Levator ani syndrome and pudendal neuralgia

Pain in the anorectal and pelvic area is a frequent occurrence. In cases in which diagnostic measures do not reveal any overt pathologies, possible differential diagnoses include the levator ani syndrome (LAS), so-called unspecific anorectal pain and pudendal neuropathy (PN). The LAS is characterized by recurrent dull pain each lasting longer than 30 min. A typical clinical finding important for the diagnosis is tenderness of the levator muscle, which can be triggered by digital rectal examination. In the absence of tenderness it is more likely to be unspecific anorectal pain. Biofeedback therapy should be the main treatment approach. The diagnosis of PN is made according to the Nantes criteria, with the positive effect of a pudendal nerve block being an essential criterion. For treatment, surgical neurolysis of the pudendal nerve has the highest probability of achieving long-term pain relief and cessation.