Levator ani syndrome is a type of chronic pelvic pain characterized by spasms in the levator ani muscle, located in the pelvic floor. While not serious or life-threatening, it can significantly impact quality of life.
Understanding the Condition
Levator ani syndrome involves the levator ani muscle, a key component of the pelvic floor that forms a sling-like structure supporting organs such as the bladder, rectum, and in women, the uterus and vagina.
The primary symptom is often a dull ache or pressure deep in the rectum or pelvis. This discomfort can also manifest as sharp, stabbing pain or a burning sensation. People with the syndrome may describe the feeling as sitting on a ball or having something inside their rectum.
The pain frequently worsens with prolonged sitting and may ease when standing or lying down. While typically unrelated to bowel movements, some individuals might experience pain during or after defecation. The pain can be intermittent, lasting for hours, or it can be constant.
Common Contributing Factors
The exact cause of levator ani syndrome is often unclear, but several factors are associated with its development. Chronic tension in the pelvic floor muscles is believed to play a role. Inflammation in the pelvic area may also be a contributing factor.
Trauma to the pelvic area can predispose individuals to the condition. Childbirth, especially if involving a large incision or vaginal tears, is a recognized risk factor. Surgical procedures involving the pelvic area, anus, or spine can also increase the likelihood of developing the syndrome. Other factors include prolonged sitting, which can strain the pelvic muscles, and chronic constipation or diarrhea, which can irritate the region. Psychological stress and anxiety are also linked to muscle tension and can contribute to the syndrome.
How it is Diagnosed
Diagnosing levator ani syndrome typically involves a comprehensive evaluation by a healthcare professional. The process begins with a thorough medical history, where the doctor inquires about the nature, duration, and location of the pain. A physical examination follows, which includes a digital rectal exam to assess the levator ani muscles. Tenderness, particularly in the puborectalis muscle, a part of the levator ani group, is a key diagnostic feature.
Levator ani syndrome is often a diagnosis of exclusion, requiring other conditions with similar symptoms to be ruled out. These conditions can include hemorrhoids, anal fissures, inflammatory bowel disease, or prostate issues in men. While specific blood tests or imaging studies cannot directly diagnose the syndrome, they may be used to exclude other potential causes of pain. Diagnostic criteria often include chronic or recurrent rectal pain lasting at least 30 minutes, tenderness in the puborectalis muscle, and symptoms present for at least six months with no other identifiable cause.
Approaches to Treatment
Treatment for levator ani syndrome focuses on managing symptoms and reducing pain, often involving a combination of approaches. Non-invasive options are typically explored first. Warm baths, such as sitz baths, can provide temporary relief by relaxing the muscles. Over-the-counter pain relievers may also help alleviate discomfort.
Pelvic floor physical therapy is a common treatment modality. A specialized therapist can teach exercises to help relax and strengthen the pelvic floor muscles, and techniques like biofeedback can help individuals learn to control muscle activity. Lifestyle modifications are also beneficial, including avoiding prolonged sitting and adopting a diet with adequate fiber to prevent constipation. Stress management techniques, such as relaxation exercises, can help reduce muscle tension. For some, muscle relaxants or trigger point injections may be considered to further ease muscle spasms.