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Levator Muscle Syndrome

Proctalgia Fugax is an episodic deep rectal pain that may awaken you from sleep and become excruciating before it lets up spontaneously. The pain is often on the left side, and is usually unrelated to bowel movements.

In this condition, the pain is a spasm of the Levator Muscles, which support the rectum within the pelvis. The cause is unknown, but it is frequently associated with 1) Diarrhea, which increases anal muscle tone to prevent incontinence. 2) Straining to defecate and/or sitting for prolonged periods of time on the commode. 3) Chronic low back pain, and 4) Poor posture with the loss of the lumbar spine curvature (often occurring when driving or sitting for long period). The pain is not due to cancer, and with proper care the symptoms usually resolve in several weeks.

Treatment is directed at breaking the painful muscle spasm and preventing its recurrence.

Treatment includes:

  1. Control diarrhea (Immodium AD) or prevent constipation (Fiber supplements, stool softeners, prune juice).
  2. Avoid straining to have a bowel movement.
  3. Remove all newspapers and reading materials from the bathroom. The time spent sitting on the toilet should be minimal.
  4. Warm Sitz/tub baths for 15-20 minutes.
  5. Muscle relaxing medications (Advil, Valium, Elavil, Nitroglycerine ointment, Quinine Sulfate, etc)
  6. Use of anti-inflammatory meds (Dolobid) or muscle relaxants (low dose Valium)
  7. Electrogalvanic stimulation — A low frequency oscillating current is applied to the muscles, inducing muscle activity to the point of fatigue, thereby breaking the spasm. This is successful in about 2/3's of patients.