An Overview of Levator Ani Syndrome

Chronic Anal Pain

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Levator ani syndrome (LAS) is a medical condition characterized by chronic anal pain that is caused by tight muscles in the pelvic and anal regions. 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. It is estimated that LAS affects approximately 7.4 percent of women and 5.7 percent of men. Only about a third of those with the condition seek medical attention for it, but there are strategies that can help relieve symptoms for those who do.

Criteria and Symptoms

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 that last for at least 30 minutes
  • Tenderness of the puborectalis muscle (which wraps around the rectum and the pubic bone) when it is touched
  • A least six months of symptoms, at least three of which must be consecutive
  • 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 related to the puborectalis muscle.

Other Characteristics

Aside from the syndrome criteria, you may also experience other symptoms, including difficulty having bowel and/ or bladder movements, frequent bowel and/or bladder urges, or bowel and/or bladder incontinence.

Women and men may experience pain during or after sex, and men may experience sexual dysfunction.

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 vaginal childbirth, particularly if you had a large incision or vaginal tears. Surgery or trauma involving 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.
  • Inflammatory disease: Conditions characterized by irritation or inflammation near the anal area, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), chronic constipation, and infections, can increase your risk of developing this condition.

Diagnosis

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

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 temporarily relieve muscle spasms and symptoms of LAS.
  • 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.
  • Therapies: 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 prescription muscle relaxant that may relieve temporarily relieve symptoms for some people who have LAS.
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