Tuesday, September 02, 2014

Levator Syndrome

Definition

Levator syndrome consists of pain, pressure, and discomfort in the region of the rectum, sacrum, and coccyx, which appears to be aggravated by sitting.

This is also known as coccygodynia, levator ani syndrome, levator ani spasm syndrome, proctalgia fugax, and proctodynia.

Description

Gluteal discomfort and high rectal distress usually occur. Tenderness and muscle spasm affecting the levator ani muscles are the principal symptoms of this disorder.

Causes

The etiology is unknown.

Symptoms

Most patients complain of a dull ache high in the rectum. There may be a feeling of constant rectal pressure and occasional burning. Some patients complain of feeling like they are sitting on a "ball" or that there is a "ball" in their rectum. The pain can be made worse by a bowel movement when the stool presses against the levator ani (muscle) as it is being expelled.

A variant of the levator syndrome is proctalgia fugax, a feeling of severe pain in the rectum which generally occurs at night and which will awaken the patient from a sound sleep.

The term coccygodynia was often used in the past for this condition, but few patients actually have coccygeal (tailbone) pain.

Diagnosis

Many patients will have sought previous treatment for their discomfort, but the diagnosis was missed. A complete examination fails to reveal other painful lesions in the anorectum. Rectal examination reveals a tender levator muscle, which when digitally pressed, reproduces the patient's discomfort.

Treatment

Periodic massage of the painful spastic muscle combined with warm baths and muscle relaxants may be useful. The patient should be instructed to take hot baths nightly for 20 minutes. Sleeping on an electric heating pad applied to the anal area is also effective. Biofeedback training is also effective.

In those patients who do not respond to massage, electrogalvanic stimulation is employed. Galvanic muscle stimulation for the treatment of levator syndrome is based on prior experience of physiatrists in using this modality to treat spastic muscle groups. The rationale on which this therapy is based is that a low frequency oscillating current applied to the muscle induces fasciculation and fatigue which breaks the spastic cycle.

Questions

Is there an underlying organic cause of the rectal pain?

What is the probable cause of the discomfort?

Will massage be of benefit?

Should hot baths be taken?

Do you recommend treatment by galvanic muscle stimulation?