Question: What can be done for levator ani syndrome?
Answer from Dr. Daniel Gruber, urogynecologist from Sibley Memorial Hospital in Washington D.C., part of John Hopkins medicine.
Think about levator ani syndrome as more of a pelvic floor spasm.
If you look at the pelvic floor muscles, of which there are many, some or many of them can be spasmed.
Now, if you think of a charlie horse, where your calf muscles are squeezing and spasming, you can stretch your calf very easily and to relieve it.
But the pelvic floor is very difficult, because you can’t stretch those muscles out very easily. They’re very difficult to stretch out because you don’t have feedback like you do with many other muscles. If you take your arm, for example, and I tell you to contract your bicep muscle, you get a visual cue because you can see right away whether or not your arm moving. That visual feedback tells you that your arm is moving. The pelvic floor isn’t the same way.
One way to check is to put a finger in the vagina, like your thumb for example, and then you can squeeze and relax to see if you can feel it. All muscles need to both contract and relax, and the pelvic floor is exactly the same way.
If there is pelvic floor spasm, one of the things that we can do is use a dilator. We give patients this device (see video) for example, and they can put it in the vagina, then push down usually on the back wall to gently stretch it out. It’s just like a massage essentially.
I definitely would recommend people who have pelvic floor spasm to see a pelvic floor physical therapist. They can do a lot of manual work, where they insert their fingers into the vagina and push on those specific muscles to try get them to relax. Sometimes if that reaches a plateau where it’s not working as much, we can also do Botox injections into the pelvic floor muscles.
If you have the pelvic floor muscles (see below) insert picture and, for example this is the pelvis right here, there’s the muscles you can see inside and from underneath here in the red so there’s a lot of pelvic floor muscles.