Levator ani syndrome is a type of nonrelaxing pelvic floor dysfunction. That means the pelvic floor muscles are too tight. The pelvic floor supports the rectum, bladder, and urethra. In women, it also supports the uterus and vagina.
Levator ani syndrome is more common in women. Its main symptom is constant or frequent dull pain in the rectum caused from a spasm in the levator ani muscle, which is near the anus. Levator ani syndrome has many other names, including:
- chronic anorectal pain
- chronic proctalgia
- levator spasm
- pelvic tension myalgia
- piriformis syndrome
- puborectalis syndrome
Pelvic floor disorders
Pelvic floor disorders occur when the muscles aren’t working correctly. They occur from two problems. Either the pelvic floor muscles are too relaxed or too tight.
Pelvic floor muscles that are too relaxed can cause pelvic organ prolapse. An unsupported bladder can lead to urinary incontinence. And in women, the cervix or uterus can drop into the vagina. This can cause back pain, problems urinating or having a bowel movement, and painful intercourse.
Pelvic floor muscles that are too tight can lead to nonrelaxing pelvic floor dysfunction. This can cause problems with storing or emptying bowels, as well as pelvic pain, painful intercourse, or erectile dysfunction.
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.
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.
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:
- needing to urinate often, urgently, or without being able to start the flow
- bladder pain or pain with urination
- urinary incontinence
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 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
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.
With the right evaluation and treatment, people who have levator ani syndrome can find relief.
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.
You can also try these exercises to loosen tight pelvic floor muscles.
- 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.
- 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.
Kegel exercises may also help. Learn tips for Kegel exercises.
Home treatment may not be enough to manage your condition. Your doctor may talk to you about any of these treatments for levator ani syndrome:
- physical therapy, including massage, heat, and biofeedback, with a therapist trained in pelvic floor dysfunction
- prescription muscle relaxants or pain medication, such as gabapentin (Neurontin) and pregabalin (Lyrica)
- trigger point injections, which may be with a corticosteroid or botulinum toxin (Botox)
- nerve stimulation
- sex therapy
Tricyclic antidepressants should not be used, as they may aggravate bowel and bladder symptoms.
With the right diagnosis and treatment, people who have levator ani syndrome can get relief from the uncomfortable symptoms.