His and Her Health

Niva

Which muscles being in spasm would cause the external anal sphincter muscle to pain at the top, bottom and left side?

the sphincter itself may be causing the pain itself.

Niva,

What can I do to get rid of the pain there? I am considering botox but how would they botox for that?

Also, when I lie down, the pain in my lower vestibule is gone after resting or sleeping, as soon as I get on my feet and sit, and press again- the pain returns. Its the lower vestibule area and the sides of my vagina ( I think the trans perineal muscles- are they to the sides) anyway, the pain in the morning is gone until I get on my feet and move around. What does this sound like?

thank you

You need to speak with your physician regarding Botox; PTs do not administer these. Perhaps the Puborectalis or Pubococcygeus are causing pain and they can be injected?
Your pain easing while laying down is common; one bc you are resting and perhaps easing your mind a bit, but also bc you are not provoking the area which causes more pain. Also, has your spine and SI joints been cleared? You may have an orthopedic component to this issue.

Niva

Who can evaluate my spine and si joints. I do have lower back pain.. (L 5 and si joints) I am afraid the pt I was seeing was not versed in all of this. Should I be seeing a certain physician that can evaluate these areas??? i had chiropractic adjustments as well that did not remedy these areas

thank you

A trained physical therapist can evaluate and treat a back/SI dysfunction. Not all PT's have the same expertise, so you may want to call some PT offices and ask who and how much training the PT has in SI. the Best would be to talk to one of the PT's.

You can try to seek a Physiatrist (physical medicine and rehab doctor). They can evaluate both the joints and nerves usually. Have you had an MRI or X Rays of your spin, pelvis or hips? I think a combination of both muscle and joint work can help. Did your PT assess the SI joint?

I just had an mri today of my lumbar spine and pelvis. It hurts at L5 and when I bend backwards the spine and si joints hurt. My doctor said that it is unclear whether the levator spasms cause the back pain or the other way around.
I wish I knew what was going on exactly. The vestibule pain(bottom) is there as soon as I get out of bed in the morning and start moving around. Before I get out of bed, I am fine.

You will need to see the results of your imagin before diagnosing. If it is hurting when you stand, perhaps you are throwing your back into extension. Try to maintain a neutral spine. What happens if you bend forward? Did you have the back issue before or at same time as levator pain?

Niva,

When I bend forward and touch the vestibule I have no pain. When I stand upright the pain returns.

Any idea what this means??

thank you

Also, I feel better when my rectum is throbbing ( levator muscle) when I lie down on my side, or bend to touch my toes. This is the same for the vestibule pain. Does this sound more like a back issue or muscles? I am scheduled for botox and want to address the root problem

Well it seems that some movements are reproducing or easing your pain, so there could be a relation to your back. But, I am sure there is pelvic muscle involvement. It is hard to tell you the root of the problem via forums/internet.

Niva

I am awaiting the results of an mri, but in the event that it does not show anything, who could tell me if my back is involved with this. If I sit and lower my head, I get pain down my spine into the top of my butt crack. I know something is off. Just not sure who can help me.

Thank you

Could bulging discs in ur back cause levator spasms?

Not typically. The levator ani muscles are innervated (or 'controlled') by the muscles in the sacroiliac area (from the sacral nerves). an MRI does NOT typically show a dysfunction in the sacroiliac joint, which is what is most common in our patient populations. You need to see a specialist to rule this out.