levator ani syndrome (also called levator spasm, puborectalis syndrome, chronic proctalgia, pyriformis syndrome, and pelvic tension myalgia)
pain - often described as a dull, vague ache or pressure sensation high in the rectum, often worse with sitting or lying down, which lasts for hours to days
prevalence of symptoms compatible with levator ani syndrome in the general population is 6.6%
the condition is more common in women
more than 50% of affected patients are aged 30-60 years, and prevalence tends to decline after age
aetiology is unknown
diagnostic criteria(1) Chronic or recurrent rectal pain or aching; (2) Episodes last 20 minutes or longer; and (3) Other causes of rectal pain such as ischemia, inflammatory bowel disease, cryptitis, intramuscular abscess, fissure, hemorrhoids, prostatitis, and solitary rectal ulcer have been excluded
at least 12 weeks, which need not be consecutive, in the preceding 12 months of:
clinical evaluation
diagnosis of levator ani syndrome is made on the basis of symptoms alone and exclusion of other causes of rectal pain
however if posterior traction on the puborectalis reveals tight levator ani muscles and tenderness or pain then this is suggestive of levator ani syndrome
tenderness may be predominantly left-sided, and massage of this muscle will usually elicit the characteristic rectal discomfort
clinical evaluation will generallly include sigmoidoscopy and appropriate imaging studies such as ultrasound, or pelvic CT to exclude alternative diseases
treatment
a variety of treatments directed at reducing tension in the levator ani muscles have been described:
digital massage of the levator ani muscles
Sitz baths
muscle relaxants such as diazepam
electrogalvanic stimulation
and biofeedback training
however none of the treatment studies included a control group, and patient selection criteria varied (1)
many patients fail to respond to treatment. Surgical treatment of this condition should be avoided
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