Levator Ani Syndrome

What is levator ani syndrome?

Levator ani (luh-VEE-tor ah-ne) syndrome is a type of pelvic floor dysfunction. It happens when you have spasms (tightening) in your levator ani, a pelvic floor muscle near your anus (butthole) and vagina. The spasms may feel like a dull ache in your rectum and pelvis, but they may also cause sharp pain.

Your levator ani does many things, like supporting organs in your pelvis and controlling when you poop. Other names for levator ani syndrome are pelvic floor myalgia, pelvic floor myofascial pain, and pelvic floor muscle spasm.

Levator ani syndrome isn’t serious or life-threatening. But it’s painful and won’t go away without treatment. We’re all a little self-conscious about sharing problems with our private parts. But healthcare providers can treat levator ani syndrome and ease painful spasms.

What are the symptoms of levator ani syndrome?

The most common symptom of levator ani syndrome is a dull ache or pressure in your rectum, vagina or pelvis. The pain and pressure may:

• Cause pain during sexual intercourse
• Feel like you’re sitting on a ball or that there’s a ball inside your rectum
• Be more noticeable when you sit down for a long time
• Go away when you stand up
• Last for hours but may suddenly get worse

The pain may start in the morning and get worse throughout the day. Sometimes. the pain may spread to your butt (buttocks) or upper thigh. In some cases, the pain may start while you’re sleeping and be so strong that it makes you wake up.

What causes levator ani syndrome?

Experts don’t know the exact reason your levator ani goes into spasms. Research suggests some activities may trigger the spasms, including:

• Long-distance car travel
• Stress
• Sexual intercourse
• Pooping

How do healthcare providers diagnose levator ani syndrome?

There’s no single test for diagnosing levator ani syndrome. A healthcare provider will do a physical examination, including a digital rectal examination (DRE) and pelvic examination.

How is levator ani syndrome treated?

There are several ways to treat levator ani syndrome. Research shows the following treatments are effective:

• Biofeedback therapy. This treatment involves learning to control or relax certain muscles. A physical therapist uses special sensors and video to watch your levator ani as you try to relax or clench the muscle. (Think of tightening your butt to keep from breaking wind.) Your therapist will give you feedback and work with you to improve muscle coordination.
• Electrogalvanic stimulation. In this treatment, a healthcare provider inserts a probe into your rectum. The probe delivers a very mild electrical current to relax your rectal muscles.
• Muscle relaxers. These are prescription medications that can ease muscle spasms. Common muscle relaxers to treat levator ani syndrome include methocarbamol (Robaxin®), diazepam (Valium®) and cyclobenzaprine (Flexmid®, Flexeril®).
• Myofascial release therapy. This is massage using a device to massage trigger points in your levator ani.
• Pelvic floor physical therapy. Physical therapy involves exercises to stretch your lower back, pelvis and pelvic floor muscles.
• Sitz baths. This is sitting in a warm, shallow bath to help your levator ani relax.

What kind of healthcare provider treats levator ani syndrome?

You may start by talking to a primary care physician (PCP). They may refer you to a gastroenterologist. Gastroenterologists specialize in conditions that affect your digestive system. But your PCP may refer you to a gynecologist or a colorectal surgeon. These specialists treat conditions that affect your anus, colon, rectum and vagina.

What can I expect if I have levator ani syndrome?

If you’re like most people, a combination of medication and physical therapy should ease your symptoms.

When should I see my healthcare provider?

You should contact your provider if you have levator ani symptoms that come back during treatment or get worse. You should also contact them if you notice changes like rectal bleeding or new pain in your rectum or vagina.

What’s the difference between levator ani syndrome and proctalgia fugax?

Both conditions cause pain in your rectum. The difference is proctalgia fugax pain is very sharp, comes on quickly and often goes away within 20 minutes. Pain from levator ani syndrome can be sharp but is typically a dull ache that may come and go or last for several hours.

Can hemorrhoids cause levator ani syndrome?

No, hemorrhoids don’t cause levator ani syndrome. Hemorrhoids are swollen veins inside your rectum or anus that may develop if you put a strain on veins in those parts of your body. That can happen if you struggle to lift a heavy object or to poop. Experts don’t know what causes levator ani syndrome.