Approach and Treatment

When evaluating these patients, a comprehensive history and physical examination are needed to rule out other pathology. In addition to a physical examination, which includes endoscopy of the rectum, a computed tomography or magnetic resonance imaging of the pelvis may be indicated if the diagnosis is in doubt. When embarking on treatment for levator syndrome or proctalgia, the literature is not straightforward, because authors frequently refer to all anal pain by the same name without deference to there being two distinct problems that can occur. Patient should be reassured that they do not have a serious condition such as cancer. They should also be encouraged to improve their fiber and fluid intake if deficient, as well as sitz baths and perineal strengthening exercises. Even without scientific evidence to corroborate this approach, this has proven helpful in the majority of patients. For those who are unresponsive to these measures, more intensive therapies are indicated, using individualized approaches.

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