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.