normal, although tenderness or tightness of the levator muscle, usually on the left, may be present. Occasional cases are caused by low back or prostate disorders. Other causes of pelvic pain Pelvic Pain Pelvic pain is discomfort in the lower torso; it is a common complaint in women. It is considered separately from perineal pain, which occurs in the external genitals and nearby perineal skin... read more (eg, cancer) must be ruled out. In most cases, a distinct cause of levator syndrome is not identified.
Treatment of levator syndrome consists of explanations to the patient of the benign nature of the condition. An acute episode may be relieved by the passage of gas or a bowel movement, by a sitz bath, or by a mild analgesic. When the symptoms are more intense, physical therapy may be effective. Skeletal muscle relaxants or anal sphincter massage under local or regional anesthesia can be tried, but the benefit is unclear.