This book describes Levator Ani Syndrome, Diagnosis and Treatment and Related Diseases

Levator ani Syndrome is an episodic rectal pain produced by the spasms of the rectal muscle, called the levator ani.

The levator ani is a thin, broad muscle which is located on the side of the pelvis.

This syndrome comprises:
1. Pain,
2. Gluteal discomfort and
3. Distress in the rectal area,

It spreads to the region of the sacrum and coccyx.

The pain and discomfort produced by this disease is often exacerbated by sitting.

Levator ani syndrome is a pelvic floor dysfunction where the muscles are not relaxed.

It indicates that the pelvic floor muscles are too tight.

The pelvic floor strengthens the rectum, bladder, and urethra.

In women, levator ani muscle also has supported the uterus and vagina.

Levator ani syndrome is more frequent in women.

Its main symptom is constant or frequent dull pain in the rectum caused from a spasm in the levator ani muscle, which is near the anus.

Generally speaking, pelvic pain as a whole is considered a neuropathic disorder indicating the pain is caused by nerve damage which causes pain in the associated area.

Levator ani syndrome, on the other hand, is a combination of neuropathic and muscular pain which makes it much harder to tease out from other types of pain.

It is not obvious if the muscle dysfunction is what led to nerve damage or the other way around.

Either way, one cannot effectively treat levator ani syndrome without treating both pathologies.

The precise cause of levator ani syndrome is not known.

It may be related to any of these:
1. Not urinating or passing stool when needed
2. Vaginal shrinking (atrophy) or pain in the vulva (vulvodynia)
3. Continuing sexual intercourse even when it is painful
4. Injury to the pelvic floor from surgery or trauma, such as sexual abuse
5. Having another type of chronic pelvic pain:
a. Irritable bowel syndrome,
b. Endometriosis
c. Interstitial cystitis

Spasm of the levator ani muscles and inflammation of the arcus tendon are known to produce the episodes of pain itself.

Childbirth and surgery are suspected possible causes that may make one more prone to develop it.

While levator ani syndrome is not a psychosomatic disorder, it can be made worse with stress and anxiety.

Levator ani syndrome has been linked with a high incidence of hypochondriasis, depression, hysteria, perseveration and catastophization.

A doctor will suspect levator ani syndrome if the patient:
1. Reports chronic or recurrent rectal pain that lasts for at least 20 minutes.
2. Develops severe tenderness when the levator muscle is touched.

The most important first stage in treating levator ani syndrome is to aim for relaxation

Something as simple as taking a relaxing walk can relieve muscle tension in the pelvic floor

The doctor may use any of these treatments for levator ani syndrome:
1. Physical therapy, including massage, heat, and biofeedback, with a therapist trained in pelvic floor dysfunction
2. Prescription muscle relaxants or pain medicine, such as gabapentin and pregabalin
3. Trigger point injections, which may be with a corticosteroid or botulinum toxin
4. Nerve stimulation

Biofeedback has been found to be very effective and a better treatment than the rest.

TABLE OF CONTENT
Introduction
Chapter 1 Levator Ani Syndrome,
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Pelvic Floor Disorders ...read more