Levator Ani Syndrome: Symptoms, Causes, and Treatment

Levator Ani Syndrome: Symptoms, Causes, and Treatment


Levator ani syndrome (LAS) is a pelvic floor disorder that causes recurrent pain and discomfort in the rectal and pelvic areas of the body. With LAS, tension or spasms occur in the levator ani muscle—a broad, funnel-shaped muscle that supports the pelvic floor and organs. This tension can then cause dull, aching, or burning pressure in the rectum and pelvic area that worsens when you’re sitting. 

This condition affects 7.4% of people assigned female at birth and 5.7% of people assigned male at birth and most commonly develops between 30-60 years old. The causes of LAS are not fully understood, but factors like stress, anxiety, and underlying pelvic floor dysfunction may contribute to its development.

Treatment options like physical therapy, massage, and medications can help relieve LAS symptoms.

The hallmark symptom of levator ani syndrome is chronic (long-term) and episodic pain in the rectum, pelvis, or glutes (buttocks) that may radiate to the vagina or thighs. Episodes of LAS pain can last anywhere from 20 minutes to several hours.

Some people with LAS experience symptoms that come and go, while others experience persistent or constant pain with sudden, more severe symptom flares. Pain varies from person to person and may feel like: 

  • A dull ache or pressure deep in the rectum 
  • Sharp, stabbing pain
  • Burning or stinging sensations

Symptoms of LAS may worsen with or after: 

  • Prolonged periods of sitting
  • Bowel movements
  • Sex
  • Stress or anxiety
  • Back or abdominal surgery 

LAS can also affect other areas and functions related to the pelvic floor, which may cause: 

  • Bowel problems (e.g., pain while pooping or tenesmus—a persistent urge to use the bathroom)
  • Frequent urination or urgency to urinate
  • Sexual dysfunction or pain during sex

Levator ani syndrome occurs when the levator ani muscle in the pelvic floor becomes hypertonic (excessively tight and tense). Persistent tension in the levator ani muscle can cause muscle spasms, leading to chronic pelvic or rectal pain. 

What causes this tension in the levator ani and leads to LAS is currently unknown, but several factors may play a role, such as:

  • Muscle damage or trauma: Childbirth and pelvic or back surgery may alter the function and structure of the pelvic floor muscles, leading to LAS.
  • Underlying conditions: Bowel disorders that cause inflammation near the pelvic floor, such as irritable bowel syndrome (IBS), may increase the risk of LAS.
  • Psychological factors: Stress, anxiety, and depression may trigger or worsen pelvic floor muscle tension and trigger LAS symptoms.

Risk Factors

While anyone can develop LAS, certain risk factors may increase your risk. For example:

  • Being assigned female
  • Age between 30-60
  • Chronic constipation
  • Previous surgeries in the pelvic region

If you’re experiencing chronic pelvic or rectal pain, seeing a healthcare provider can help you get a proper diagnosis and timely treatment. Levator ani syndrome is a “diagnosis of exclusion,” meaning healthcare providers typically rule out other potential causes of your symptoms before diagnosing LAS. To receive a diagnosis for LAS, your provider will look for the following criteria: 

  • Chronic pain in the rectum, pelvis, or pubic bone that occurs for six months or more
  • Pain episodes that last 30 minutes or longer 
  • Tenderness when you press on the puborectalis (a portion of the levator ani muscle) 

To diagnose LAS, your healthcare provider will review your medical history and ask about your symptoms and lifestyle habits. They will also perform a physical exam that includes a digital rectal exam—the most telling way to determine if your symptoms are from LAS.

During a rectal exam, your provider will insert a gloved, lubricated finger into your anus and press on the levator ani muscle. If you have LAS, you may experience a muscle spasm when your provider presses on the muscle. 

Depending on your symptoms, your healthcare provider may order imaging tests or other diagnostic tests to rule out other possible causes of your symptoms or to diagnose underlying conditions that may be contributing to LAS symptoms. However, these tests are not required to diagnose LAS.

If you receive a diagnosis for LAS, treatment is available to help reduce symptoms. Treatment options for levator ani syndrome (such as home remedies, medications, and therapies) can minimize symptoms and improve quality of life.

Finding the treatment option(s) that works for you may take some trial and error, but patience on this journey can help you get the relief you need.

Home Remedies

Several home remedies can help reduce your LAS symptoms. These include:

  • Sitz bath: Soaking your hips and buttocks in warm water may help relax tense pelvic floor muscles and relieve pain 
  • Dietary changes: Eating plenty of high-fiber foods can help prevent constipation and reduce straining during bowel movements 
  • Stress management: Incorporating relaxation techniques into your daily routine, such as spending time in nature, meditation, or breathing exercises, may help you manage stress and prevent symptoms from flaring up
  • Heat therapy: Sitting on a heating pad may help soothe tense pelvic floor muscles
  • Movement: Prolonged sitting can worsen LAS pain, so frequent breaks throughout the day to stand up, stretch, and walk around may prevent pain

Medications

If home remedies aren’t enough to improve symptoms, your healthcare provider may prescribe medications to relieve moderate to severe LAS pain. These medications may include:

  • Muscle relaxants: Valium (diazepam) can help ease anxiety and reduce muscle spasms.
  • Antidepressants: Aventyl (nortriptyline) and Elavil (amitriptyline) have pain-modulating effects that may help some people with LAS.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Advil (ibuprofen) or Aleve (naproxen) may help reduce inflammation and pain.
  • Botox injections: High-dose botulinum toxin injections directly in the levator ani muscle may reduce muscle spasms.

Therapies

In addition to home remedies and medications, your provider may recommend therapeutic interventions to relieve LAS pain effectively. These therapies include:

  • Physical therapy (PT): Pelvic floor PT programs help reduce LAS pain by relaxing the pelvic floor muscles through strength and stretching exercises. Pelvic floor physical therapists who perform internal treatments are specialized and might be board-certified in pelvic health. Look for a pelvic floor therapist on the American Physical Therapy Association’s website.
  • Biofeedback therapy: A therapeutic technique that involves visualizing and controlling pelvic floor muscle activity. Biofeedback may be a part of your physical therapy program to enhance the effectiveness of relaxation exercises for the levator ani muscles.
  • Electrogalvanic stimulation: Uses low-level electrical currents to stimulate and potentially retrain the levator ani muscles, aiming to improve muscle function and reduce pain.

While there is no guaranteed way to prevent levator ani syndrome, lifestyle habits may help reduce the frequency and severity of pain episodes associated with LAS. Consider the following strategies: 

  • Pelvic floor exercises: To relax and strengthen your pelvic floor muscles, practice regular pelvic floor exercises and stretches. Yoga poses, such as the child’s and happy baby poses, are examples of relaxing pelvic floor stretches. 
  • Manage stress: Incorporate stress-reduction techniques into your daily routine, such as meditation, yoga, or diaphragmatic breathing to relax tense muscles.
  • Adopt a proper sitting posture: Prolonged sitting can trigger or worsen LAS pain. Sit in a well-padded chair that supports your hips and thighs, with your feet on the floor and your shoulders relaxed. Take regular movement breaks to walk and stretch. 

People with levator ani syndrome are more likely to have or develop related conditions that involve pelvic floor dysfunction. These conditions often overlap and can contribute to or worsen pelvic pain. 

  • Interstitial cystitis: Chronic bladder inflammation
  • Irritable bowel syndrome (IBS): Pain and inflammation in the gastrointestinal (GI) tract
  • Endometriosis: Thick tissue that grows outside of the uterus
  • Vulvodynia: Chronic vulva pain) 

Living with a chronic, painful condition like levator ani syndrome can affect your physical and emotional well-being and make it difficult to carry out daily activities.

Treatments like stress management techniques, medications, and physical therapy can all help you better manage your condition and maintain a good quality of life.

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