A Simple Guide to Levator Ani Syndrome, Diagnosis, Treatment and Related Conditions

By Kenneth Kee

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
Chapter 8 Encopresis
Epilogue

• Language: English
• Publisher: Kenneth Kee
• Release date: Jun 2, 2021
• ISBN: 9781005489625

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

A

Simple

Guide

To

Levator Ani Syndrome,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2021 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Levator Ani Syndrome, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What You Need to Treat Levator Ani Syndrome)

This e-Book is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiography account of my journey as a medical student to family doctor on my other blog: http://afamilydoctorstale.blogspot.com.

This autobiography account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

My diagnosis and treatment capability has improved tremendously from my continued education.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Levator ani syndrome

What is Levator ani syndrome?

Levator ani syndrome is a form of 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.

It is evaluated that 33-39% of woman will develop pelvic pain at least one point in their lives with as many as 20% of these cases progressing to Chronic Pelvic Pain (CPP).

It is also evaluated that up to 5% of the general population of women will experience CPP that estimate rises to 20% in those with a previous diagnosis of pelvic inflammatory disease (PID).

Of the disorders that cause pelvic pain, levator ani syndrome is one of the least frequent, overall.

Despite its overall rarity, it can affect as many as 7.4% of woman, and 5.4% of men.

While it is not entirely understood as to why women seems to be more vulnerable to it, the obvious differences in the content of the pelvis between men and women is thought to play a role.

In men, the organs and the pelvic floor are never meant to move.

Women have evolved to possess a dynamic pelvic region and pelvic floor to accommodate a baby during pregnancy and musculature that can shift during the process of child birth.

It is believed that the relative lack of rigidity may play a part such that the area may be more predisposed to movement and change which causes spasm and dysfunction.

Levator ani syndrome has many other names such as:

1. Chronic anorectal pain

2. Chronic proctalgia

3. Levator spasm

4. Pelvic tension myalgia

5. Piriformis syndrome

6. Puborectalis syndrome

Pelvic floor disorders

Pelvic floor disorders happen when the muscles are not working correctly.

They happen from two disorders.

Either the pelvic floor muscles are too relaxed or too tight.

1. Pelvic floor muscles that are too relaxed can produce pelvic organ prolapse.

An unsupported bladder can cause urinary incontinence.

In women, the cervix or uterus can fall into the vagina.

This can induce back pain, disorder urinating or having a bowel movement, and painful intercourse.

2. Pelvic floor muscles that are too tight can cause non-relaxing pelvic floor dysfunction.

This can produce disorders with storing or emptying bowels, and pelvic pain, painful intercourse, or erectile dysfunction.

The pain of levator ani syndrome is produced by a spasm in the levator ani muscle.

Pain may extend to the hips, tailbone, or other areas.

This pain is normally not linked to a bowel movement, and there seem to be no structural abnormalities or underlying disorders responsible for the symptoms.

Until 2016, levator ani syndrome was regarded as a form of chronic proctalgia.

The term chronic proctalgia is now not used, and levator ani syndrome is no longer a subtype.

What are the causes of Levator ani syndrome?

Causes

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 there is a need to

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, such as:

a. Irritable bowel syndrome,

b. Endometriosis, or

c. Interstitial cystitis

Spasm of the levator ani muscles and inflammation of the arcus tendon are known to produce the episodes of pain itself but why these 2 happens in the first place is a mystery.

Childbirth and surgery are suspected possible causes or at the very least precipitating factors that may make one more prone to develop it.

While levator ani syndrome is not considered 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.

The