Levator Syndrome: Can a Colorectal Surgeon Help?

Medically reviewed by: Gary H. Hoffman, MD

Awake At Night?  It May Be Levator Syndrome. Proctalgia Fugax.  Coccydinia.

Levator Syndrome. It Hurts! Can A Colon And Rectal Surgeon HelpHave you ever awakened at night with severe pain in your pelvis or around your anal opening?  Have you tried home remedies or, perhaps a bit of alcohol to relieve the discomfort and feeling of spasm?  You are not alone.  You may have levator syndrome, or one of its relatives coccydynia or proctalgia fugax.  A proctologist, also known as a colon and rectal surgeon, may be able to help.

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The levator ani muscles are a group of broad flat muscles which act as the floor of the abdominal cavity and, at the same time are also the ceiling of the pelvis.  Picture a large cavity divided by a set of muscles.  The muscles have various names. They serve to provide support for the organs that rest atop them.  They also support the rectum as it passes through the levators, toward the anal canal.

Muscular Spasm.  Why So Uptight?

For reasons unknown, these muscles, much like any muscle, can go into spasm.  If you have ever had a leg cramp, then you understand the feeling.  In the pelvis, pain is experienced deep in the pelvic cavity or just inside of the anal canal.  The pain is sharp, constant and intense.  The pain seems to occur at night and awakens the sufferer from sleep.  Perhaps it is the intense night time dreaming experience, full of the good and the bad that sets off these vigorous muscular contractions.  The pain may occur during waking hours as well.  In levator ani syndrome, pain usually lasts for 20 to 30 minutes as opposed to the pain of a related syndrome, proctalgia fugax, which is fleeting, lasting for only several minutes. When a person has coccydinia, biking, horseback riding or other activities associated with pressure on the coccyx (tailbone) can cause pain to be precipitated.

Patients describe the pain as “unimaginable”, “awful” and “terrifying”.  As the contracting muscles literally pull on the surrounding nerves and on the rectum, these nerves, the pudendal nerve, the perineal nerve and the inferior rectal nerve, become very sensitive to stretch and send pain signals to the brain.

The Proctologist May Be Able To Help.

No single cause has been identified and it would be fruitless to name all of the theories that explain the cause.  None has been found.   The most important thing to do if you are experiencing this type of discomfort is to consult a colon and rectal surgeon Los Angeles or Beverly Hills.  It is important to be sure that your pain is not caused by any other issues such as rectal tumors or polyps, infections or inflammations such as ulcerative colitis and Crohn’s disease or hemorrhoidal disease.

Treatment focuses on symptoms.  Warm tubs, pelvic exercise such as Kegel exercises, electro-galvanic stimulation of the muscles, muscle relaxants, digital anal massage, biofeedback and even botulinum toxin, which may serve to temporarily paralyze the muscles, allowing them to relax have been tried.  Success has been limited.

There is a bit  of good news here.  The pain is self limited and will resolve spontaneously.  It will recur, but many patients report “growing out of it” as they age.

Los Angeles Colon and Rectal Surgical Associates

If you have any concerns or questions, the board certified surgeons at Los Angeles Colon and Rectal Surgical Associates will be able to address these with you in a calm and reliable way.  Your confidential appointment may be made by calling (310)273-2310.  There are many pre-appointment forms available online on the office website.

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