(See also Evaluation of Anorectal Disorders.)
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, fissures, abscesses). 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 (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.