Levator ani syndrome is a long-term condition characterized by sporadic episodes of pain in the rectum and anus.
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.
This article will provide an overview of levator ani syndrome, its symptoms, causes, and available treatment options.
Fast facts on levator ani syndrome
Here are some key points about levator ani syndrome. More detail and supporting information is in the main article.
- Levator ani syndrome occurs when a muscle near the anus – the levator ani muscle – spasms and causes pain.
- The cause of levator ani syndrome is not clear.
- Treatment involves managing the symptoms and trying to reduce the pain.
- Some self-administered and home remedies can give relief for some people with levator ani syndrome.
The pain of levator ani syndrome is caused by a spasm in the levator ani muscle.
Pain may radiate to the hips, tailbone, or other areas.
This pain is usually unrelated to a bowel movement, and there appear to be no structural abnormalities or underlying conditions responsible for the symptoms.
Until 2016, levator ani syndrome was considered to be a form of chronic proctalgia.
However, the term chronic proctalgia is now disbanded, and levator ani syndrome is no longer considered a subtype.
Though the precise cause is unknown, it is commonly believed that chronic tension of the pelvic floor muscles plays a role in levator ani syndrome. Another theory is that inflammation in the pelvic area is a contributing factor.
People may be at higher risk of levator ani syndrome after childbirth or following surgery on the pelvic area, anus, or spine.
The symptoms of levator ani syndrome include pain high in the rectum that may be:
- irregular and spontaneous
- less than 20 minutes in duration
- specific or general
- a dull ache
- a sense of pressure in the rectum
- felt when sitting
- relieved when standing or lying down
- unrelated to bowel movements
- severe enough to interrupt sleep
Furthermore, a person may feel that passing gas or defecating can give them relief from the pain. In severe cases, the rectal pain may recur frequently and may last for several hours.
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.
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.
Home remedies and relief
Home remedies include:
- Sitz baths: Soaking the anal region in warm water, known as a sitz bath, can provide relief from episodes of anal spasms.
- Non-steroidal anti-inflammatory medication (NSAIDs): Taking an over-the-counter pain reliever may help to reduce discomfort.
- 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.
As levator ani syndrome is a chronic condition, there is no known cure. However, with proper management over time, the symptoms can become less severe, less frequent, or both.
Those who are experiencing chronic or recurrent periods of anal or rectal pain or discomfort should consult a doctor.