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
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
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 lower rectum has proven to be effective.