Category Archives: rectal pain

Try These 8 Tips to Relieve Constipation | Minnesota

Constipation is one of the most common bowel disorders affecting American adults, with roughly 20 percent of the population suffering from hard, painful stools. Defined as having fewer than three bowel movements per week for several weeks, constipation occurs when the colon absorbs too much water from the food passing through it, creating dry stool that’s extremely difficult to pass.

While constipation is never pleasant, there are a few ways to manage and improve symptoms so that other complications—like hemorrhoids—don’t set in. Below are a few tips for boosting your bowel movements:
 
1. Eat more apples – This juicy fruit is packed with pectin fibre, which has been found to help relieve constipation and slow down the absorption of excess dietary fats, making you feel fuller for longer. The sorbitol in apple juice also has a laxative effect.

2. Eat more raisins and figs – If apples aren’t your thing, perhaps these two dried fruits can be added to your diet. High in fiber, raisins and figs are even more beneficial to your digestive system when soaked in water.

3. Exercise more – Being more active is always beneficial to your health! Hitting the gym or simply going for a jog outside helps aid food breakdown and reduce the time it takes food to move through the large intestine. The less time food sits in your colon, the more water it retains to help ease stool passage later.
 
 
4. Hydrate – Retaining water in your stool is the key takeaway here, so drinking more fluids is critical. When you don’t drink enough water, your body absorbs more water from the food you eat in order to make up for the imbalance.

5. Try over-the-counter medications – For a quicker fix, laxatives (used in moderation) can help with constipation. These substances work to loosen your stools and increase bowel movements pretty quickly.

6. Don’t hold your poop – If you feel even the slightest urge, go to the bathroom! Holding your bowel movements causes stools to sit longer in the colon, increasing the amount of water absorbed. Definitely not what we want!

7. Drink some coffee – Despite being a diuretic that can dehydrate you if consumed in large quantities, coffee has been shown to stimulate the muscles in your digestive system. Small amounts of soluble fiber in coffee can also boost the balance of your gut bacteria.

8. Try probiotics – Studies have shown that Bifidobacterium, a bacteria of the gastrointestinal tract, can aid in digestion and reducing constipation. Yogurt, fermented vegetables (kimchi, miso, sauerkraut), cured meats, vinegar and sourdough bread are good options for increasing your probiotics intake.

 

The Potential Health Benefits of Elephant Foot Yam | Minnesota

Alternative MedicineYes, you read that correctly—elephant foot yam is loaded with potential medicinal benefits and may even improve hemorrhoidal symptoms. This alternative medicine has long been used in Ayurveda, a traditional system of medicine rooted in the Indian subcontinent whose practices have recently been globalized. Used to treat numerous conditions such as sperm quality, liver and spleen disorders, and hemorrhages, elephant foot yam just may be the next big home remedy for treating hemorrhoids as well.

The thickened, underground part of the yam’s stem, known as tubers, is often prescribed as medicine in Ayurveda to treat hemorrhoids, dysentery, asthma, vomiting and abdominal pain. While it is typically used as a blood purifier, tubers can also be made into a paste to externally treat arthritis pain.

In treating hemorrhoid symptoms, elephant foot yam can be prepared as a medicine called “suran vataka,” recommended to be taken in small capsules (1-2 grams each) both morning and evening on an empty stomach. While the exact treatment results are unclear due to the yam’s alternative nature, this has long been a prescribed treatment method for patients in India suffering from hemorrhoid/bowel discomfort.
 

Other Potential Health Benefits of Elephant Foot Yam

  • The cooling effect of the yam can be a cure for hypertension.
  • The yam may help reduce cholesterol levels.
  • It can serve as an anticoagulant (blood thinner) to improve blood flow.
  • Elephant foot yam may even help maintain hormonal balance in women by increasing estrogen levels and relieving them of pre-menstrual syndrome.
  • The presence of Vitamin C can help delay aging.
  • Elephant foot yam may also benefit patients who suffer from acute rheumatism.
  • Irregular bowel movements and constipation may be cured through consuming elephant foot yam.
  • It may help reduce muscle spasms.
  •  
    Please note that while elephant foot yam may help with hemorrhoid symptoms, anyone who suffers from hemorrhoid discomfort should see a doctor for a full evaluation. Home remedies certainly help with symptoms, but it’s always best to see a doctor for a complete, thorough treatment method.

     

    Ways to Manage Proctalgia Fugax Pain | Minnesota

    While the term “proctalgia fugax” (pronounced proh-TAL-ja few-gacks) may sound completely obscure, the rectal condition actually affects up to 18 percent of Americans. The Latin term literally translates to “fleeting rectal pain” and is characterized by intensely painful, sporadic rectal or anal spasms that last anywhere from a few seconds to a few minutes. Sometimes described as feeling like a severe muscle cramp or like a knife is shoved up one’s rear end, proctalgia fugax is extremely unpleasant to experience. However, home remedies can help alleviate some of the pain and discomfort.

    One of two primary functional anorectal pain syndromes, proctalgia fugax occurs as a result of cramping of the levator ani muscle. Attacks are more common in the middle of the night, but they can occur during the daytime as well. The pain is usually so intense that patients must stop what they were doing and attempt to alleviate the discomfort or wait until the spasm subsides. While these episodes typically only occur a few times per year, some patients have reported feeling pain almost everyday. While attacks are technically spontaneous and unpredictable, certain lifestyle factors such as stress, anxiety, excessive sitting and defecation may trigger episodes.

    Roughly 80 percent of patients suffering from proctalgia fugax do not seek medical attention due to the infrequency of their attacks, and the condition, thankfully, does not cause lasting damage. However, it’s helpful to know some effective pain reliever options, as well as lifestyle changes to potentially prevent future attacks.

    Medications: Topical glyceryl nitrate (pain-relieving drug), nerve blockers, muscle relaxers, hemorrhoid creams

    Warm baths: To relax the anal muscles and potentially reduce the chance of spasms

    More potassium: Food like bananas, cantaloupe, spinach, potatoes and oranges are rich in potassium and can aid in preventing spasms

    More vegetables: More vegetables and whole grains mean more fiber and less chance of constipation, which in turn reduces straining of the anal muscles. Natural vegetable powder can also help produce softer stool

    Relaxation techniques: Reduce stress and anxiety via meditation, deep-breathing exercises and yoga

    Pelvic muscle retraining: Pelvic muscle exercises, such as kegel exercises, can help strengthen and relax muscles in that area.

     

    Comparing Anal Abscesses and Anal Fistulas | Minnesota

    Hemorrhoids, abscesses, fistulas, fissures, anal itching, rectal prolapse—with so many anorectal disorders out there, it’s hard to keep track of which is which. Two of these conditions, anal abscesses and anal fistulas, are closely linked to one another but can be easily distinguished via the guidelines below.
     

    Defining Each Disorder

    Anal Abscess – This is a pus-filled, infected cavity near the opening of the anus or deep in the rectum. Most abscesses result from infection of anal glands in the lining of the anal canal near the anus opening. When bacteria from the gut passes the anal sphincter barrier and into the surrounding tissue of the rectum, an abscess of varying severity and depth forms. When an abscess fails to fully heal, an anal fistula may form.

    Anal Fistula – As mentioned above, fistulas usually occur due to a previous anal abscess. A fistula is an inflamed tunnel under the skin, connecting the anal canal and the surface of the surrounding skin. The majority result from an anorectal infection, wherein the anal crypts are infected and cause pus-filled cysts to form near the anal canal.
     

    Symptoms

    Anal Abscess – The most common symptoms are pain around the anal area, swelling, redness, and fever. Rectal bleeding and urinary complications (difficult or painful urination) may also occur.

    Anal Fistula – In addition to most likely having a history of anal abscesses, patients may also experience skin irritation around the anus, a throbbing pain when sitting, anal discharge, swelling and redness, and fever.

     

    Causes

    Anal Abscess – This usually occurs from infection of anal glands in the lining of the anal canal near the anus opening. Other causes include an anal fissure and sexually transmitted infections (STIs).

    Anal Fistula – As previously mentioned, fistulas typically result from an abscess that did not fully heal. They may also, though less frequently, be caused by Crohn’s disease, STDs, trauma, tuberculosis, cancer or diverticulitis.
     

    Treatments

    Anal Abscess – Surgical incision and drainage should be performed ASAP, as antibiotics are ineffective at this stage of the infection. Delaying surgery can result in tissue destruction, fibrosis (scar tissue formation), and impaired anal continence. Drainage involves making a small incision above the abscess as close to the anus as possible, then removing the gauze after 24 hours. Sitz baths and stool softeners can help with post-surgery discomfort.

    Anal Fistula – Surgery is generally needed to treat fistulas and involves cutting a small part of the anal sphincter muscle away. By doing so, the tunnel/fistula is opened up to form a trench that heals from the bottom outwards. After a few weeks, the trench ideally fills up with scar tissue and heals. Post-surgery discomfort is mild and can usually be addressed with painkillers.
     

    Recurrence Rates

    Anal Abscess – Nearly half of abscesses may recur, either in the form of a new abscess or as a frank fistula.

    Anal Fistula – Fistulas can also potentially recur, with recurrence rates dependent upon the particular surgical technique utilized.

     

    10 Reasons For Rectal Bleeding That Aren’t Hemorrhoids | Minnesota

    Bleeding from your rectum or anus is never a pleasant experience, and it can understandably cause immediate panic. Generally, bright red blood indicates bleeding in the lower rectum, while dark red blood indicates bleeding from deeper and further up in the body. While passing dark red blood is usually a sign of digestive bleeding and requires immediate attention, any amount of rectal bleeding should be taken seriously.

    While rectal bleeding can be caused by pesky hemorrhoids, there are a number of other potential causes ranging from fistulas and fissures to more serious cases of colon/bowel cancer.
     
    1. Anal Fistula
    An anal fistula is an inflammatory tunnel under the skin connecting the anal canal and the surface of the surrounding skin. Most fistulas occur from an anorectal infection, where the anal crypts are infected and cysts containing pus form near the anal canal. Fistulas are often misdiagnosed as hemorrhoids, as symptoms can be similar, including drainage from the anus, itchiness and pain during bowel movements. They can be treated with antibiotics, pain meds and a fistulotomy.

    2. Anal Fissure
    An anal fissure is a small rip or tear in the lining of the anal cana typically caused by trauma to the inner lining of the anus via a bowel movement or stretching of the anal canal. They can be painful, but fissures often heal within a few weeks through increasing fiber/fluid intake to keep stool soft and help ease bowel movements.

    3. Colon Cancer
    As scary as it may sound, rectal bleeding is a dangerous sign of colon cancer and must be taken very seriously. Symptoms of colorectal cancer include abdominal pain, a change in bowel habits, an anal or rectal lump, and bleeding during bowel movements. Click here to read our post on the differences between rectal cancer and hemorrhoids.

    4. Gastroenteritis
    Gastroenteritis, otherwise known as the stomach flu, is a common bacterial infection that causes diarrhea, fever and vomiting. Due to inflammation in the stomach and colon, the bowel becomes more sensitive during the illness and may cause bloody stools. While the process is uncomfortable, gastroenteritis normally clears up after a few days of rest and hydration.

    5. Diverticulosis
    Diverticulosis is a chronic bowel condition that causes small bulges or pockets to develop in the lining of the intestine/digestive tract. If these bulges become inflamed or infected, abdominal pain, bloating, constipation, diarrhea, and bloody stools can occur. More common in people over 40, diverticulosis can be treated using diet modifications, antibiotics and, if needed, surgery.

    6. Rectal Prolapse
    Believe it or not, a bit of your intestine can actually slip outside of your body. A rectal prolapse occurs when part of the large intestine slips outside the anus, which can happen during a bowel movement. This in turn causes pain and bright red blood in the stool, as well as difficulty in controlling your bowel movements. A prolapse usually requires surgical treatment, so call your doctor right away.

    7. Polyps
    Polyps are non-cancerous growths that can develop along the lining of your bowel. They’re pretty common and don’t usually manifest symptoms. In more severe cases, they can cause diarrhea, constipation, mucus in the stool and bloody stools. While most polyps do not escalate into cancer, there is still risk of cancer development. Be sure to call your doctor for a full examination.

    8. Internal Bleeding
    As mentioned earlier, darker colored blood can be a sign of internal bleeding in your digestive system. It can also be a sign of cancer, stomach ulcers or severe gastrointestinal disease. If you see dark red blood in your stool call your doctor ASAP.

    9. Colitis
    Colitis is a chronic inflammation of the innermost lining of the large intestine and rectum. Small ulcers develop in the lining of the bowel, which then bleed and produce pus. This causes recurring diarrhea, abdominal pain, rectal bleeding, and the frequent urge to pass stools. Management of colitis conditions can include antibiotics, medications and surgery.

    10. Sexually Transmitted Infection (STI)
    Sexually transmitted infections (STI) can result from unprotected anal sex and cause inflammation of the lining of the anus, which can lead to bleeding and pus. Treatment includes antibiotics and antiviral/antifungal medications.

     

    Four Cardinal Symptoms of Hemorrhoids | Minnesota

    Although hemorrhoidal symptoms and complaints are common and typically not a serious concern, all patients should be examined for signs of possible cancer and other associated diseases. There are four cardinal symptoms of hemorrhoids, including rectal pain, bleeding, anal itching, and rectal mass or lump.

    Anal Itching
    Anal itching is the most common complaint in the hemorrhoid patients. It often comes and goes. The initial relief of the itching does not necessarily mean the problem goes away. Continuous scratching or excessive cleaning of the anal area may further harm the sensitive tissues and worsen symptoms. In addition, the area can be highly sensitive to perfumes, soaps, fabrics, dietary intake and superficial trauma. When chronic itching occurs, the perianal area becomes white with fine fissures.

    Treatments for anal itching include taking antihistamine as a sedative prior to sleeping to prevent the patient from unconsciously scratching, or using a topical corticosteroid to alleviate the itching. Underlying hemorrhoids and other rectal diseases must be considered and treated when diagnosing and treating anal itching.

    Anal pain
    Anal pain is a common sign of hemorrhoids. The patients with hemorrhodis often complain the aching pain, irritating pain, and spasmodic pain. If the hemorrhoid patient also has anal fissure, sharp pain may occur during intense, forced bowel movements that are often accompanied by rectal bleeding. Immediate onsets of intense pain accompanied by a palpable mass are usually a result of an external thrombosed hemorrhoid, which may last a few days to a couple of weeks. Internal hemorrhoids, however, are not very painful due to being located above the dentate line of the rectum.

    Proctalgia fugax is a more serious anal pain condition that involves short spasms of intense pain at night. Hemorrhoids could be its trigger or cause.

    Rectal Lump
    A palpable anal lumps can be caused by a variety of conditions including anal warts, hemorrhoids, polyps, fissures, or cancer.

    Hemorrhoids are probably the most common reason for having a rectal lump. It can be caused by internal hemorrhoids, but more commonly by external hemorrhoids. If a rectal lump is related to internal hemorrhoids, it usually gets bigger and more prolapsed right after the bowel movement; it could be spontaneously reduced in the early stage of internal hemorrhoids. But it could be non-reducible in the late stage of hemorrhoids.

    The thrombosed external hemorrhoids often cause very painful, bluish anal lumps when the hemorrhoidal veins rupture and the blood clots develop.

    Rectal bleeding
    Rectal bleeding can be caused by hemorrhoids and other conditions, but even the slightest amount of bleeding should be taken seriously. Common causes of bleeding are internal hemorrhoids, ruptured thrombosed external hemorrhoids, fissures, diverticulosis, colon cancer, colitis, polyps and angiodysplasias. Patients of older age or with significant family history of bowel disease or cancer should consider further examination. In addition, patients who were previously treated for rectal bleeding but continued to experience bleeding must be further examined.

    The source of rectal bleeding is determined by history, physical examination and blood tests, assisted with anoscopy, sigmoidoscopy, colonoscopy, radionuclide scans, and angiograms.

    Proctalgia Fugax Means “Fleeting” Rectal Pain | Minneapolis & St Paul

    8%-18% of people have it. And of those people, only 20-30% seek a professional diagnosis for it. Patients suffer from episodes of severe pain that can make it difficult to function in their daily lives. What is this mysterious ailment?

    Proctalgia fugax is the answer. Proctalgia fugax, fugax meaning “fleeting” in Latin, is a condition that causes severe episodic pain in the anorectal area caused by cramps in the levator ani, the main pelvic floor muscle. Attacks typically occur at night and are often mistaken as an urge to defecate. When the levator ani spasms, the result is anorectal pain lasting anywhere from a few seconds to 30 minutes. Men may even get an involuntary erection! This condition typically starts around the age of 45. While it does not cause physical damage to the body, proctalgia fugax can be very painful and debilitating.

    Proctalgia fugax cannot be cured, but its symptoms can be managed. Here’s a list of some of the many treatments that can help ease the pain during an attack:
    1. Warm baths
    2. Warm enemas
    3. Cold packs
    4. Relaxation techniques
    5. Salbutamol inhaler – Usually used for bronchitis, salbutamol inexplicably seems to shorten episodes of pain
    6. Botox – Inhibits acetylcholine, the neurotransmitter that controls muscle, which reduces contractions
    7. Topical calcium channel blockers – Vasodilates blood vessels, reduces muscle contractions
    8. Counseling – Stress can be a major trigger of proctalgia fugax. Eliminating stress may reduce the frequency of attacks.
    9. Galvanic stimulation – High voltage stimulation has been shown to reduce frequency of attacks
    10. Treatments of the underlying diseases, such as hemorrhoids and anal fissures.

    Overall, proctalgia fugax can be a real nuisance. The 8%-18% figure above may be even greater in reality because so few people seek treatment. And it’s understandable why people don’t- it’s an uncomfortable and embarrassing thing to talk about. Many will just try to ride it out. Proctalgia fugax can be a struggle. It’s not worth the loss in quality of life. If you feel that proctalgia fugax is making your life worse, it might be time to see your doctor.

    Injections of Botulinum toxin for Anal Pain and Anal Fissure

    Introduction
    Botulinum toxin A, is a toxin protein produced by bacteria called clostridium botulinum. When injected into a muscle, it will temporarily blocking neural signals for muscle contractions, causing the muscle fibers at the injection area to relax. Botulinum toxin A has been successfully used for the treatment of a variety of medical conditions involving unwanted muscle spasms such as strabismus and cervical dystonia. It is also commonly used for removing unwanted wrinkles in cosmetic care.

    The internal anal sphincter that controls the anus is always under tension. If this tension (also called resting pressure) is too high, it causes rectal pain. The common diseases associated with anal sphincter spasms are anal fissure and functional anal rectal pain. Spasm can make an anal fissure worse or prevent an existing one from healing.

    Botulinum toxin A has also been used to treat anal fissure for several years. Injecting Botulinum toxin A into muscle around the anus will temporarily relax the internal anal sphincter. This reduces the spasm and pain and allows the fissure to heal.

    Most patients have at least some pain relief in their pain after treatment with Botulinum toxin A. The success rate for an anal fissure healing after the injection is 70 out of 100 treatments. Sometimes the injection might need to be repeated, especially in the patients with functional anorectal pain.

    What Happens During the Procedure?
    There is no special preparation needed before the injection procedure. You don’t need to do any preparation, but you are encouraged to have bowel movement and please do carry out your usual hygiene routine (shower or bath) before you come in.

    Dr. Shu will perform the injection procedure in the exam room or procedure room, and it takes a few minutes to perform. You will be awake throughout the procedure.

    You will be asked to lie on your left side on the exam table. The area around your anus will be cleaned with an alcohol spray. Dr. Shu will then give 6-8 injections of Botulinum toxin A into your sphincter muscle with a hair thin needle. This will be uncomfortable during the injection, but it is an extremely quick procedure.

    After the Procedure
    You can drive home or return to work afterwards. Very occasionally, the patient develops vasovagal reaction (fainting) to the procedure, the you lie on the table for a few minutes to recover.

    The Botulinum toxin A will start to work in a few days. The effects of Botulinum toxin A peaks in 1-2 weeks and usually lasts 3-6 months. During this time, anal fissures are allowed to heal.

    Most people do not have any side effects. The potential side effects of botulinum injections may include the inability to control the passage of gas (gas incontinence), pain from the injections, bleeding, infection at the injection site, and rarely, fecal incontinence (we don’t have any case of fecal incontinence). If symptoms of incontinence occur following Botox® injection, they typically disappear completely after several months.

    It is important to make sure that you continue to keep your stool soft following the treatment, to avoid straining. Continue anal care measures including Sitz bath, fibre in your diet, and drinking enough water.

    How to Differentiate Anal Fissure from Hemorrhoids | Minneapolis & St Paul

    The patients in Minnesota often couldn’t tell the differences between anal fissure and hemorrhoids. Although both hemorrhoids and anal fissure are associated with rectal pain and rectal bleeding, they are two very different diseases that are important to distinguish.

    Hemorrhoids could be as painful as anal fissure when thrombosis develops. In the most time, the pain caused by hemorrhoids is mild, persistant, dull aching pain, not always related to bowel movement. Anal fissure usually has sharp rectal pain during bowel movements.

    Anal Fissure
    An anal fissure is a tear in the anal canal in the lower rectum. Anal fissures are typically thought to be caused by trauma from a hard or painful bowel movement, and are often associated with a lack of fiber in the diet. Symptoms include severe rectal pain during bowel movements, which can last from minutes to hours after. The pain is worse with constipation, which may occur if the patient has been avoiding bowel movements due to pain. Many patients report bright red blood on the toilet paper or the stool, though bleeding is usually not significant. If a fissure persists over time it may become a chronic fissure.

    Anal fissure require anoscopy as it cannot be directly observed visually. However, anoscopy is quite painful for those with an anal fissure so a doctor may treat it based on symptoms alone. About 80% of fissures resolve themselves without the need for surgery. Initial treatment is generally conservative in nature, with the goal of relieving constipation and breaking the cycle of hard bowel movements. Patients may take stool-bulking agents like fiber supplements and stool softeners, as well as laxatives to encourage regular bowel movements. Mineral oil can serve this purpose as well, but it is not advisable to be used indefinitely. Sitz baths after bowel movements are effective in relieving symptoms.

    If these first-line treatments do not work, the patient may be directed to use 0.4% nitroglycerine (NTG) ointment in conjunction the treatments listed above; however, this is generally not preferred as NTG ointment can cause adverse side effects like headache and dizziness. Alternatively, Nifedipine gel is a better option to treat anal fissure.

    Botox has also shown to be a promising treatment, its relaxation effect on sphincters lasts for three months that is long enough for anal fissure to heal. If the anal fissure does not resolve following treatments, then a partial anal sphincterotomy may be needed, where a cut will be made on the anal sphincter in a different location in the anus, and both the fissure and new cut will heal together.

    Functional Anorectal Pain

    Functional anorectal pain is a relatively common symptom that occurs in the absence of any clinical abnormality although some patients may also have other anorectal diseases, such as hemorrhoids. It is not sure if the local inflammation caused by hemorrhoids contributes to the development of anorectal pain syndromes in those patients. Despite their benign nature of functional anorectal pain, they can cause debilitating to the sufferer.

    There are two functional anorectal pain syndromes.
    • Proctalgia fugax (PF) (fugax = fugitive/fleeting in Latin)
    • Levator ani syndrome (LAS)

    Proctalgia Fugax is an anorectal pain syndrome that occurs as a result of cramping of the levator ani muscle. It occurs in episodes lasting seconds or minutes, typically in the middle of the night, though it is very possible to experience it during the day as well. Patients may feel spasm-like, sharp pain in the anus that is often mistaken for a sign that they must defecate. This may also be accompanied by an involuntary erection in men. Attacks, and typically start at the age of 45. An estimated 8-18% of people in the developed world are affected by proctalgia fugax, but true figures are not clear because many people do not seek professional diagnosis. It is estimated that only 20-30% of people with this condition seek out professional diagnosis.

    The condition is recurrent, and while not curable, treatments are available.

    Traditional ways to manage pain include warm baths, warn/hot enemas, relaxation techniques. Applying ice or some similar cold pack to the afflicted area can help pain as well. Severe attacks can be mitigated a bit using salbutamol. For most cases, reassurance, and topical calcium-channel blockers, salbutamol inhalers, and sublingual nitroglycerine are used for treatment. Botulinum toxin A injection is a new way to effectively reduce the tone of anal sphincters and reduce anorectal pain. Co-existent psychological issues should be addressed with behavioral and/or pharmacological therapies. Increased fiber intake and withdrawing gut-affecting medication can also help with pain. High-voltage pulsed galvanic stimulation has been shown to reduce short-term frequency of the attacks.

    Levator ani syndrome presents the symptoms with vague, aching or pressure feeling high in the rectum. It could be worsened by sitting and relieved by walking. The pain tends to be constant and lasts from hours to days. It recurs regularly.

    The diagnostic criteria of levator ani syndrome is that the symptoms must be present for three months with symptom onset at least six months prior to diagnosis, and other causes of similar anorectal pain must have been excluded.

    Management of levator ani syndrome is similar to that of proctalgia fugax, including biofeedback treatment, Inhaled salbutamol, Botulinum toxin A, electrogalvanic stimulation and nerve stimulation.

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