Levator Syndrome

Levator syndrome is an episodic rectal pain caused by spasm of the levator ani muscle. The ischiococcygeal syndrome, proctalgia fugax, and coccydynia, are variants of the levator syndrome.

At first, the sensation is that of a cramp or spasm situated in the rectum approximately 10 to 15 cm above the anus, gradually becoming more intense to a point of intolerance. After reaching a peak, it gradually subsides, and usually lasts for about 20 minutes at a time. The pain may be related to sitting, can occur spontaneously, and can awaken the patient from sleep. The pain is often described as a vague ache high in the rectum, or as a sharp pain overwhelming in character, like a knife twisting inside the rectum.

Physical examination is usually found to be normal. Emotional factors, sexual activity, or fatigue may trigger an attack. Often levator syndrome is triggered by a physical malady, like a direct injury to the coccyx, low back pain, anal fissures, abscesses, gas distention of the lower bowel, or prostate disorders. Structural deviations of the lumbo-sacral area, sacro-iliac, coccyx, and supportive structures are factors that can predispose the levator ani muscle to spasm.

Osteopathic Treatment for Levator Syndrome

A fracture or dislocation of the coccyx should be reduced by bi-manual manipulation with a finger in the rectum. Tenderness or tightness of the levator muscle, usually on the left, may be found. Mostly, this will respond readily to osteopathic manipulative treatment. Correction of the sacro-iliac subluxation and maintainence of the sacro-iliac integrity is most essential. Digital stretching of the ischiococcygeus tends to relax the structure, and allows it to assume a more normal attitude. In some instances, the syndrome may be bilateral, but the treatment is the same. Results are often dramatic.

When the symptoms are more intense, skeletal muscle relaxants or anal sphincter massage under regional or general anesthesia can be tried. Additionally, physical therapy with electro-galvanic stimulation applied to the prednisone lower rectum has proven to be effective.