-
levator spasm
- levator syndrome
- proctalgia fugax
-
sx
- severe episodic, agonizing discomfirt in rectum
- ddx: hemorrhoid, fissure localized to anal area, this is often on left side
- wakes patient up from sleep
-
PE
- tender spastic PR on left side
- RP higher than controls in manometry
-
RX
- bowel management, toilet training
- sitz baths
- levator massage
- perineal strenthening training exercises
- biofeedback
-
RX-chronic
- muscle relaxants
- SL, topical NTG and quinine sulfate
- electrogalvanic stimulation (69% success)-fatigue muscle by overstimulation and contraction
- steroid caudal block
- japan linearly polarized near-infrared irradiation
- refer to pain clinic
-
coccygodynia
- spasm of pubococcygeal portion of levator ani
- pain increases when patient rises from sitting position
-
coccygodynia-rx
- bowel managment
- perineal strengthening exercises
- levator massage
- injection of local anesthetic and cortisone-relief temporary
- coccygectomy
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