What is Levator Ani Syndrome?
Levator ani Syndrome is episodic rectal pain caused by the spasms of the rectal muscle, called the levator ani. The levator ani is a thin, broad muscle which is situated on the side of the pelvis. This syndrome consists of pain, Gluteal discomfort and distress in the rectal area, and spreads to the region of the sacrum and coccyx. The pain and discomfort caused by this disease is often aggravated by sitting.
The Levator Ani Syndrome is also known as Proctodynia, Proctalgia Fugax, Coccygodynia and Levator Ani Spasm Syndrome.
Levator Ani Syndrome Symptoms
The patients experience a dull ache in the rectum and occasional burning. The pain is often worsened when the stool presses against the levator ani while being expelled.
The most common signs and symptoms of levator ani syndrome include:
- Rectal Pain and Burning
- Rectal tightness and Muscle spasm
- Dull ache in the rectum
- Pain in the tailbone area
- Pressure and Discomfort in the tailbone area
- Discomfort in the rectal area
These are the most commonly occurring symptoms, though the signs may vary from one patient to the other.
Levator Ani Syndrome Causes
Although the exact Etiology is unknown, some relation has been found out between the occurrence of this disease and chronic intermittent rectal pain. The chief cause is Pelvic floor muscle or Myalgia.
When myalgia occurs, it causes acute pain in the rectum followed by tightness and burning. The chronic tension of the levator ani muscle is the cause of this acute pain, and thus the root cause of the Levator Ani Syndrome.
Levator Ani Syndrome and Pelvic Floor Myalgia
The pelvic floor Myalgia is the root cause of Levator Ani Syndrome. It is often associated with pelvic pain. Myalgia implies the appearance of knots in the internal walls of the rectum. These “knots” are the trigger points of action. The pain is the greatest when these knots are active. This is followed by a sensation of tightening and pressure.
Proctalgia Fugax Levator Ani Syndrome
Proctalgia Fugax connotes the perirectal pain which lasts for just a few seconds, disappears for days or even months, due to the absence of the organic disease. On the other hand, Levator Ani Syndrome refers to recurrent and chronic rectal pain, lasting for almost 20 minutes or longer in the absence of the organic disease that causes this pain.
Both these disorders are synonymic and the terms are often used interchangeably. Even the causes of these disorders are somewhat similar. Rectal muscle spasm causes Proctalgia Fugax. Levator Ani Syndrome is caused by Pelvic Floor Myalgia. The treatment of both these disorders is controversial. The patients of either of these disorders should be made to believe that the disorder will diminish over a period of time, since the painful attacks are benign.
Levator Ani Syndrome Vulvodynia
Many a times, people use Vulvodynia and Levator Ani Syndrome interchangeably. But they are not the same. Vulvodynia is a chronic vulvar discomfort characterized by perineal burning, irritation, rawness and stinging. The common signs of vulvodynia are:
- Perineal Irritation,
- Severe point tenderness, and
- Vestibular erythema (inflammation and redness).
Vulvodynia ends on a very chronic note, it can last for months. It also leads to certain neurological problems. Both Levator Ani Syndrome and Vulvodynia are pelvic disorders, affecting mostly women. Doctors should study the type and number of symptoms clearly to differentiate between the two disorders.
Levator Ani Syndrome Diagnosis
Levator Ani Syndrome is diagnosed by rectal examination. While the digital rectal examination is being performed, there may be palpation of the Levator ani muscle, and often this palpation reproduces the pain and causes discomfort to the patients.
The Levator ani muscle is felt as a firm band to the examiner, as he gradually moves from the lateral to the anterior position within the rectum. It was also noted, that the muscle is tender or tight towards the left. If the disorder is accompanied by some other problem, like prostrate disorder, then the diagnosis should be carried out in a different way.
There are no accurate diagnostic studies to confirm this disorder. Therefore, if the practitioner is inexperienced, he should consider other causes of the rectal pain as well, and obtain further consultations, before he comes to the conclusion that the disorder is actually the Levator Ani Syndrome.
Treatment For Levator Ani Syndrome
There hasn’t been any single treatment, which has worked for all Levator Ani Syndrome patients. Some of the traditional Levator Ani Syndrome remedies include:
- Treatment with hot baths
- Muscle relaxants
- Anti-inflammatory Drugs
- Nonsteroidal drugs
- Medication like Medical Marijuana
- Use of Botulinum Toxin
- Electrogalvanic stimulation
Electrogalvanation is suggested for those patients, who do not respond to massage. It is based on the technique of applying low frequency oscillating current to the levator ani muscle, to induce fatigue and fasciculation, so as to break the spastic cycle.
In cases where the attacks have been prolonged and frequent, inhalation of Sulbutanol has helped. Some patients have even been recommended the use of Paracetamol or Acetaminophen to get cured. If one method is not enough to cure the disorder, then a combination of two or more methods should be used.
Levator Ani Syndrome Spasm
The traditional method of Levator ani Syndrome cure involves Spasm and Meditation. It gives relief from the anxiety caused by the occurrence of this disorder. Although medical treatments work a great deal in curing this disorder, but it may benefit those people, who do not want to seek medical treatment.
Those who are very anxious, usually avail this treatment, for it relaxes the mind of the anxiety, and gives it a feeling that the disease is not benign, and will get cured with the passage of the time.
Levator Ani Syndrome Biofeedback
Biofeedback is an effective treatment for Levator Ani Syndrome. The effect of biofeedback in curing the pain caused by the Levator Ani Syndrome was studied by many physiologists all over the world. The patients responded to this treatment positively and marked improvement was noticed in anorectal pain.
In this treatment, the patients are given are given a full course of biofeedback using manometric balloon technique. The physiological tests and the pain score is then effectively administered by an observer both, before and after the test.
It was noticed that the analgesic requirement was reduced significantly. Although not much improvement was observed in the anorectal pain, but there was no side effects related to this technique. It has a negligible effect on anorectal pain, but it is an effective pain reliever.
Levator Ani Syndrome is a curable disease. If you suspect yourself having this disorder, seek medical advice at once. Early diagnosis, followed by a proper medical treatment will help quick recovery and prevent future complications as well.