Levator ani syndrome

Signs and symptoms

A dull ache, often felt on the left side about two inches above the anus or higher in the rectum, is a common symptom, along with a constant sense of rectal pressure or burning. Pain episodes last at least half an hour and are chronic or intermittent, unlike the brief pain of proctalgia fugax.

Sitting typically worsens the discomfort. Triggers include prolonged sitting, defecation, stress, sexual intercourse, childbirth, and surgery. The levator ani muscle may feel tender when pressed.

Cause

Levator ani syndrome involves painful spasm of the levator ani muscle. The cause is unknown, but inflammation of the arcus tendon is a suggested mechanism. The condition is not considered psychosomatic, though stressful events can provoke attacks. Affected individuals show elevated scores on the hypochondriasis, depression, and hysteria scales of the Minnesota Multiphasic Personality Inventory, a pattern also seen in other chronic pain patients.

Did You Know?

• Diagnosis is clinical and does not require routine imaging; other causes of rectal pain must be excluded.
• Treatments include walking, pelvic relaxation, massage, warm baths, muscle relaxants like cyclobenzaprine, therapeutic ultrasound, biofeedback, electrical stimulation, and botulinum toxin A injection.