Levator syndrome is sporadic pain in the rectum caused by spasm of a muscle near the anus (the levator ani muscle).

Proctalgia fugax (fleeting pain in the rectum) and coccydynia (pain near the tailbone [coccyx]) are variations of levator syndrome. The muscle spasm causes pain that typically is not related to defecation. The pain usually lasts less than 20 minutes. Pain may be brief and intense or be a vague ache high in the rectum. It may occur spontaneously or with sitting and can waken a person from sleep. The pain may feel as if it would be relieved by the passage of gas or a bowel movement. In severe cases, the pain can persist for many hours and can recur frequently. A person may have undergone various unsuccessful rectal operations to relieve these symptoms.

Diagnosis

A doctor performs a physical examination to exclude other painful rectal conditions (such as thrombosed hemorrhoids, fissures, or abscesses). The physical examination is often normal, although the muscle may be tender or tight. Occasionally, the pain is caused by low back or prostate disorders.

Treatment

The doctor explains the benign nature of the condition. An episode may be relieved by the passage of gas or a bowel movement, by a sitz bath, or by a mild pain reliever (such as aspirin). When the symptoms are more intense, people can undergo therapy with electrogalvanic stimulation, in which a high-voltage current is delivered to the muscle via a probe inserted into the anus. Such stimulation helps stop muscle spasms.

Last full review/revision October 2007 by Parswa Ansari, MD; Norman Sohn, MD