1 General introduction 21 first; abnormal anorectal evacuation pattern with manometry or electromyography, second; abnormal balloon expulsion test and third; impaired rectal evacuation by imaging (e.g. defecography).40 Anorectal pain could also result in increased tone (non-neurogenic hypertonicity) of the pelvic floor muscles, and this is typically associated with symptoms of postdefecatory pain which can last for hours.41,42 Levator ani syndrome is associated with tenderness to palpation on the levator ani muscle and increased anal resting pressures and there is an overlap between increased pelvic floor muscle tone and dyssynergia.37,40 This chronic anal pain resulting from tension or spasms in the levator muscles leads to compression of nerve endings and pain via peripheral sensitization.43 Myofascial pain is expressed in dysfunction in the muscle and surrounding connective tissues 44 and in the levator ani syndrome, the pain can radiate into the vagina, gluteal area or the thighs.43 Dyssynergia and/or increased tone of the pelvic floor may probably lead to a vicious circle of pain and be an underlying cause of delayed healing in patients with CAF.45 Impact on quality of life CAF is associated with reduced quality of life and can be influenced by physical, psychological, and social factors.1 Continuing complaints may lead to functional and psychosocial impairment.2 Patients with CAF show a high comorbidity of psychopathology, depression, and anxiety disorders with stress acting as a trigger and/or exacerbating factor.1 Symptomatic improvement with successful nonsurgical treatment, beneficially affects health-related quality of life.2 Diagnostics The diagnosis of CAF is based on medical history taking and a thorough physical exam should be performed to rule out other pathology. Before performing a digital rectal examination, it is important to explain the procedure to the patient and why, to diminish any fears and anxiety. Patients should be reassured that the digital examination will only last for a couple of minutes.46 During the assessment the patient lies on his/her left lateral position with the knees flexed at 900.. The examiner uses non-allergic gloves lubricated with water-based gel or vaseline.
RkJQdWJsaXNoZXIy MTk4NDMw