Reasons you might need Rectal Dilators and How to Relax Anal Muscles

This article will first explore the reasons for tight rectum and then how to increase the size of the anal canal the easy way with a rectal dilator. Anal dilation is the process of opening up or stretching the anus using small plastic dilator or silicone dilators, so it becomes a normal size.

Levator Ani Syndrome is condition characterized by sporadic episodes of pain in the rectum and anus that can cause stress on someone’s everyday activities.

1. Facts about Levator Ani Syndrome
2. What is Levator Ani Syndrome
3. Causes of Levator Ani Syndrome
4. Symptoms
5. Diagnosis
6. Treatment
7. Home Remedies
8. Rectal Dilators
   1. Instructions
9. Pelvic Floor Physical Therapy

Here are some key points about levator ani syndrome. More detail and supporting information is in the main article.

• Levator ani syndrome occurs when a muscle near the rectum - the levator ani muscle - spasms and causes pain.
• The cause of levator ani syndrome is not very clear, but it is common.
• Treatment involves managing the symptoms and trying to reduce the pain with pelvic floor therapy in both men and women.
• Some self-administered and home remedies, including dilators, can give relief for some people with levator ani syndrome.

Levator ani syndrome is caused by a muscle spasm near to the anus.

The pain of levator ani syndrome is caused by a spasm in the levator ani muscle.

Pain may radiate to the hips, tailbone, or other areas.

This pain is usually unrelated to a bowel movement, and there appear to be no structural abnormalities or underlying conditions responsible for the symptoms.

Until 2016, levator ani syndrome was considered to be a form of chronic proctalgia.

However, the term chronic proctalgia is now disbanded, and levator ani syndrome is no longer considered a subtype.

In levator ani syndrome, the levator ani muscles of the pelvic floor are short, contracted, and weak. This contracted state does not allow for the levator muscles to support its surrounding structures and leads to a decrease in blood blow to the area. After several months, this decrease in blood flow leads to an acidic environment which stimulates an inflammatory cascade. The inflammatory cascade causes an “inflammatory” soup in the pelvis and surrounding area, in addition to inflammation around the nerves. This cascade is ultimately what leads to the pain symptoms described above and lack of muscle coordination for the pelvic floor muscles in levator ani syndrome.

There are both local and systemic factors that contribute to causing the symptoms of levator ani syndrome. Locally, unconscious tensing of the pelvic floor muscles from stress and anxiety, contribute to the symptoms. Often this is combined with certain “triggers” or risk factors. Additionally, contributing factors include chronic constipation or loose stools, poor toileting habits usually started as a young child, a history of hemorrhoids or an anal fissure, a history of colorectal or gynecological surgery. Systemically, a genetically wired nervous system with a “dial” or “amplifier” that is turned up or “hyperexcitable” predisposes patients to potentially suffering from levator ani syndrome.

The symptoms of levator ani syndrome may be relieved when lying down or standing up straight.

The symptoms of levator ani syndrome include pain high in the rectum that may be:

• irregular and spontaneous
• less than 20 minutes in duration
• specific or general
• a dull ache
• a sense of pressure in the rectum
• felt when sitting
• relieved when standing or lying down
• unrelated to bowel movements
• severe enough to interrupt sleep

Furthermore, a person may feel that passing gas or defecating can give them relief from the pain. In severe cases, the rectal pain may recur frequently and may last for several hours.

Diagnosis of levator ani syndrome is based upon excluding other diseases that may be responsible for the symptoms. This may be done through a physical examination and diagnostic testing:

Medical history and examination

A doctor will first take a full medical history and do a physical examination. A person may experience tenderness in the levator muscle when it is pressed during a rectal examination.

A doctor will suspect levator ani syndrome if the individual:

• Reports chronic or recurrent rectal pain that lasts for at least 20 minutes.
• Experiences severe tenderness when the levator muscle is touched.

Examples of tests to exclude other disorders that may lead to a diagnosis of levator ani syndrome include:

• stool sample
• blood test
• endoscopic procedures
• imaging tests

The tests used will depend on what the doctor considers necessary based on the reported symptoms.

Physical therapy may help to treat levator ani syndrome. Other treatments may include botox injections and sitting on pillows.

The treatment options for levator ani syndrome include:

• Physical therapy: When applied to the pelvis, physical therapy, such as massage, may reduce spasms and cramping in the muscles of the pelvic floor.
• Electrogalvanic stimulation (EGS): This involves inserting a probe into the anus to administer mild electrical stimulation and has been shown to be more effective than physical therapy.
• Biofeedback: This technique uses specialized equipment to measure muscle activity while exercises are done. Through the feedback they get, people learn to control or relax certain muscles to reduce symptoms.
• Botox injections: Botox has been investigated as a potential treatment. A previous study documents relief from spasms due to regular Botox injections.

• Sitz baths: Soaking the anal region in warm water, known as a sitz bath, can provide relief from episodes of anal spasms.
• Non-steroidal anti-inflammatory medication (NSAIDs): Taking an over-the-counter pain reliever may help to reduce discomfort.
• Sitting on a pillow: Some people report that sitting on a donut-shaped pillow reduces the pressure on the anus, which may alleviate symptoms.
• Gas or bowel movement: Episodes of levator ani spasms may be relieved by passing gas or by a bowel movement.
• Rectal Dilator Therapy: Due to muscles needing to be relaxed and stretched, home pelvic floor physical therapy is a recommended by most pelvic floor physical therapists.  

Please consult with a medical professional before beginning any type of treatment or rectal health therapy.

1. Wash rectal dilators before use with a mild hypoallergenic soap and warm water.
2. Find a comfortable position.
3. Many patients prefer to lie on their left side. However, any comfortable position is appropriate.
4. Lubricate both the anal canal and the tip of the dilator. Proper lubrication will help prevent potential tearing or discomfort due to dryness. Do not use a petroleum-based lubricant because it will increase your risk of infection and be more difficult to wash off.
5. The tip of the dilator should be positioned lightly and at a right angle to the rectum. Exhale and gently ease the dilator into the anal canal. Breathing deeply and inching the dilator deeper with each exhalation will aid penetration.
6. Do not continue if you become tense. Practice controlled breathing and attempt to relax. Remove the dilator if there is any chance you might become hurt or injured.
7. The dilator is fully inserted once the cuff (the flat end) is in contact with the skin. At this point it can be removed immediately. It is not necessary for the dilator to remain within the anal canal.
8. Wash and dry the dilator thoroughly. Hygiene is important to avoid risk of infection during the next use of the rectal dilator. Use a mild hypoallergenic soap and warm water.

Pelvic floor physical therapy is usually prescribed for women who, after a few pregnancies, tend to leak urine.

But men can leak, too, especially after surgery for prostate cancer. Men can also suffer from chronic pelvic pain. Physical therapy specific to the pelvic floor muscles can provide relief.

The pelvic floor comprises muscles and connective tissue that support abdominal organs, control the bowels and bladder and are involved in sexual function.

The two main symptoms that send men to pelvic floor physical therapy are incontinence (inability to control your urination) and pelvic pain.

Men who have had surgery for prostate cancer may have incontinence at least temporarily after their surgery, which is normal. Some men who receive radiation therapy for prostate cancer can also experience incontinence which is normal as well.

Another common pelvic problem for men is chronic (ongoing) pelvic pain. Pain can come from the bladder, rectum or prostate (the latter is sometimes called prostatitis). Pain tends to make muscles tighten up, like a constant cramp, and this becomes an uncomfortable cycle: pain leads to muscle tension, which causes more pain.

The problem with male pelvic pain is that it’s often misdiagnosed. These men have these symptoms and no one knows what to do with them because they simply do not do research. They often get treated with antibiotics but don’t improve.  Sometimes they see multiple specialists before they get diagnosed with pelvic pain and receive comprehensive treatment including PT.

The antibiotics that you are given might be causing the pain. But if there’s no actual infection, this will not sure your painful symptoms.

There are many aspects to pelvic floor rehab:

Education and a frank conversation. The therapist gives men a basic education about their pelvic floor, an often mysterious part of male anatomy.

Men don’t tend to think about their pelvic floor. By the time a female sees a doctor, she’s probably had several children and her obstetrician has recommended pelvic floor exercise. Men simply don’t have that experience.

On the first visit, the physical therapist has a discussion with men: They ask about their pain symptoms — what their urination is like, what their bowel movements are like, what their sexual activity is like. It is important to answer all questions to create a successful treatment plan.

Men with questions about any part of pelvic floor rehab can call or email the physical therapist before the first visit to talk through any concerns. They want to make you feel as comfortable as possible.

A physical check up. The pelvic therapist will check strength, flexibility and range of motion in the back and pelvic floor areas.

An internal exam. Often the therapist will do a rectal exam with a gloved finger, to feel whether the muscles are weak or in spasm, or have some other dysfunction. Pelvic floor rehab may also involve massaging certain muscles and dilator therapy.

Exercises targeting the right muscles. For incontinence, pelvic floor rehab aims to strengthen the muscles controlling urination. For pelvic pain, the aim is coaxing tight muscles to relax. Both will involve exercises that, with practice, will retrain pelvic floor muscles to function properly.

There are other exercises beyond Kegels that a therapist will teach men so they can target pelvic floor muscles.

Regular sessions for about 20 weeks – sometimes longer – can help men dramatically strengthen control over urination or treat levator ani syndrome.

Pelvic pain can have many factors, so resolving it may take six months or longer, everyone is different based on the severity on pain. Behavioral, lifestyle or emotional challenges are often part of the problem, and men may need to tackle one or more of those issues in addition to getting physical therapy. For example, a person with a high-stress life may need to make life changes and learn to manage stress in addition to getting physical therapy, to prevent pain flare-ups.

The frequency of in-person visits to the therapist tapers off as the patient makes progress, especially if he is consistently doing his exercises at home between visits.

Do you need pelvic floor physical therapy or rectal dilators? Order your dilators here.