What is Levator Syndrome?
Levator syndrome is episodic pain in the rectum, sacrum, or coccyx, also associated with aching pressure in the buttocks and thighs. The exact causes of levator syndrome are not known, but it is largely attributed to spasm or inflammation in the muscles of the pelvic floor (levators). The pain may be vague or localize to the rectum, anus, rear of the pelvis, or tailbone. This is intermittent, but may last for days in certain cases. Digital rectal examination by a practitioner may reproduce this pain.
What is Proctalgia Fugax?
A variant of levator syndrome is known as proctalgia fugax (fleeting rectal pain). This is characterized by brief, intense pain in the rectum that lasts for just seconds to minutes. The spasms often wake patients from sleep, but may happen during the day as well. Proctalgia fugax is difficult to evaluate due to its brief episodes, but often may be diagnosed on history alone. It is felt to be due to cramping of the pelvic floor muscles.
How is Levator Syndrome Treated?
Physical therapy, including massage of the pelvic floor muscles, is extremely effective at treating the symptoms. Biofeedback therapy relieves the pain by modifying the pelvic activity. Muscle relaxants provide excellent relief, though with the side effect of drowsiness. Local anesthesia or steroid injections have been performed, but are less consistent than therapy or muscle relaxants.