By Dr. Allen Douma
Q: Recently a member of my family was diagnosed with levator ani syndrome. The colorectal specialist who saw him said there is no cure for this painful and embarrassing ailment! Perhaps you have bumped into a cure for levator syndrome.
— B.
A: I haven’t bumped into a cure. But, in researching the problem, I found some approaches that may help. A number of conditions cause pain in and around the perineum, which is the area between the tail bone and pubic bone. These include abnormalities of the anus, colon, vagina and testicles. But often the source of pain cannot be identified.
Three of the most common disorders that cause anorectal and perineal pain are levator ani syndrome, coccygodynia and proctalgia fugax. Making the diagnosis of levator ani syndrome requires tenderness when pressing on the levator ani muscles.
These are two muscles that stretch across the bottom of the pelvic cavity. They act like a hammock and support the organs in the bottom of the abdominal cavity. They also provide support so that when organs such as the bladder and colon contract they have something to pull against.
The pain comes and goes over a few minutes to days without anything that seems to set it off. Some people can lessen the pain with relaxation; for others, eating may decrease it.
People with this problem are also much more likely to have irritable bowel syndrome.
Presumably, the pain and tenderness is due to spasm or cramping of part of the levator ani muscles. But the cause or causes of the cramping are not known.
Most people with levator ani syndrome will be able to live with the condition without specific treatment. For many others, training themselves to relax the pain away can make the condition much more comfortable.
Research reports indicate that four types of treatment help some people: massage, electrostimulation, injection of botulinum toxin, and injection of a combination of a steroid and anesthetic. No research has compared these approaches for effectiveness (except for one study that compared electrostimulation to steroid injection and found that similar results were obtained).
One study found that about half the people were helped by massage of the perineal area, especially toward the tail bone. In this study, people who also had irritable bowel syndrome showed improvement in the symptoms of that condition as well, for completely unknown reasons.
Unfortunately, only about half of those treated with any of the approaches to levator ani syndrome will be helped. And the effects and benefits wear off within a few months to years.
In summary, levator ani syndrome must be diagnosed with care after other physical causes have been ruled out. Treatment should then be focused on trying to manage it using relaxation techniques during times of pain. And if this is not satisfactory, specialist care should be sought to discuss the risks, benefits and costs of various other approaches.
Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, NY 14207; or contact him at [email protected].
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