Levator ani syndrome is a type of pelvic floor dysfunction characterized by overly tight pelvic floor muscles. This condition, a type of nonrelaxing pelvic floor dysfunction, can significantly impact a person's quality of life. The pelvic floor muscles, including the levator ani, support the rectum, bladder, and urethra, and in women, the uterus and vagina. When these muscles are too tight, it can lead to a range of uncomfortable and disruptive symptoms. While levator ani syndrome can affect both men and women, it is more commonly diagnosed in women.
What is Levator Ani Syndrome?
Levator ani syndrome is characterized by a spasm in the levator ani muscle, which is located near the anus. The levator ani is the largest component of the pelvic floor muscles. It provides support to the vagina, uterus, and rectum. If you think of the pelvis as a bowl, the pelvic floor is the “bottom of the bowl”, where a sling of muscles helps to elevate and provide a muscular function to the organs in the pelvis.
The condition has been known by many other names, including chronic anorectal pain, chronic proctalgia, levator spasm, pelvic tension myalgia, piriformis syndrome, and puborectalis syndrome. Until 2016, levator ani syndrome was considered to be a form of chronic proctalgia. However, the term chronic proctalgia is now disbanded, and levator ani syndrome is no longer considered a subtype.
It is estimated to affect 7.4 percent of women and 5.7 percent of men in the general population. Over half of all those with symptoms of levator ani syndrome are 30-60 years of age.
Symptoms of Levator Ani Syndrome
Symptoms of levator ani syndrome can be ongoing and impact your quality of life. Most people with this disorder have at least a few of the following symptoms, if not all of them.
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- Pain: People with this syndrome may experience rectal pain not associated with having a bowel movement. It may be brief, or it may come and go, lasting several hours or days. The pain may be brought on or made worse by sitting or lying down. It may wake you from sleep. The pain is usually higher in the rectum. One side, often the left, may feel more tender than the other. The pain of levator ani syndrome is caused by a spasm in the levator ani muscle. Pain may radiate to the hips, tailbone, or other areas. This pain is usually unrelated to a bowel movement, and there appear to be no structural abnormalities or underlying conditions responsible for the symptoms. The symptoms of levator ani syndrome include pain high in the rectum that may be: irregular and spontaneous, less than 20 minutes in duration, specific or general, a dull ache, a sense of pressure in the rectum, felt when sitting, relieved when standing or lying down, unrelated to bowel movements, severe enough to interrupt sleep. Furthermore, a person may feel that passing gas or defecating can give them relief from the pain. In severe cases, the rectal pain may recur frequently and may last for several hours. Share on PinterestThe symptoms of levator ani syndrome may be relieved when lying down or standing up straight.
- You may also experience low back pain that may spread to the groin or thighs. In men, pain may spread to the prostate, testicles, and tip of the penis and urethra.
- Urinary and bowel problems: You may experience constipation, problems passing bowel movements, or straining to pass them. You may also have a feeling like you haven’t finished having a bowel movement. Additional symptoms may include: bloating, needing to urinate often, urgently, or without being able to start the flow, bladder pain or pain with urination, urinary incontinence.
- Sexual problems: Levator ani syndrome can also cause pain before, during, or after intercourse in women. In men, the condition can cause painful ejaculation, premature ejaculation, or erectile dysfunction. The symptoms of levator ani syndrome include pain in the rectum when sitting, after a bowel movement, and during urination or sexual intercourse.
Causes and Risk Factors
The exact cause of levator ani syndrome is unknown. It may be related to any of the following: not urinating or passing stool when you need to, vaginal shrinking (atrophy) or pain in the vulva (vulvodynia), continuing intercourse even when it’s painful, injury to the pelvic floor from surgery or trauma, including sexual abuse, having another type of chronic pelvic pain, including irritable bowel syndrome, endometriosis, or interstitial cystitis. Though the precise cause is unknown, it is commonly believed that chronic tension of the pelvic floor muscles plays a role in levator ani syndrome. Another theory is that inflammation in the pelvic area is a contributing factor. Because the levator ani muscles are chronically contracted, there is a decrease in blood flow to the pelvic area. Although the exact cause is not clear, endometriosis can increase the risk of levator ani syndrome. Because of inflammation, women with endometriosis experience severe pelvic pain.
People may be at higher risk of levator ani syndrome after childbirth or following surgery on the pelvic area, anus, or spine.
Diagnosis
Identifying levator ani syndrome is often called a “diagnosis of exclusion.” That’s because doctors have to test to rule out other problems that could be causing the symptoms before diagnosing levator ani syndrome. In men, levator ani syndrome is often misdiagnosed as prostatitis.
Diagnosis of levator ani syndrome is based upon excluding other diseases that may be responsible for the symptoms. This may be done through a physical examination and diagnostic testing:
- Medical history and examination: A doctor will first take a full medical history and do a physical examination. A person may experience tenderness in the levator muscle when it is pressed during a rectal examination. The puborectalis muscle is the muscle that wraps around the rectum and the pubic bone. Doctors will examine this as part of a physical exam to see if it is tender. A doctor will suspect levator ani syndrome if the individual: Reports chronic or recurrent rectal pain that lasts for at least 20 minutes. Experiences severe tenderness when the levator muscle is touched.
- Tests: Examples of tests to exclude other disorders that may lead to a diagnosis of levator ani syndrome include: stool sample, blood test, endoscopic procedures, imaging tests. The tests used will depend on what the doctor considers necessary based on the reported symptoms.
Treatment Options
With the right evaluation and treatment, people who have levator ani syndrome can find relief. As levator ani syndrome is a chronic condition, there is no known cure.
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Treatment options for levator ani syndrome include:
- Physical therapy: When applied to the pelvis, physical therapy, such as massage, may reduce spasms and cramping in the muscles of the pelvic floor. Pelvic floor physical therapy is another approach that can reduce the symptoms of levator ani syndrome. It involves a qualified physical therapist teaching the patient pelvic floor exercises where they contract and relax their pelvic floor muscles. Techniques such as biofeedback and digitally massaging the levator ani muscle can also help. In biofeedback, a probe is inserted into the patient’s vagina to monitor the working of the pelvic floor muscles including the levator ani. Share on PinterestPhysical therapy may help to treat levator ani syndrome.
- Electrogalvanic stimulation (EGS): This involves inserting a probe into the anus to administer mild electrical stimulation and has been shown to be more effective than physical therapy.
- Biofeedback: This technique uses specialized equipment to measure muscle activity while exercises are done. Through the feedback they get, people learn to control or relax certain muscles to reduce symptoms.
- Botox injections: Botox has been investigated as a potential treatment. One study documents relief from spasms due to regular Botox injections. A 2004 study reported similar findings. Other treatments may include botox injections and sitting on pillows.
Home Remedies and Lifestyle Adjustments
Talk with your doctor about over-the-counter pain relievers that may help. Many people find comfort from a sitz bath. To take one: Soak the anus in warm (not hot) water by squatting or sitting in a container on top of the toilet bowl. Continue to soak for 10 to 15 minutes. Pat yourself dry after the bath. Avoid rubbing yourself dry with the towel, which may irritate the area. Lifestyle changes can also alleviate the symptoms of the syndrome. For example, a diet that contains a moderate amount of fiber can help with regular bowel movements and avoid constipation or diarrhea. It is also important to stay active and avoid prolonged periods of sitting.
Home remedies include:
- Sitz baths: Soaking the anal region in warm water, known as a sitz bath, can provide relief from episodes of anal spasms.
- Non-steroidal anti-inflammatory medication (NSAIDs): Taking an over-the-counter pain reliever may help to reduce discomfort.
- Sitting on a pillow: Some people report that sitting on a donut-shaped pillow reduces the pressure on the anus, which may alleviate symptoms.
- Gas or bowel movement: Episodes of levator ani spasms may be relieved by passing gas or by a bowel movement.
You can also try these exercises to loosen tight pelvic floor muscles.
- Deep squat: Stand with your legs spread wider than your hips. Hold onto something stable. Squat down until you feel a stretch through your legs. Hold for 30 seconds as you breathe deeply. Repeat five times throughout the day.
- Happy baby: Lie on your back on your bed or on a mat on the floor. Bend your knees and raise your feet toward the ceiling. Grip the outside of your feet or ankles with your hands. Gently separate your legs wider than your hips. Hold for 30 seconds as you breathe deeply. Repeat 3 to 5 times throughout the day.
- Legs up the wall: Sit with your hips about 5 to 6 inches from a wall. Lie down, and swing your legs up so your heels rest high against the wall. Keep your legs relaxed. If it’s more comfortable, let your legs fall out to the sides so you feel a stretch in your inner thighs. Focus on your breathing. Stay in this position 3 to 5 minutes.
Home treatment may not be enough to manage your condition.
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