Most women are familiar with common pelvic conditions like urinary tract infections and endometriosis.
What is levator ani syndrome? This less common ailment can be painful, the pain can vary between sharp and sudden or a dull ache, and the pain can come and go.
Need to know more? Here’s all about levator ani syndrome.
What is the Levator Ani?
The first step in understanding this condition is understanding the levator ani.
This is a pelvic floor muscle that is located on either side of your lower pelvis. It’s a complex, funnel-shaped structure, formed by the junction of three muscles, that is mainly composed of striated muscle with some smooth muscle components.1
The levator ani is considered part of the pelvic floor, but it also supports and raises your pelvic floor, and allows various pelvic structures to pass through it.1 This “sling” of muscles stretches across from the front to the back of your pelvis, holding up the bladder, uterus, vagina, and the descending rectum.2
Besides supporting organs in your pelvis, the levator ani performs other functions, like controlling when you poop.3
What is Levator Ani Syndrome?
Levator ani syndrome is a type of pelvic floor dysfunction that happens when you have tightening or spasms in your levator ani, or spasms near your anus. It causes unexpected pain in your rectum or vagina that comes and goes. These spasms may feel like a dull ache in your rectum and pelvis, but they may also cause sharp pain.
You may feel the symptoms when you sit for a long time, and sometimes the pain eases when you stand up.
Levator ani syndrome is also called pelvic floor myalgia, pelvic floor myofascial pain, and pelvic floor muscle spasm.3
What are the Symptoms of Levator Ani Syndrome?
Besides pain in the rectum or the bottom and back of the pelvis, what are the symptoms of levator ani syndrome?
It might feel like you’re sitting on a ball, or that there’s a ball inside your rectum. Pain may last for hours and then suddenly get worse. The pain could also get progressively worse throughout the day. Or, it might start while you’re sleeping and be so strong that it wakes you. It can also spread to your buttocks or upper thighs. And as mentioned, it may be more noticeable when you sit for a long time, and then go away when you stand up.3
Here are some other side effects:2
- lower abdominal and groin pain
- pain during intercourse
- pain when you’re sitting
- pain during your periods
- postpartum pelvic pain
- postpartum sexual dysfunction
- rectal pain
- sacroiliac or SI joint pain
- increased urgency and frequency of urination
- vaginal pain
- bladder pain
- chronic constipation
Men can have this condition too, with the added symptom of testicular pain.2
What Causes Levator Ani Syndrome?
It’s not clear what causes your levator ani to go into spasms. There could be certain activities that trigger spasms, such as long-distance car travel that requires long hours of sitting. Stress may bring on the spasms. The muscle spasms may also be induced by pooping, or sexual intercourse.3
Your pelvic floor muscles could be short, contracted, and weak, which doesn’t allow the ani levator muscles to properly support the surrounding structures. That can lead to a decrease in blood flow to the area, which in turn leads to an acidic environment, which in turn stimulates inflammation.2
The resulting inflammation in the pelvis and surrounding area, and around the nerves, can lead to pain and lack of muscle coordination for the pelvic floor muscles.2
There are also several factors that could contribute to levator ani syndrome. For instance, unconscious tensing of the pelvic floor muscles from stress and anxiety can lead to symptoms. Other possible “triggers” or risk factors include chronic constipation or loose stool; poor toileting habits such as frequently holding in urine or stool; and previous colorectal or gynecological surgery.2
It’s also possible to suffer an injury to the muscles through childbirth that lead to the condition,4 or for chronic pelvic pain from other conditions — like endometriosis, irritable bowel syndrome, and interstitial cystitis — to lead to levator ani syndrome.5
While levator ani syndrome isn’t serious or life-threatening, it is painful, and it won’t go away without treatment.3 It’s worth noting that disorders of the lower pelvic floor due to overly tense muscles can lead to health issues in other organs.5
How is Levator Ani Syndrome Diagnosed?
It’s not always easy to diagnose the cause of ongoing pelvic pain. In the case of levator ani syndrome, there isn’t one single test to diagnose it. Typically, your healthcare provider will review your medical history, ask about your symptoms, and then do a physical examination, which could include a digital rectal examination (DRE) and a pelvic examination.3
Sometimes imaging is performed too, to see if there is a related cause of the pelvic nerve and muscle pain. The goal is to perform an examination of both the nerves and muscles within the pelvis.2 Your doctor will want to rule out other possible causes of rectal pain, such as inflammatory bowel disease or an intramuscular abscess.5
How is Levator Ani Syndrome Treated?
There are a number of treatment options for levator ani syndrome, and some seem like you are retraining your pelvic muscles and nervous system.
Here are some possible treatments.
1. Biofeedback therapy
A physical therapist will support your goal of learning to control or relax certain muscles. This therapy is done using special sensors and video as you relax and clench the muscle. The therapist provides feedback as you perform the tasks, with a goal of improving muscle coordination.3
2. Myofascial release therapy
Fascia is the thin cover of tissue that holds muscles in place. Myofascial pain is pain felt in muscles and that thin cover of tissue. Pressure on these areas, called trigger points, causes pain.6 Myofascial release therapy is a form of massage using a device to relax the trigger points that are causing the pain in your levator ani.3 Other options include acupuncture or nerve stimulation.5
3. Pelvic floor physical therapy
This is a specific form of physical therapy that involves exercises to stretch your lower back, pelvis and pelvic floor muscles, to bring relief to the levator ani muscles.3
4. Sitz baths
This involves sitting in a warm, shallow bath to help relax the levator ani muscles.3
5. Nutrition Coaching
Another option is nutrition counseling, in which you make diet and lifestyle changes to find what works to reduce inflammation and pain. Certain foods may trigger your inflammation. An improved diet may also help you deal with anxiety and stress, which in turn can help with pain.2
6. Electrogalvanic stimulation
This is a treatment delivered by a trained healthcare provider. In this therapy, a probe is inserted into your rectum, and it provides a very mild electrical current to relax your rectal muscles.3
7. Medication
It’s also possible that your doctor will suggest muscle relaxers, or prescription medications that can ease muscle spasms.3
Ask Your Doctor
Chronic pelvic pain is not normal, but unfortunately, it is also far too common for women. Chronic pelvic pain affects as many as 15% of women in the United States.7 See a doctor if you are experiencing the symptoms of levator ani syndrome, in particular if the pain has continued for six months or longer. See a doctor immediately if you notice changes like rectal bleeding or new pain in your rectum or vagina.3 Use our Physician Finder to find a doctor near you with expertise in women’s health.
It’s important to talk to your doctor about any concerns with your pelvic health.More common pelvic conditions are caused by weakened pelvic floor muscles. In this instance, exercises known as Kegels or pelvic floor muscles exercises can help. As your doctor for guidance, and consider using a tool like the Gynesis pelvic floor trainer shorts to properly perform Kegels. The exclusive Multipath Technology delivers electrical stimulation to multiple areas of your pelvic floor muscles, not just one part of your pelvic floor.
