Understanding Levator Ani Syndrome

Chronic Anal Pain

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Levator ani syndrome (LAS) is a medical condition characterized by chronic anal pain. It is estimated that LAS affects approximately 7.4 percent of all women and 5.7 percent of all men. Only about a third of those with the condition seek medical attention for it. The cause of the syndrome is not clear, and there are some strategies that can help relieve the symptoms.

LAS is one of the functional gastrointestinal disorders (FGD), which are a group of digestive disorders that cause signs and symptoms without a known cause.

Definition of Levator Ani Syndrome

LAS produces chronic intermittent pain in the upper region of the rectum. The pain is typically described as a dull ache, a sense of pressure, or a burning sensation, and it generally worsens with sitting and eases when standing up or lying down.

LAS has been defined according to Rome IV criteria, which classifies the FGD, including levator ani syndrome.

Levator ani syndrome criteria are:

  • Episodes of chronic or recurrent rectal pain or aching
  • The episodes must last for at least 30 minutes
  • Tenderness of the puborectalis muscle when it is touched. The puborectalis muscle wraps around the rectum and the pubic bone.
  • Symptoms lasting for at least a three-month consecutive period
  • A least six months of symptoms
  • No identifiable cause

LAS used to be considered a form of chronic proctalgia, although this term is no longer used. There are several other terms that are synonymous with LAS, including levator spasm, levator syndrome, and puborectalis syndrome, all of which describe the symptoms of spasm or pain of the puborectalis muscle.

Risk Factors

The cause of LAS is not clear, but it is associated with dysfunction and spasm of the puborectalis muscle.

  • Medical history: You may be at higher risk for developing levator ani syndrome after childbirth. Surgery of the spine, anus, or pelvic area may also predispose you to the condition.
  • Muscle dysfunction: Dyssynergic defecation is a condition in which the pelvic floor muscles, including the puborectalis muscle, do not function as they should. It may play a role in the development of the syndrome.

Diagnosis of Levator Ani Syndrome

Levator ani syndrome is diagnosed after other health conditions have been ruled out.

In addition to listening to your history, your doctor will need to do a physical exam. Your physical examination will probably be normal. You will probably have a rectal examination, and, while this exam does not typically hurt, you are highly likely to experience some pain and tenderness if you have LAS, and your anal muscles may be tight or may spasm during the exam.

In general, blood tests and imaging tests are not diagnostic of this disorder, but you may need to have some diagnostic tests to rule out other disorders.

Possible causes of rectal pain that need to be ruled out before a diagnosis of LAS is made include:

Treatment of Levator Anti Syndrome

There are a few treatment options for LAS, including at-home treatments, prescription medication, and interventional procedures. Most of the recommended treatments can provide temporary relief, but they have not been proven effective for the long term.

  • At-home treatments: Using sitz baths can help relieve muscle spasms and symptoms of LAS for the short term.
  • Lifestyle strategies: Maintaining a diet that is moderate in fiber to promote regular bowel movements and help avoid constipation or diarrhea, can prevent exacerbation of your symptoms. Staying active and avoiding prolonged sitting can help as well.
  • Procedures: Some interventional strategies, including digital message by a qualified physical therapist, biofeedback, and electrogalvanic stimulation have been shown effective for some people who have LAS.
  • Flexeril (cyclobenzaprine): Flexeril is a muscle relaxant that may relieve temporarily relieve symptoms for some people who have LAS.
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