Levator ani syndrome (LAS) is a medical condition that causes chronic rectal pain due to spasms of the pelvic floor muscles. It is considered a functional gastrointestinal disorder (FDG), meaning a digestive disorder that causes symptoms without a known cause.

It is estimated that LAS affects 7.4% of females and 5.7% of 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.

Levator Ani Syndrome Symptoms

Levator ani syndrome, formerly known as chronic proctalgia, causes chronic pain in the upper part of the rectum.

The pain often comes in waves and is described by some as a dull ache, a burning sensation, or a feeling of rectal pressure. The pain generally worsens with sitting and eases when standing up or lying down.

In addition to pain, other symptoms are possible, including:

  • Painful or difficult bowel movements
  • Frequent bowel movements
  • Urinary urgency (the sensation you have to pee all the time)
  • Loss of bowel or bladder control
  • Painful sexual intercourse (in both females and males)
  • Sexual dysfunction (in males)

Causes and Risk Factors

The cause of levator ani syndrome is not clear. The pain is due to spasms of the puborectalis muscle, part of the pelvic floor muscles. This sling-like muscle wraps around the lower rectum and plays an important role in controlling bowel movements.Dysfunction of the puborectalis muscle is associated with certain medical conditions, such as:

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 have depression and anxiety due to chronic rectal pain.

  • Childbirth: You may be at higher risk for developing LAS after vaginal childbirth, particularly if you had a large incision or vaginal tears.
  • Surgery or trauma: If you experience trauma or have surgery around the spine, anus, or rectum, you may be predisposed to LAS.
  • Muscle dysfunction: Dyssynergic defecation is a condition in which the pelvic floor muscles do not function as they should, causing chronic constipation.
  • Bowel diseases: Conditions characterized by irritation or inflammation near the rectum, such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), can increase your risk of LAS.

Diagnosis

LAS is largely based on an exclusion of all other causes.

Alternative Names

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.

In addition to reviewing your medical history, your healthcare provider will need to do a physical exam. This would include a rectal exam, which is likely to cause some pain and tenderness if you have LAS. Your anal muscles may be also tight or spasm during the exam.

When diagnosing the condition, your healthcare provider will look for the following criteria:

  • A history of chronic or recurrent rectal pain that lasts for at least 30 minutes
  • Tenderness of the puborectalis muscle when touched
  • At least six months of symptoms, three of which must be consecutive
  • No identifiable cause or explanation

There are no blood tests and imaging tests that can diagnose LAS, although they may help rule out other causes.

Among the conditions included in the differential diagnosis (used to differentiate LAS from all other causes) are:

  • Anorectal abscess (a pus-filled cavity in the anus or rectum)
  • Anorectal fissure (a tear or crack in the anus or rectum)
  • Coccygodynia (tailbone pain)
  • Crohn’s disease (a type of IBD)
  • Prostatitis (inflammation of the prostate)
  • Thrombosed hemorrhoid (a blood clot in a hemorrhoid)
  • Ulcerative colitis (another type of IBD)
  • Prostate cancer
  • Colon cancer

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.

Lifestyle and Home Remedies

You can use lifestyle changes to help manage the pain and discomfort of levator ani syndrome. Maintaining a diet that is moderate in fiber can promote regular bowel movements and avoid constipation that can make LAS worse. Staying active and avoiding prolonged sitting can also help.

Sitz baths can also help temporarily relieve muscle spasms and symptoms of LAS.

In addition, there are exercises you can do at home that can help ease rectal pain:

  • Pelvis squat stretch: Squat down by lowering your hips straight down from a standing position, bending your knees toward your ears, and relaxing your lower back down between your legs.
  • Butterfly stretch: Sit on the floor with the soles of your feet touching and your knees spread out to each side.
  • Belly breathing: Lie on your back and breathe deeply into your diaphragm.

Medical Treatments

Some of the medical options commonly used to relieve LAS pain include:

  • Therapeutic massage by a qualified physical therapist
  • Electrogalvanic stimulation, in which a rectal probe delivers a gentle electrical current to relax rectal muscles
  • Flexeril (cyclobenzaprine), a prescription muscle relaxant
  • Botox (botulinum A), delivered by injection to reduce muscle spasms

Alternative Therapies

There has been at least one case study that shows traditional therapies such as herbal medicine and acupuncture may relieve symptoms of LAS. The research is not conclusive, though. Discuss alternative therapies with your healthcare provider to weigh the potential benefits and risks.