Levator ani syndrome: transperineal botox injections

Excerpt

Levator spasm is a condition characterized by constant or frequent anal pain that is typically dull in nature. This is due either to paradoxical contraction of the puborectalis at the anorectal junction during defecation, or the failure of muscular relaxation [1]. Symptoms typically occur more than 6 months prior to diagnosis, with episodes lasting for longer than 20 min at a time, on a background of persistent rectal pain. The pain is reproduced by posterior palpation of the puborectalis during a digital rectal examination [2]. This condition must be differentiated from proctalgia fugax, which is sudden, severe pain in the anal area that lasts for seconds to minutes and then disappears between attacks [2]. When examining a patient, the thickest fibers of the pubococcygeus are located inferomedially. These fibers are called “puborectalis muscle fibers”. …