Levator ani syndrome



What is levator ani syndrome?

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, rectum, and urethra. In women, it also supports the uterus and vagina.

Levator ani syndrome is a long-term condition and is characterized by sporadic episodes of pain in the rectum and anus.

How common is levator ani syndrome?

Levator ani syndrome is more common in women. Also called levator syndrome or levator ani spasm syndrome, 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. Please discuss with your doctor for further information.


What are the symptoms of levator ani syndrome?


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:

  • 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.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes levator ani syndrome?

The exact cause of levator ani syndrome is unknown.

Risk factors

What increases my risk for levator ani syndrome?

There are many risk factors for levator ani syndrome, such as:

  • 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

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is levator ani syndrome diagnosed?

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.

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.


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.

How is levator ani syndrome treated?

The 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.

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: prescription muscle relaxants or pain medication, such as gabapentin (Neurontin) and pregabalin (Lyrica), acupuncture, nerve stimulation, sex therapy,

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage levator ani syndrome?

The following lifestyles and home remedies might help you cope with levator ani syndrome:

Sitz bath

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.

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

  1. Stand with your legs spread wider than your hips. Hold onto something stable.
  2. Squat down until you feel a stretch through your legs.
  3. Hold for 30 seconds as you breathe deeply.
  4. Repeat five times throughout the day.

Happy baby

  1. Lie on your back on your bed or on a mat on the floor.
  2. Bend your knees and raise your feet toward the ceiling.
  3. Grip the outside of your feet or ankles with your hands.
  4. Gently separate your legs wider than your hips.
  5. Hold for 30 seconds as you breathe deeply.

Repeat 3 to 5 times throughout the day.

Legs up the wall

  1. Sit with your hips about 5 to 6 inches from a wall.
  2. Lie down, and swing your legs up so your heels rest high against the wall. Keep your legs relaxed.
  3. If it’s more comfortable, let your legs fall out to the sides so you feel a stretch in your inner thighs.
  4. Focus on your breathing. Stay in this position 3 to 5 minutes.

Kegel exercises may also help.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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