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Dr. Mark
Dr. Mark, M.D.
Category: Urology
Satisfied Customers: 7145
Experience:  30 years of primary care medicine including urology evaluation
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I have a constant ache and pressure in my anus. It goes away

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Hello. I have a constant ache and pressure in my anus. It goes away when I sleep and even if I'm really relaxed or distracted. The problem is once its there I can't stop thinking about it. I have had it on and off for 9 years and have had many tests. A doctor said it was a form of proctalgia or levator ani syndrome. I just need some reassurance and advice on how anxiety and psychological issues can cause this. Many thanks
Hi. What workup have you had? Colonoscopy? Cat scan?
Any serious condition would have become evident by now. So cancer is definitely ruled out. Since it’s worse when you think about it, then there is a huge component of anxiety . A serious condition wouldn’t last this long and would cause constant pain.
Customer: replied 8 months ago.
Iv had an mri scan and had 4 proctoscope checks. Also blood tests and loads of digital rectal exams. Have you heard of this before? How does simply thinking about it cause it to come on? It's like it's a tense muscle back there
Customer: replied 8 months ago.
I Google levator ani syndrome all the time but I don't have any urinary issues or pain anywhere else.
It’s not uncommon for stress and anxiety to make your symptoms worse. You concentrate on them when you think about it.
The mri would have detected a problem. It’s just your nerves that are the problem. Medically you are fine.
Customer: replied 8 months ago.
Is levator ani a possibility? I read horror stories about it. I think it's a tense anal sphincter. The one we can't control the internal one. It's like my body is holding back a poop even though I don't need one. It's a bizarre pressure sensation. No one has ever put a label on the problem. I obsess over it
I doubt you have Levator ani. You don’t have urinary sympathy. And this diagnosis is by exclusion. There’s no specific tests as you know. Treatment of this condition is with exercises. You ca try them to see if they are helpful. But I think you are obsessing over this condition and that’s the reason you feel symptoms.
Here’s an article about the topic. While I don’t believe you have the condition, I think trying biofeedback would help you relax.
https://www.jwatch.org/*****************/2010/05/14/treatments-levator-ani-syndrome
Customer: replied 8 months ago.
The tension is about an inch inside my anus and towards the tailbone side. A pelvic floor therapist found it. What muscle could that be?
That’s the area of the levator ani.
Customer: replied 8 months ago.
Ah I see. But it surely is me causing it to myself isn't it
your worrying is causing the discomfort. You focus on the problem and then your brain tricks you into believing you have pain.
Customer: replied 8 months ago.
Can the brain cause the tension? Is the internal anal sphincter part of the levator ani
Customer: replied 8 months ago.
Can levator ani be caused by anxiety and the brain
It’s due to increased pelvic muscle pressure and is made worse by anxiety.
Have I answered your questions?
Customer: replied 8 months ago.
Sorry to bombard you with questions. Is it possible that the more I think about it I'm actually causing the problems myself? I worry I have damaged the muscles. But surely if that was the case it wouldn't go away when I sleep. Do those muscles tense up out of my control or am I doing it myself without knowing?
You are not damaging the muscles by thinking about it. But thinking about it causes the discomfort. And even subconsciously you are doing it.
Customer: replied 8 months ago.
The muscles are actually tense and sore to press against
Customer: replied 8 months ago.
I just need some reassurance
Customer: replied 8 months ago.
Is it the levator ani muscle that helps with pooping? Is that a muscle that helps bowel movement
No it doesn’t. It supports the pelvic floor.
Sorry for the delay. I lost my internet connection. Finally got it back.
Customer: replied 8 months ago.
I can subconsciously be tensing these muscles because of stress and just by thinking about it?
you can.
Customer: replied 8 months ago.
OK I will stop worrying and searching for answers. I'm just making myself worse. I was just after reassurance. Feels like I need to poop when I don't
Customer: replied 8 months ago.
Sometimes when I wee it can be a bit slow but I guess that is also tension
Customer: replied 8 months ago.
Is it possible to learn to relax the muscles without biofeedback
Sorry for the delay. I’m having internet problems today. I recommend CBT. Cognitive behavioral therapy. It’s a method of learning to deal with anxiety. There are many books on CBT and online. I theink CBT can help you learn how to relax and not think about the problem.
Customer: replied 8 months ago.
Th. I just worry I'm damaging my muscles. I need to stop googlling
No, you’re definitely not damaging the muscles.
Glad to help. I’d appreciate you rating my answers with the stars on your screen so I receive feedback and credit. Thanks
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