What is anal sphincter syndrome?
Anorectalgia is a functional pain condition in which a person feels recurrent pain or heaviness in the anus, rectum, or perineal area, but endoscopy or imaging tests do not reveal any abnormalities. It is characterized by pain that is particularly severe when sitting still or straining, and is relieved by lying down and resting. Many people suspect hemorrhoids or inflammation, but the real cause is chronic contraction of the muscles surrounding the anus.
Perineal sphincter pain, is it really a sphincter problem?
When you have perineal pain, most people think it’s a problem with the anal sphincter itself, but in reality, it’s often caused by the levator ani muscle, which is located further up than the sphincter. The levator ani is the muscle that wraps around and supports the anus and rectum from above, and when it’s tight, it can cause dull pain or pressure in the perineum and deep in the anus. This explains why the pain persists even though the sphincter is normal.
Key muscles that contribute to pain
The most important muscle in anal sphincter syndrome is the anal sphincter, but it rarely causes problems alone. Often, the entire pelvic floor muscle group is tight and stiff together. Typically, when the puborectalis, pubococcygeus, and iliacoccygeus muscles are tight together, it can cause pain after bowel movements, pain when sitting for long periods of time, and even discomfort after sex. These muscles are all strongly influenced by the autonomic nervous system.
The relationship between the autonomic nervous system and anal sphincter syndrome
Patients with anal sphincter syndrome often have a history of stress sensitivity or prolonged tension. When the sympathetic nervous system is triggered, muscles remain contracted and are unable to relax. The anal sphincter is no exception, and the longer the autonomic imbalance persists, the more chronic the pain becomes. This is why simply treating the area of pain is often ineffective.
Key directions in the treatment of anal sphincter syndrome
Treatment for psoas syndrome doesn’t just target the area where the pain is felt. It’s important to restore balance to the autonomic nervous system, along with an approach that relaxes the anal sphincter and pelvic floor muscles. This, along with correcting factors such as a sedentary lifestyle, overwork, and lack of sleep, can help reduce recurrence. If you are experiencing recurrent pain, you need to look at it from a holistic neuromuscular control perspective, not just as a sphincter issue.
