A surprisingly common problem not often talked about in polite company, as they say, is levator ani syndrome. An estimated 6% of the US population suffers this chronic pain in the rectal area, and while the joke potential is obvious, the situation is no laughing matter. It’s a dull ache high in the rectum that results in discomfort variously described as fullness, pressure and sometimes burning. The discomfort is caused by spasm in the levator ani, a pair of muscles that stretch across the pelvic cavity and help support the pelvic organs. (Incidentally, these are the muscles dogs use to wag their tails.) Sufferers say that sitting can hurt so much that they often choose to stand instead, and some find having a bowel movement intensely painful because of the pressure it puts on the levator ani muscles. New research has identified a solution that works quite well, for some patients at least.
There seems to be more than one cause for levator ani syndrome, and few treatments that help. Some people find that walking alleviates the pain, but beyond that, doctors have only three therapies to offer — biofeedback, electro-galvanic stimulation (EGS) and deep digital massage followed by a warm bath.
A new study verifies that biofeedback training is by far the most effective — with a total of 57% of patients reporting adequate relief from biofeedback versus 26% for EGS and 21% for massage. The study was conducted by Giuseppe Chiarioni, MD, at the University of Verona, Italy, in collaboration with William E. Whitehead, PhD, professor of medicine and codirector at the University of North Carolina Center for Functional GI & Motility Disorders.
When I called Dr. Whitehead, he told me that the biofeedback used focuses on the pelvic floor. The technique teaches patients how to relax their muscles and to avoid excessive straining, reducing tension or “spasm” in the pelvic floor muscles and — usually — making the pain go away.
The biofeedback involves five to nine training sessions of up to an hour each, and patients report that the relief is long-lasting. In a typical session, the doctor or nurse will insert a small plastic cylinder that is about three inches long and three-quarter inches wide into the anal canal and connect it to the biofeedback machine. The plastic cylinder has metal plates in it that pick up electrical impulses from the pelvic floor muscles and display them as a measure of muscle tension. With guidance and encouragement from the therapist, patients use this feedback to learn how to relax the muscles. They also do exercises at home, including squeezing and relaxing the pelvic floor muscles 20 to 50 times a day.
Researchers found that 87% of the patients who reported tenderness when a doctor pressed on the levator ani muscles during a digital rectal exam found relief from the biofeedback training… and also that these were the onlypatients helped by this therapy. Dr. Whitehead said that there is likely a different mechanism causing the pain for the other patients — he recommends talking to your doctor to see if another problem (such as IBS) might be the cause, in which case different treatment might help.
Hospitals with pelvic floor biofeedback programs offering this therapy include the Mayo Clinics in Rochester, Minnesota, and Scottsdale, Arizona… the Cleveland Clinic in Fort Lauderdale, Florida… and the University of North Carolina, where Dr. Whitehead works. Dr. Whitehead also suggests checking the Web site of the American Gastroenterological Association (www.Gastro.org) for a list of gastroenterologists in your area — you can call around to find one who is familiar with this therapy.
