What is Levator Ani Syndrome & How is it Treated? |Exercises to Loosen the Tight Pelvic Floor Muscles in Levator Ani Syndrome

Levator Ani Syndrome is a type of pelvic floor dysfunction where there are non-relaxing muscles. It means that there is excessive tightening of pelvic floor muscles in Levator Ani Syndrome.⁽²⁾ The function of the pelvic floor is supporting the rectum, urethra; and in women, it also helps support the vagina and the uterus.

Women commonly suffer more from Levator ani syndrome.⁽³⁾ with the primary symptoms being frequent, constant and dull pain in the rectum occurring as a result of spasm in the levator ani muscle located adjacent to the anus.^{(1, 2, 6)}

Other names of Levator ani syndrome include: chronic proctalgia, chronic anorectal pain, pelvic tension myalgia, levator spasm, puborectalis syndrome and piriformis syndrome.^{(5, 6)}

The specific cause of Levator Ani Syndrome is not clearly understood. Any of the following can be associated and lead to Levator Ani Syndrome:

• Vulvodynia (pain in the vulva).
• Vaginal atrophy.
• Not passing stool or urinating when you need to.
• Pelvic floor injury from trauma or surgery and even sexual abuse.
• Continuing sexual intercourse even when it is causing pain.
• Having other types of chronic pelvic pain, such as endometriosis, irritable bowel syndrome or interstitial cystitis.

Pelvic floor disorders are the term coined to describe the malfunctioning of the pelvic muscles. It means that the muscles of the pelvic floor can be very tight or either very loose or relaxed.

Excessive relaxation of Pelvic floor muscles can lead to pelvic organ prolapse. An unsupported urinary bladder can cause urinary incontinence. Also, in women, this problem can lead to dropping of uterus or cervix into the vagina. All these problems with pelvic floor disorders can be a major cause of back pain, urinating problems or bowel movement problems and painful sexual intercourse.

Levator Ani Syndrome is one of the pelvic floor disorders where the pelvic muscles are too tight leading to problems with emptying or storing bowels along with erectile dysfunction, painful intercourse and pelvic pain.

The symptoms of levator ani syndrome can be continuous and also affect the quality of the patient’s life. Patients suffering from levator ani syndrome experience the following symptoms:

People suffering from Levator Ani Syndrome experience rectal pain that is not related to having a bowel movement. This pain can be of short duration or can come and go; lasting several hours or even days. The pain from Levator Ani Syndrome can be triggered or worsened by lying down or even sitting.⁽⁶⁾ The pain from Levator Ani Syndrome can also wake the patient from sleep. The pain is felt more in rectum region and typically the left side feels more tender.⁽⁶⁾

Along with rectal pain, patient suffering from Levator Ani Syndrome can also have low back pain that can radiate to the thighs or groins. In men, the pain from Levator Ani Syndrome can spread to the testicles, prostate and the tip of the urethra and penis.

Patients suffering from Levator Ani Syndrome also suffer from constipation, difficulty in passing bowel movements or strain to pass them. The patient also gets a feeling that there is incomplete emptying of the bowels.

Other Symptoms of Levator Ani Syndrome Consist of: Bloating; urinary incontinence; frequent urination, urgent urination with difficulty in starting the flow; pain with urination; and sexual problems.⁽³⁾

There is also pain before, during or after sexual intercourse in women suffering from Levator Ani Syndrome. In male patients, Levator Ani Syndrome can cause premature ejaculation, painful ejaculation or erectile dysfunction.

The process of confirming Levator Ani Syndrome is commonly known as “diagnosis of exclusion.” ⁽²⁾ This is because various tests are done to exclude other problems, which can produce similar symptoms before the final diagnosis of Levator Ani Syndrome is made.⁽²⁾ In men, Levator Ani Syndrome is commonly misdiagnosed as prostatitis.

After the confirmation of the diagnosis, treatment is planned according to the underlying cause of Levator Ani Syndrome, such that there is relief to the patient.

There are other treatments available to loosen the tight pelvic floor muscles in Levator Ani Syndrome and these include:

• Physical Therapy that consists of heat, massage and biofeedback with a therapist experienced in pelvic floor dysfunction.^{(1, 2, 4, 6)}
• Prescription muscle relaxants such as pregabalin or gabapentin can help with the pain from Levator Ani Syndrome.⁽¹⁾
• Trigger point injections consisting of botulinum toxin (Botox)⁽⁴⁾ or corticosteroid are also helpful in treating Levator Ani Syndrome.
• Some other alternative treatments for Levator Ani Syndrome consist of acupuncture, sex therapy and nerve stimulation.
• Tricyclic antidepressants should NOT be used for treating Levator Ani Syndrome, as they can worsen the bladder and bowel symptoms.

Pain Medicines: Over-the-counter pain killers and muscle relaxants can help with pain from Levator Ani Syndrome.^{(1, 4)}

Sitz Bath Taking a sitz bath also helps in alleviating the pain from Levator Ani Syndrome.^{(1, 6)} Sitz bath is where you need to soak your anus in warm water by sitting or squatting in a container. Sitz bath has to be taken for 10 to 15 minutes after which you need to pat the area dry.

Lie down on your back and bend your knees while raising your feet upwards. Catch hold of the outside of your ankles or feet with your hands. Slowly separate your legs till they are wider than the hips. Hold this position for 25 seconds and continue to breathe deeply. Repeat this exercise 5 times a day.

Stand with legs apart than your hips and hold onto something. Squat down until there is a stretch felt through your legs. Hold this position for 30 seconds and breathe deeply. Repeat deeps squats five times a day.

• Sit with your hips about 6 inches away the wall. Then lie down and slowly move your legs up so that your heels are placed against the wall and keep your legs relaxed.
• Concentrate on your breathing and continue to stay in this position for 3 to 5 minutes.
• Kegel Exercises Can Also Be A Great Help in Treating Levator Ani Syndrome.

The prognosis is good for Levator Ani Syndrome providing the patient gets the appropriate treatment for symptom relief so as to live a normal life as much as possible.

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