Patients With Sensation of a Rectal Mass

Abstract

To the Editor.— The question concerning the cause of a sensation of a mass in the rectum in a 44-year-old woman was submitted to two authorities (242:1785, 1979) whose answers were (1) a mass within or outside the rectum (although there was no demonstrable evidence of a mass), (2) nerve root compression, (3) rectal prolapse, and (4) functional disorder. While these conditions may, indeed, be unusual causes of the complaint in question, the most common pathogenesis is the so-called levator syndrome from tonic spasm of the puborectalis, pubococcygeus, and piriformis muscles, so well described by Thiele. 1 The levator syndrome may consist of episodic pain, fullness, and pressure in the rectum and sacrococcygeal area, often aggravated by sitting. Some patients describe only a sensation of an intrarectal object. A variant of the syndrome is sharp rectal pain, sometimes awakening the person at night (proctalgia fugax). Coccygodynia (pain in the coccyx)