Causes and risk factors
The main cause of this condition is said to be the spasm of the levator ani muscle, although the exact cause and mechanism involved is still not clear. Studies have shown that certain factors can trigger this condition. A few among them are anxiety, stress, fatigue, or exposure to cold and heat. Levator syndrome can also be induced due to side effect of certain medications like narcotics, calcium channel blockers, etc.
Clinical presentation:
Pain and discomfort in the rectal region is the characteristic feature seen. The pain is mostly restricted to upper anal region. Dull aching pain is felt. The complaints have an episodic pattern. The patient has to frequently wake up at night due to pain. Prolonged sitting aggravates the pain. In some cases, the pain starts during bowel movement. Straining of stool can also initiate the pain. The pain lasts from a few seconds to minutes and disappears suddenly. The patient feels pressure like sensation in the lower abdomen, with a feeling as if the pain and discomfort will get better by passage of gas or by passage of stools. In severe cases, the pain can persist for long hours. The severity of complaints and frequency of appearance decreases after the age of 60 years.
Investigations:
Diagnosis is done on the basis of the symptoms narrated by the patient. A per rectal examination is carried out. Usually this condition is diagnosed by excluding the other ones. Investigations like routine and specialized blood tests, stool examination, ultrasonography, proctoscopic examination, etc., is done. Certain other investigations can also be advised.
Treatment:
The treatment plan consists of administration of medications like pain reliving medications or muscle relaxants. In some cases, botulinum toxin injections have also given good results. Warm baths (sitz baths), exercises for perineal muscle strengthening, and rectal massage seems to be useful. High-fiber diet is recommended. Use of medications which stimulate the complaint should be avoided. Use of high-voltage pulsed galvanic stimulation has also been used effectively in this treatment.
Other Modes of treatment:
Biofeedback and acupuncture are certain other modes of treatment which seems to be giving effective results. Certain yoga exercises or physical exercises under trained physiotherapists will help to strengthen the muscles of the pelvic region.
When to contact a doctor:
Seek an advice from an orthopedic doctor if one experiences any pain or discomfort in the rectal region.
System Involved: Gastrointestinal tract.
Organ involved: Muscles, bones, nerves, rectum, and anus
