Levator Ani spasms - treatments

Treatments I have tried which worked (and which didn't)

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Levator Ani spasms - treatments

Postby ChronosWS » 13 Apr 2016, 14:54

Summary:

There are several treatments for Levator syndrome (anal sphincter spasms) which *may* work for you and which are either free or low cost and have few-to-no side effects. Most revolve around learning how to relax and specifically relax the anal sphincter. They may also be of help with proctalgia fugax (lower colon pain/spasms), but we don't think I have that condition so I cannot say if they will help.

Background (and apologies for the long, detailed post):

I've had what we believe to be Levator syndrome (spasms/pain of the interior anal sphincter) since I was about 16. My particular issues do not appear to be directly related to having an anal fissure - instead, they will happen periodically, sometimes in clusters, sometimes after long spans of time. This is apparently fairly typical for this condition. When I was younger I *also* had "irritable bowel syndrome* and a lot of anxiety related to going to the bathroom, no doubt partially reinforced by the spasms. I've been trying to find good treatments for over 20 years with mixed success. I wanted to relate what has worked for me which others may find useful, and also to let you know you are not alone.

I am not a doctor; you should consult with your physician before altering your treatment regime.

First, my spasms typically manifest as what I describe as someone jamming a pencil eraser head into the sphincter muscle - usually on the left-hand side. The pain is never "sharp" but it goes from mild to very intense, sometimes intense enough for me to pass out. As soon as it starts to manifest, I can feel a tension throughout most of my lower colon, concentrated around the anus. I am not sure if that's anxiety kicking in or an actual physiological reaction. The pain may then migrate from side to side, usually building in intensity until it either peaks or I pass out (which is much more rare these days thankfully.) After that it usually subsides fairly quickly. I've had attacks that last from 5 minutes to several hours (ugh!) Waking up after passing out (which I think only lasts a few seconds) usually leaves me completely exhausted and sweating. I suspect this is actually a stress reaction, and my physician did not seem especially alarmed about it.

Triggers for the spasms seem to be one of four things:
1) Passing a stool - usually starts immediately after passing it
2) Gas - This one is erratic, but passing gas seems to be frequently associated with relieving an attack, see below.
3) Orgasm (this one is a real bummer) - Also erratic, might start immediately or several minutes after.
4) Nothing at all - spontaneous onset, any time of the day or night

Treatments I have used:
For prevention I have tried the following, with the associated effects:
1) Relaxation while passing stools, using a squat method. I try very hard to remain relaxed while passing stools, letting the smooth muscles do their job and avoid tensing the sphincters. This seems to have a positive effect on reducing the number of attacks, but isn't 100% reliable. I use a box at home on which I rest my feet so I am in a more squatting position, which relieves the puborectalis muscle and allows the colon to achieve a more "straight line" effect for elimination. I highly recommend this - for me this has significantly reduced the severity of those attacks I do have. When I am out and about, I try to bend over as far as I comfortably can and relaxing.
2) Changing diet. For me, eating wheat products (though I am not gluten intolerant, and don't have Celiac's or other disorders) is associated with increased constipation, so I try to avoid them. Also psyllium husk caps taken with meals make stools softer and easier to pass for me (If you have inflamed bowel, consult your doctor before adding fiber to your diet!)
3) Low-dose antidepressants. Early on in my treatment, my doctor prescribed a common antidepressant (which I can't remember now) at a very low dose because of it's side effect of relaxing the smooth muscle. I don't think this had any significant effect on me.

For treatment of an attack, I have tried the following:
1) Hyoscyamine 0.125mg. This is a sublingual I can take at the onset of a spasm which usually works within a couple of minutes. On occasion I have had to take two. It seems to work most of the time to reduce or outright stop the attack. Unfortunately it has a side effect of making me feel rather tired, so I try to avoid it, but otherwise it seems pretty benign. Also super cheap. I consider it my "emergency backup".
2) General relaxation and breathing. For me, a fairly big part of the severity of the attacks is the anxiety which is associated with it. This manifests as a tightening of the senses, a feel that the world is closing in, dread, worry that it's serious, and fear of passing out. Maintaining rational thought in the face of the episode is very difficult. However, the fact is that the attacks are not a sign of something more serious (at least in my case) and are not really dangerous (though passing out in some situations would be dangerous and/or embarassing.) Keeping this in mind while trying to keep my breathing regular and focusing on relaxation has helped me keep an attack from progressing too far.
3) Going for a walk. When I am at work and one of these attacks happens, if it doesn't feel too severe, I try to go for a walk. Usually 10 to 20 minutes of walking allows the attack to subside and the fresh air makes me feel better rather than sitting in the office or bathroom letting anxiety build. I don't know if this reduces the duration of the attacks, but the anxiety relief alone is worth the price of admission. I've never passed out after starting to walk, either. That has only ever happened when I just sit or lie down.
4) Sphincter relaxation. I only really discovered this recently after a conversation with a friend who recommended it (she uses it to releive cramping and gas from other causes.) It has been amazingly effective for me. When I recognize an attack is mounting, I put myself in a "playful dog" position - basically, head and hands/arms down on the floor, butt up in the air. Then I focus on relaxing the voluntary anal sphincter. What this does is that when the voluntary sphincter relaxes, the involuntary one *also* relaxes. You can tell when it has worked because you'll probably hear it, and air will move into your rectum. There may be a reaction to tighten down from this, but try not to - if you do, just try to relax and open up again, and maintain the relaxation as long as you can. For me, this relaxation usually caues the spasms to completely subside within a few seconds to a couple of minutes. I can't do this everywhere (obviously in a public space this wouldn't work) but at home it seems to work pretty well. I recommend practicing this when you *aren't* having an attack too so you can get used to the feel and process.

Conclusion:
I hope this information is of use to someone. If you experience these debilitating attacks, know that you are not alone and they are not dangerous (though if you are experiencing them because of a related issue like a fissure, get that treated.) Most of the above require no doctor's prescription and cost nothing to try. Learning to relax is a skill, and it takes practice, so if it isn't working for you immediately, keep trying. Obviously if it exacerbates any problems you have, stop immediately and consult a qualified physician. Good luck, and if you have any questions I would be happy to try and answer them for you.
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Re: Levator Ani spasms - treatments

Postby Canadabum » 16 Apr 2016, 08:30

Thank you for the info....this is really helpful stuff and I know many will benefit from your advice.

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Re: Levator Ani spasms - treatments

Postby drjamit » 01 Jul 2016, 12:17

Fantastic Post !!!!!!!!! Thanks for Posting this detailed info. I may be copy pasting for benefit of Many. I m A Physician and having Some Problems like these. Though still not sure what exactly it is.
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Re: Levator Ani spasms - treatments

Postby Elle1007 » 09 Feb 2018, 21:54

Great post. Thank you
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Re: Levator Ani spasms - treatments

Postby ChronosWS » 10 Feb 2018, 16:47

I want to give an update to this post since I have done some more work. In spite of all the things above I had tried I was not satisfied with the persistent condition, particularly with passing stools being able to trigger these spasms. While the sphincter relaxation technique above was pretty effective, it's one of those things you can't really use when you are out and about, even at a regular workplace (unless you have access to a private room.) I decided to ask my doctor again for some recommendations and he hooked me up with a specialist physical therapist had me doing some stretching/relaxation exercises as well trying to address bowel consistency issues. This was perhaps only marginally effective. I eventually stopped going because the cost/benefit wasn't working out.

Then I went to a different specialist closer to my home - it turns out the local hospital actually had a specialized rectal health/surgery center with people who *really* know this stuff. I saw one of the doctors there and explained my issue and he said that a) it sounded very much like classic levator spasms and b) that biofeedback treatment would absolutely the way to go. He also noted upon examination that my sphincter and surrounding muscles were very "toned", meaning excessively large and strong, most likely due to subconscious clenching. It's this subconscious clenching that he theorized was leading to the spasms.

In the case of treating these spasms and the excessive muscle tone, we started a program of weekly biofeedback therapy. The way it works is this:

You go into the therapist's office and lie down on a table and she attaches a surface probe or two (small contact patches which measure muscle electrical activity.) These go around the anus, not inside. You are then shown a screen which shows you the feedback from those probes - you can see how your muscles are behaving. The therapist then probes the anal region with a finger while you focus on the sensor readings and try to relax and bring the numbers down to the minimum level. This is the "feedback" part. For me this was highly illuminating because I could see that my "resting" numbers were actually pretty high compared to what actual relaxed numbers were. This also helps with learning what relaxation actually feels like, because you can correlate the sensor readings with your own sense of how the anus and surrounding muscles feel.

After several sessions of this I showed marked improvement in my ability to keep relaxed even during probing. Also this provided me with the tools needed to actually relax in other situations, such as practicing relaxation while sitting at my desk or going to the bathroom - really paying attention to trying to replicate the relaxation feeling from the therapists office. This has proven invaluable in preventing the spasms from fully manifesting - they now only happen very rarely. I still - on rare occasion - have gotten a full on spasm which requires one of the more aggressive techniques or muscle relaxants, but generally this has enabled me to *prevent* them from occurring in the first place.

So if all else has failed and you haven't tried it yet, I would talk to your doctor about whether biofeedback might apply for your condition, because it certainly does seem to have helped me.

Good luck!
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Re: Levator Ani spasms - treatments

Postby Elle1007 » 10 Feb 2018, 17:08

Gosh. Thank you so very much. Please know that your posts are so appreciated. Especially your explanation about what happens with biofeedback.

It sounds like you have really set yourself up for success and I wish you the best.

The female Valium suppositories I have are great for relaxing the pelvic area but not so for my ‘ring of spasms’ directly on my anal spinchter after a BM. It is so hard to talk about this, but desperate times....... in fact it is purely just the ring of fire causing spasms now. Fissure has been healed for a month. Coconut oil really helped the fissure.

I have a PT appointment set up with pelvic therapist. So sounds like this is what I have to do first to make doctor/insurance company happy. Then ask for biofeedback..

Again, thank you.
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Re: Levator Ani spasms - treatments

Postby ChronosWS » 10 Feb 2018, 18:51

Good luck, hopefully they will help you on the path to a treatment which works. At least the biofeedback stuff isn't too expensive, and once you learn what things feel like and how to "take control", it's a skill you'll have learned, not something you have to keep going back for.
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