A health condition in which unexpected pain occurs in the rectum or vagina and comes and goes is called Levator Ani syndrome. Most of the time, this syndrome happens due to a spasm in the muscles near the anus. While pain can be a dull ache, in some cases, it is sharp pain. The symptoms of Levator Ani syndrome are often triggered by sitting for a long period. Doctors often recommend biofeedback therapy, physical therapy, and medicines to treat this condition.
Furthermore, this condition is a type of pelvic floor dysfunction, and it affects the levator ani (a muscle near the anus and vagina). In normal circumstances, this muscle does multiple things, including supporting organs in the pelvic area, controlling bowel movements, and others. Sometimes, this syndrome is called pelvic floor myalgia, pelvic floor myofascial pain, and pelvic floor muscle spasm.
Generally, this syndrome is not life-threatening or serious, but it does not disappear without treatment. That’s why you should visit a doctor if you experience symptoms that resemble Levator Ani syndrome.
What Are The Symptoms of Levator Ani Syndrome?
Commonly, people who develop this condition experience the following symptoms. These include:
- Pain during sexual intercourse
- A feeling like you are sitting on a ball or that something is inside the rectum
- The pain disappears when you stand up
- In some cases, pain caused by this syndrome can last for hours and suddenly worsen
People who develop this syndrome can notice that the pain appears in the morning and may get worse during the day. In rare cases, the pain spreads to the buttocks or upper thigh. Do not ignore this symptom and visit a doctor as soon as possible.
Causes
Experts do not know the exact cause of Levator Ani syndrome, but they have identified some factors that may increase the risk. Check some of them below:
- Sexual intercourse
- Bowel movements
- Stress
- Long-distance car travel
- Childbirth
- Chronic (long-term) bowel and inflammatory problems
- Musculoskeletal and postural stresses (including lumbar spine pathologies, low back pain, hip joint problems, and others)
- Psychological factors (including anxiety)
In addition, people who leave this condition untreated may also experience some complications. For example, sexual dysfunction, bowel or bladder issues, anxiety, depression, rectal pain, severe pelvic pain, and others. For more details, discuss it with your healthcare professional.
What is The Difference between Levator Ani Syndrome and Proctalgia Fugax?
While both disorders cause rectal pain, there are some differences between them. For example, proctalgia fugax causes very sharp pain that often appears quickly and then disappears (within 20 minutes). However, Levator Ani syndrome causes pain that is not always sharp, and it may come and go multiple times per day.
Can Hemorrhoids Cause Levator Ani Syndrome?
No, hemorrhoids occur when the veins inside the rectum or anus are swollen. This condition often occurs when you are lifting heavy objects or struggle to poop.
Diagnosis
Unfortunately, there are no specific tests that can confirm this syndrome. However, physicians often start the diagnosis with a physical and pelvic examination. Furthermore, physicians may also perform a DRE (digital rectal examination) to check for abnormalities linked to the disease. Your doctor may also ask some questions about your symptoms and medical history to gather more information about your disease.
Treatment
Typically, there are several options that often help treat Levator Ani syndrome. These include:
- Biofeedback therapy – During this treatment, you will learn how to control or relax certain muscles.
- Electrogalvanic stimulation – Physicians often prescribe this treatment to relax the rectal muscles. It involves sending a mild electrical current to these muscles.
- Muscle relaxers – These are prescription medications that often help reduce muscular spasms. Usually, physicians recommend Methocarbamol, Diazepam, and Cyclobenzaprine.
- Myofascial release therapy – This option involves a device used to massage trigger points in the levator ani.
- Pelvic floor physical therapy – This treatment involves specific exercises that help stretch the lower back, pelvic area, and pelvic floor muscles.
- Sitz baths – During this treatment, you will sit in a warm bath that may help relax the levator ani.
Most of the time, treatment for Levator Ani syndrome involves a healthcare team of gastroenterologists, gynecologists, colorectal surgeons, primary care physicians (PCPs), and others.
Frequently Asked Questions
How long does Levator Ani syndrome pain usually last?
Pain episodes can vary widely. Some people experience discomfort that lasts only a few minutes, while others may have pain that persists for several hours. The pain may come and go throughout the day and is often worse after prolonged sitting.
Who is most likely to develop Levator Ani syndrome?
Levator Ani syndrome can affect anyone, but it is more common in adults, especially women. People with pelvic floor dysfunction, chronic (long-term) constipation, anxiety, or a history of childbirth may have a higher risk of developing the condition.
Is Levator Ani syndrome a chronic condition?
No, but it can become chronic if left untreated. Symptoms may recur over months or years, but many people experience significant improvement with pelvic floor physical therapy, biofeedback, stress management, and other treatments.
Can stress make Levator Ani syndrome worse?
Yes. Emotional stress and anxiety can increase tension in the pelvic floor muscles, triggering or worsening muscle spasms and pain. Learning stress-reduction techniques may help reduce symptom flare-ups.
Can constipation trigger Levator Ani syndrome?
Yes. Straining during bowel movements and chronic constipation can place extra pressure on the pelvic floor muscles, potentially contributing to muscle spasms and worsening symptoms. Treating constipation may help reduce flare-ups.
Are there any lifestyle changes that may help manage Levator Ani syndrome?
Taking breaks from prolonged sitting, practicing good posture, performing pelvic floor relaxation exercises, staying physically active, managing stress, and eating a high-fiber diet to prevent constipation may help improve symptoms.
Is surgery recommended for Levator Ani syndrome?
No. Surgery is generally not recommended because Levator Ani syndrome is usually caused by muscle dysfunction rather than a structural abnormality. Conservative treatments, such as physical therapy and biofeedback, are considered the most effective first-line options.
Can Levator Ani syndrome affect urination or bowel movements?
Sometimes. Although the syndrome primarily causes pelvic or rectal pain, some people may also experience difficulty emptying the bladder or bowels, a feeling of incomplete evacuation, or discomfort during bowel movements due to pelvic floor muscle dysfunction.
Can Levator Ani syndrome go away on its own?
In some cases, mild symptoms may improve temporarily without treatment. However, recurring or persistent symptoms often require medical evaluation and treatment to reduce muscle spasms, improve pelvic floor function, and prevent chronic pain.
When should I see a doctor for Levator Ani syndrome?
You should seek medical attention if you have persistent or recurring rectal or pelvic pain, severe pain, bleeding from the rectum, fever, unusual weight loss, or changes in bowel habits. A healthcare provider can rule out other conditions, such as hemorrhoids, anal fissures, inflammatory bowel disease (IBD), infections, or colorectal cancer, before diagnosing Levator Ani syndrome. Ask your physician if you have any other questions.
