Anorectal Symtoms and Anorectal Pathophysiologic Findings in Patients with Levator Ani Syndrome and Protalgia Fugax

Jang, Geun Young; Lee, Joon Seong; Lim, Hee Hyuk; Hwang, Kyung Rhan; Hong, Su Jin; Kim, Jin Oh; Lee, Moon Sung; Shim, Chan Sup; Kim, Bu Sung

Abstract

BACKGROUND/AIMS
Two most common functional anorectal pains, levator ani syndrome and proctalgia fugax, have a significant overlap in diagnosis and a controversy in pathogenic mechanism. Our aim was to evaluate the differences of anorectal symptoms and physiologic findings between the patients with levator ani syndrome and proctalgia fugax.
METHODS
Eight patients and 10 patients, who fulfilled Rome II criteria for levator ani syndrome and proctalgia fugax respectively, were evaluated for the various anorectal symptoms using questionnaire and diary, anorectal manometry, balloon defecation, and defecography.
RESULTS
Compared with patients with proctalgia fugax, the patients with levator ani syndrome showed higher percentage of symptoms of straining (87.5+/-30.6% vs. 40.5+/-44.9%, p<0.05), and tended to have higher percentage of the sensation of incomplete evacuation (88.1+/-26.4% vs. 53.0+/-41.9%, p=0.056). In anorectal manometric findings, squeezing pressure of the distal anal sphincter tended to be higher in patients with levator ani syndrome (201.7+/-127.7 mmHg vs. 113.0+/-43.9 mmHg, p=0.056).
CONCLUSIONS
Levator ani syndrome may be related to the constipation and hyper-contractile external anal sphincter, suggesting that different mechanisms may play a role in the development of anorectal pains in patients with levator ani syndrome and proctalgia fugax.