CHRONIC RECTAL OR PELVIC PAIN As we have discussed in previous articles, there are 3 common causes of rectal pain. THROMBOSED HEMORRHOIDS, FISSURES, AND ABCESSES. There are a number of causes of less significant irritation such as pruritus, skin tags, and anything else that can irritate the skin.

The least common cause of pain falls in the category of something we call Levator Syndrome/Spastic Levator/Pelvic Floor syndrome, or Chronic Proctalgia. Proctalgia literally translates to ‘rectal pain’. This can be intermittent discomfort which occurs over a matter of a few minutes and dissipates just as quickly, typically occurring at night, and called Proctalgia Fugax ( fleeting pain in the rectum ); or more chronic pain which can last days, weeks or in some cases many years. We refer to this more chronic discomfort as Levator or Pelvic floor syndrome. Although this has been related to pelvic surgery, or certain jobs requiring prolonged sitting or maintaining certain positioning, my experience has been that most often I can find no obvious cause! I have in fact seen it in a patient who had no rectum, it having been removed for inflammatory bowel disease many years before. Though we often use the term rectal to describe the pain, it is in fact in the muscles of the pelvic floor and the sphincter muscles. Examination will show no abnormalities on anorectal exam and colonoscopy. The diagnosis is made by eliciting pain on rectal exam within the sphincter and levator muscles of the pelvic floor. It is most often more severe on the left side.

Treatment can be difficult but is successful in most patients. It consists of warm sitz baths to relax and sooth the muscles. Physical Therapy including Kegel exercises and quite often Physical Therapy referral for more specialized treatment. If these measures alone are not effective, medicines such as Elavil ( amitriptyline ) can be used in low doses to bring about relief of pain. Though it is a benign disease it can be quite bothersome to patients. It is important when treating to remind patients that although it can take time, the majority of patients will get relief of their pain.

If you are suffering rectal pain, change in bowel pattern, rectal bleeding, or any colonic symptom…seek the advice of a Colorectal Surgeon! Remember, patients treated by Colorectal Surgeons have better outcomes. WWW.colondocs.net