Table of ContentsView AllTable of ContentsWhat It IsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
What It Is
Symptoms
Causes
Diagnosis
Treatment
Levator ani syndrome(LAS) is a pelvic floor disorder that causes chronic rectal or vaginal pain. LAS pain is typically dull but long-lasting and felt deep inside your pelvis. The pain is due to spasms of the levator ani muscles, which are near the anus, and occurs frequently or even constantly.
Levator ani syndrome is more common in people assigned female at birth. It affects an estimated 7.4% of natal females and 5.7% of natal males. While there are strategies to help relieve symptoms, only around a third of those with this chronic (persistent) condition seek medical care.
This article explains the symptoms, causes, diagnosis, and treatment of levator ani syndrome as well as the medical conditions that mimic the signs and symptoms of LAS.
Verywell / Ellen Lindner
What Is Levator Ani Syndrome?
Levator ani syndrome is a type of non-relaxing pelvic floor dysfunction. The pelvic floor is a dome-shaped group of muscles that support the organs in the pelvis and lower abdomen.
The levator ani is a symmetrical set of three deep pelvic-floor muscles: theiliococcygeus,pubococcygeus, andpuborectalis. These muscles surround the rectum, urethra, and vagina.
Sometimes, these muscles remain contracted and tense, also known as hypertonic. When this happens, the muscles are unable to relax, causing levator ani syndrome.
Levator Ani Syndrome Symptoms
Levator ani syndrome, formerly known aschronicproctalgia, causes chronic pain in the upper part of the rectum or vagina.
In addition to pain, other symptoms are possible, including:
Is Levator Ani Syndrome Serious?Levator ani syndrome will not affect your overall health and isn’t life-threatening. However, it can be persistent and affect your quality of life. It is not uncommon for those with LAS to havedepression and anxietydue to chronic pain.
Is Levator Ani Syndrome Serious?
Levator ani syndrome will not affect your overall health and isn’t life-threatening. However, it can be persistent and affect your quality of life. It is not uncommon for those with LAS to havedepression and anxietydue to chronic pain.
Causes and Risk Factors
The cause of levator ani syndrome is not clear. The pain is due to spasms of the levator ani muscles, in particular, thepuborectalis, a sling-like muscle that wraps around the lower rectum.Dysfunction of the puborectalis muscle is associated with certain medical conditions, such as:
Other terms are used synonymously for LAS, including “levator spasm,” “levator syndrome,” and “puborectalis syndrome,” all of which describe pain symptoms involving the puborectalis muscle.
Levator ani syndrome is largely based on an exclusion of all other causes.
In addition to reviewing your medical history, your healthcare provider will need to do a physical exam. This includes arectal examand pelvic exam, which is likely to cause some pain and tenderness. Your pelvic floor muscles may also spasm during the exam.
When diagnosing the condition, your healthcare provider will look for the following criteria:
There are no blood tests and imaging tests that can diagnose LAS, although they may help rule out other causes.
Differential Diagnoses
Conditions in thedifferential diagnosis(used to differentiate LAS from all other causes) include:
Levator Ani Syndrome Treatment
There are a few treatment options for levator ani syndrome, including at-home treatments, prescription medication, and interventional procedures.
Most of the recommended treatments can provide temporary relief, but they have not been proven to be effective in all people.
Home Remedies and Lifestyle Changes
At-home treatments that can help ease the pain and discomfort of levator ani syndrome include:
There are also exercises you can do at home that can help ease rectal pain. Try the following:
Medical Treatments
Some of the medical options commonly used to relieve LAS pain include:
Your healthcare provider may also prescribe medications to relieve levator ani syndrome pain. These may include:
What Is the Galvanic Skin Response (GSR)?
Alternative Therapies
There has been at least one case study that shows traditional therapies such as herbal medicine andacupuncturemay relieve symptoms of LAS.The research is not conclusive, though. Discuss alternative therapies with your healthcare provider to weigh the potential benefits and risks.
Summary
Levator ani syndrome is a pelvic-floor disorder that causes pain deep inside the rectum or vagina. It occurs when the levator ani muscles are unable to relax, causing painful muscle spasms.
LAS is diagnosed based on physical symptoms and ruling out other potential causes of pain. Symptoms must last at least 30 minutes and recur over six months before levator ani syndrome is diagnosed.
Symptoms may be relieved with home remedies, including OTC pain relievers, sitz baths, and exercise. Pelvic floor physical therapy is usually helpful and may include exercises, biofeedback, and massage treatments. Prescription muscle relaxers, tricyclic antidepressants, and anti-seizure medicines may also bring relief.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunphy L, Wood F, Mubarak ES, Coughlin L.Levator ani syndrome presenting with vaginal pain.BMJ Case Rep. 2023;16(5):e255190. doi:10.1136/bcr-2023-255190Bharucha AE, Lee TH.Anorectal and pelvic pain.Mayo Clin Proc. 2016;91(10):1471-1486. doi:10.1016/j.mayocp.2016.08.011American Society of Colon and Rectal Surgeons.Pelvic floor dysfunction.Bitti GT, Argiolas GM, Ballicu N, et al.Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities.Radiographics. 2014;34(2):429–48. doi:10.1148/rg.342125050Wallace SL, Miller LD, Mishra K.Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women.Curr Opin Obstet Gynecol. 2019;31(6):485–93. doi:10.1097/GCO.0000000000000584Son CG.Case report for a refractory levator ani syndrome treated with traditional Korean medication.J Korean Med. 2017;38(2):73-7. doi:10.13048/jkm.17019Knowles CH, Cohen RC.Chronic anal pain: a review of causes, diagnosis, and treatment.Cleve Clin J Med.2022;89(6):336-43. doi:10.3949/ccjm.89a.21102Woman’s Hospital of Louisiana.Levator ani syndrome.Van Reijn-Baggen DA, Elzevier HW, Pelger RCM, Han-Guert IJM.Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF-study): study protocol for a randomized controlled trial.Contemp Clin Trials Commun.2021;24:100874, doi:10.1016/j.conctc.2021.100874Nugent E. Beal M, Sun G, Zutshi M.Botulinum toxin A versus electrogalvanic stimulation for levator ani syndrome: is one a more effective therapy?.Tech Coloproctol.2020;24(6):545-51. doi:10.1007/s10151-019-02103-wHite M, Curran T.Biofeedback for pelvic floor disorders.Clin Colon Rectal Surg. 2021;34(1):56-61. doi:10.1055/s-0040-1714287
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunphy L, Wood F, Mubarak ES, Coughlin L.Levator ani syndrome presenting with vaginal pain.BMJ Case Rep. 2023;16(5):e255190. doi:10.1136/bcr-2023-255190Bharucha AE, Lee TH.Anorectal and pelvic pain.Mayo Clin Proc. 2016;91(10):1471-1486. doi:10.1016/j.mayocp.2016.08.011American Society of Colon and Rectal Surgeons.Pelvic floor dysfunction.Bitti GT, Argiolas GM, Ballicu N, et al.Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities.Radiographics. 2014;34(2):429–48. doi:10.1148/rg.342125050Wallace SL, Miller LD, Mishra K.Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women.Curr Opin Obstet Gynecol. 2019;31(6):485–93. doi:10.1097/GCO.0000000000000584Son CG.Case report for a refractory levator ani syndrome treated with traditional Korean medication.J Korean Med. 2017;38(2):73-7. doi:10.13048/jkm.17019Knowles CH, Cohen RC.Chronic anal pain: a review of causes, diagnosis, and treatment.Cleve Clin J Med.2022;89(6):336-43. doi:10.3949/ccjm.89a.21102Woman’s Hospital of Louisiana.Levator ani syndrome.Van Reijn-Baggen DA, Elzevier HW, Pelger RCM, Han-Guert IJM.Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF-study): study protocol for a randomized controlled trial.Contemp Clin Trials Commun.2021;24:100874, doi:10.1016/j.conctc.2021.100874Nugent E. Beal M, Sun G, Zutshi M.Botulinum toxin A versus electrogalvanic stimulation for levator ani syndrome: is one a more effective therapy?.Tech Coloproctol.2020;24(6):545-51. doi:10.1007/s10151-019-02103-wHite M, Curran T.Biofeedback for pelvic floor disorders.Clin Colon Rectal Surg. 2021;34(1):56-61. doi:10.1055/s-0040-1714287
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Dunphy L, Wood F, Mubarak ES, Coughlin L.Levator ani syndrome presenting with vaginal pain.BMJ Case Rep. 2023;16(5):e255190. doi:10.1136/bcr-2023-255190Bharucha AE, Lee TH.Anorectal and pelvic pain.Mayo Clin Proc. 2016;91(10):1471-1486. doi:10.1016/j.mayocp.2016.08.011American Society of Colon and Rectal Surgeons.Pelvic floor dysfunction.Bitti GT, Argiolas GM, Ballicu N, et al.Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities.Radiographics. 2014;34(2):429–48. doi:10.1148/rg.342125050Wallace SL, Miller LD, Mishra K.Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women.Curr Opin Obstet Gynecol. 2019;31(6):485–93. doi:10.1097/GCO.0000000000000584Son CG.Case report for a refractory levator ani syndrome treated with traditional Korean medication.J Korean Med. 2017;38(2):73-7. doi:10.13048/jkm.17019Knowles CH, Cohen RC.Chronic anal pain: a review of causes, diagnosis, and treatment.Cleve Clin J Med.2022;89(6):336-43. doi:10.3949/ccjm.89a.21102Woman’s Hospital of Louisiana.Levator ani syndrome.Van Reijn-Baggen DA, Elzevier HW, Pelger RCM, Han-Guert IJM.Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF-study): study protocol for a randomized controlled trial.Contemp Clin Trials Commun.2021;24:100874, doi:10.1016/j.conctc.2021.100874Nugent E. Beal M, Sun G, Zutshi M.Botulinum toxin A versus electrogalvanic stimulation for levator ani syndrome: is one a more effective therapy?.Tech Coloproctol.2020;24(6):545-51. doi:10.1007/s10151-019-02103-wHite M, Curran T.Biofeedback for pelvic floor disorders.Clin Colon Rectal Surg. 2021;34(1):56-61. doi:10.1055/s-0040-1714287
Dunphy L, Wood F, Mubarak ES, Coughlin L.Levator ani syndrome presenting with vaginal pain.BMJ Case Rep. 2023;16(5):e255190. doi:10.1136/bcr-2023-255190
Bharucha AE, Lee TH.Anorectal and pelvic pain.Mayo Clin Proc. 2016;91(10):1471-1486. doi:10.1016/j.mayocp.2016.08.011
American Society of Colon and Rectal Surgeons.Pelvic floor dysfunction.
Bitti GT, Argiolas GM, Ballicu N, et al.Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities.Radiographics. 2014;34(2):429–48. doi:10.1148/rg.342125050
Wallace SL, Miller LD, Mishra K.Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women.Curr Opin Obstet Gynecol. 2019;31(6):485–93. doi:10.1097/GCO.0000000000000584
Son CG.Case report for a refractory levator ani syndrome treated with traditional Korean medication.J Korean Med. 2017;38(2):73-7. doi:10.13048/jkm.17019
Knowles CH, Cohen RC.Chronic anal pain: a review of causes, diagnosis, and treatment.Cleve Clin J Med.2022;89(6):336-43. doi:10.3949/ccjm.89a.21102
Woman’s Hospital of Louisiana.Levator ani syndrome.
Van Reijn-Baggen DA, Elzevier HW, Pelger RCM, Han-Guert IJM.Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF-study): study protocol for a randomized controlled trial.Contemp Clin Trials Commun.2021;24:100874, doi:10.1016/j.conctc.2021.100874
Nugent E. Beal M, Sun G, Zutshi M.Botulinum toxin A versus electrogalvanic stimulation for levator ani syndrome: is one a more effective therapy?.Tech Coloproctol.2020;24(6):545-51. doi:10.1007/s10151-019-02103-w
Hite M, Curran T.Biofeedback for pelvic floor disorders.Clin Colon Rectal Surg. 2021;34(1):56-61. doi:10.1055/s-0040-1714287
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