Levator ani syndrome is a disorder in which a person experiences pain in the rectum. The rectum is the last section of the gut, where feces collects before leaving the body through the opening known as the anus. In this syndrome, rectal pain is thought to be caused by spasms in the muscles of the pelvic floor. The pain keeps returning, and typically lasts for hours or even days. Many people are too embarrassed to consult a medical professional about the condition, although treatments are available to ease the symptoms and the disorder is not harmful.
Around 6% of people in developed countries are thought to suffer from levator ani syndrome, although no more than a third consult a healthcare professional about the problem. The main symptom is a dull pain which is experienced in the upper part of the rectum. Lying down or sitting can make the pain worse, while walking may ease it. Painful episodes occur on a regular basis and, when examined, the levator ani muscles may feel tender and unusually tight.
Levator ani syndrome appears to be closely related to another condition, known as proctalgia fugax, which causes short episodes of pain in the anus or the lower end of the rectum. The pain lasts for only minutes or seconds, and it is thought to be due to cramping of the anal sphincter, the ring of muscles that controls the anal opening. Both conditions are thought to be associated with irritable bowel syndrome, in which people experience pain in the abdomen together with constipation or diarrhea.
Diagnosis involves ruling out other causes of tailbone pain, or coccodynia, and anal pain, or proctodynia. Common conditions that may give rise to similar symptoms around the anus include swollen veins, or hemorrhoids, and skin tears, or fissures. The symptoms of this syndrome are usually quite distinctive, but a thorough examination is made to rule out other problems.
Treatment first involves reassuring the sufferer that the condition is not harmful. Taking pain-relieving drugs and massaging the levator ani muscles may help ease the pain. Soaking the painful area in a hot bath may provide relief and, in some cases, what is called electrogalvanic stimulation can be beneficial, where a probe is used to electrically stimulate the muscles. Other treatments, such as biofeedback, where people learn to relax the levator ani muscles, have proved useful for some. Further research needs to be carried out to determine which are the most effective treatment options.
