Levator Ani Syndrome is a form of pelvic floor muscle dysfunction marked by the persistent contraction of pelvic floor muscles, causing them to remain overly tense. These muscles play a crucial role in supporting the pelvic organs including the rectum, bladder, and urethra, and in women, the uterus and vagina.

The syndrome is more prevalent among women, manifesting primarily as a continual or frequent dull rectal pain attributed to spasms in the levator ani muscle, located near the anus. This condition is known by various names, such as persistent anorectal pain, persistent proctalgia, levator spasm, pelvic tension myalgia, and puborectalis syndrome.

⭐ Key Takeaways: Levator Ani Syndrome

Levator Ani Syndrome is caused by persistent overactivity and tension in the pelvic floor muscles, leading to rectal, pelvic, low-back, or vaginal pain.

The condition is often associated with bowel, bladder, and sexual symptoms, including constipation, incomplete emptying, urinary urgency, and pain with intercourse.
Causes are multifactorial and may include pelvic floor injuries, chronic pelvic pain conditions (IBS, endometriosis, IC), delayed voiding habits, vaginal atrophy, or persistent painful intercourse.
Pelvic floor dysfunction may present as either hypotonic (loose) or hypertonic (tight) muscles, but Levator Ani Syndrome is typically rooted in hypertonicity.
Pelvic floor physiotherapy is considered a primary treatment, focusing on reducing tone, restoring function, and improving bowel, bladder, and sexual health.
Effective physiotherapy approaches include manual therapy, muscle relaxation techniques, biofeedback, desensitization, breathing retraining, and individualized exercise programs.
Kegels are not appropriate for this condition and may make symptoms worse if performed without assessment.
A multidisciplinary care plan may involve physiotherapy, gynecology, gastroenterology, psychology, medications, injections, or acupuncture, depending on the individual’s needs.

What are the Pelvic Floor Muscles?

Pelvic floor muscles are a group of muscles that cover the button of the bony pelvis like a hammock. There are three layers of these muscles and they have important roles in our body including:

Supporting the joints of the pelvis; Pubic Symphysis and the Sacroiliac Joint
Sexual Function; Orgasm, Arousal, Tone around the vagina and anus
Sphincteric Action and Continence
Supporting the Pelvic Organs; Bladder, Urethra, Uterus, Vagina, Rectum
Blood and Lymph Circulation in the Pelvis

When the intricate balance of muscle function is disrupted, we can see signs and symptoms of pelvic floor dysfunction. This imbalance manifests in two ways:

Hypotonic Muscles (Loose and Weak): The pelvic floor muscles become excessively relaxed.
When pelvic floor muscles are too relaxed, it may result in a lack of support from these muscles which can lead to Pelvic Organ Prolapse (POP), Pelvic and Lower Back Pain, and Pain During Intercourse. The weakened sphincteric support provided by these muscles may also lead to issues like urinary and/or bowel incontinence.
Hypertonic Muscles (Tight and Weak): The pelvic floor muscles become overly tight.
This may result in Difficulties with Bowel Movements, Bloating, Difficulty with Voiding Urine, Straining, Sense of Incomplete Emptying, Urinary Urgency and Frequency, Pelvic Pain, Painful Intercourse, or Pain during Orgasm and Arousal.

How Does Levator Ani Syndrome Impact the Pelvic Floor Muscles’ Function?

Levator Ani Syndrome presents ongoing symptoms that significantly impact one's quality of life. Individuals affected by this disorder commonly exhibit a range of symptoms, often experiencing several, if not all, of the following manifestations:

Pain: People with levator ani syndrome may encounter anorectal pain unrelated to bowel movements. This pain, brief or intermittent, can be exacerbated by sitting or lying down, potentially disrupting sleep. Typically situated higher in the rectum, and often more severe on one side than the other. Additionally, individuals may experience low back pain extending to the groin or thighs.
Urinary and Bowel Problems: Due to the tightness of the pelvic floor muscles common issues that impact the bowel and bladder functions include constipation, difficulty passing bowel movements, or a sensation of incomplete bowel evacuation. Additional symptoms are bloating, frequent or urgent urination, difficulty initiating the flow, bladder pain, and urinary incontinence.
Sexual Problems: Levator Ani Syndrome can contribute to pain before, during, or after intercourse in women.

What are the Causes of Levator Ani Syndrome?

The exact cause of Levator Ani Syndrome remains elusive, and it could be associated with various factors, such as:

Pelvic Floor Injury from Surgery or Trauma: A history of soft tissue injuries and pelvic floor muscle damage resulting from surgical procedures and trauma could be implicated in the development of the syndrome.
Presence of Other Chronic Pelvic Pain Conditions: Individuals with coexisting chronic pelvic pain conditions, such as Irritable Bowel Syndrome (IBS), Endometriosis, or Interstitial Cystitis, may be more susceptible to levator Ani Syndrome.
Delayed Urination or Bowel Movements: Not attending to the urge to urinate or pass stool when needed may contribute to the development of the syndrome.

Vaginal Atrophy or Vulvodynia: Conditions involving vaginal atrophy or pain in the Vulva (Vulvodynia) might be linked to levator ani syndrome.

Persistent Painful Intercourse: Painful intercourse is another factor that can lead to Levator Ani Syndrome. Engaging in intercourse despite experiencing pain may be a contributing factor to the onset of levator ani syndrome.

What are the Treatments for Levator Ani Syndrome?

Treatment options for Levator Ani Syndrome should be personalized based on the individual’s symptoms and presentation. Consultation with your healthcare provider could involve discussions about various treatments, including:

Pelvic Floor Physiotherapy: Pelvic floor physiotherapy plays a pivotal role in managing Levator Ani Syndrome, serving as a primary treatment modality.
Prescription Medications: Your doctor might prescribe muscle relaxants or pain medications to help manage your symptoms.
Sex Therapy: In certain cases, sex therapy may be recommended to address all factors contributing to pain and for a more rounded, whole-person approach.
Trigger Point Injections: This treatment involves injecting a substance such as Corticosteroids or Botulinum Toxin (BOTOX) into specific tender points for pain management.
Acupuncture: Traditional acupuncture techniques may be considered as part of the treatment plan.
Nerve Stimulation: This approach focuses on stimulating nerves to alleviate symptoms.

How does pelvic floor physiotherapy help in treating Levator Ani Syndrome?

Here are a few ways a pelvic floor physiotherapist can help alleviate the pain and discomfort caused by the overactive pelvic floor muscles, and improve their function and the quality of your life:

Muscle Relaxation Techniques: Pelvic floor physiotherapists utilize various relaxation exercises to alleviate tension in the pelvic floor muscles. This is particularly important in Levator Ani Syndrome, where spasms and cramping contribute to symptoms.
Biofeedback: Biofeedback is commonly used during pelvic floor physiotherapy sessions. It involves providing real-time feedback to patients about their muscle activity. This helps individuals gain awareness and control over their pelvic floor muscles, promoting relaxation.
Manual Therapy: Physiotherapists use specific manual techniques to target the pelvic floor muscles affected by Levator Ani Syndrome. These techniques may include gentle manipulation, stretching, and pressure-point releases.
Individualized Treatment Plans: Pelvic floor physiotherapy is highly individualized, tailoring the treatment plan to the specific needs and symptoms of each patient. Therapists work closely with individuals to address their unique challenges.
Long-Term Management: Beyond symptom relief, pelvic floor physiotherapy aims to equip individuals with long-term management strategies, empowering them to maintain pelvic health and minimize the impact of Levator Ani Syndrome on their daily lives.

Kegels Are Not Always The Answer!

Kegels are isolated pelvic floor muscle contractions and are recommended to retrain the pelvic floor muscles and improve their function. While performing Kegels is indicated for many conditions related to pelvic floor muscle dysfunction, it is not always the answer and in some cases can make symptoms worse!

In the presence of tension and pain, performing Kegels can often result in aggravation of symptoms. In order to help the overactive muscles regain their function, we will need to improve your control over the muscles and promote relaxation before we begin loading the muscles through isolated contractions.

This is why it is crucial to see a pelvic floor physiotherapist with experience and advanced training in the treatment of pelvic pain in order to have a thorough assessment and receive individualized care and not rely on online resources as sometimes they can do more harm than good.

In addressing Levator Ani Condition, pelvic floor physiotherapy emerges as a cornerstone in therapeutic intervention. Recognizing the integral role of pelvic floor physiotherapy positions it as a primary and effective treatment modality for individuals grappling with Levator Ani Syndrome.

Why Choose Ova in Burnaby, BC?

We’re not just pelvic floor physiotherapists; we’re international experts in complex pelvic pain conditions.

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At Ova Women’s Health, we understand how disruptive and exhausting Levator Ani Syndrome can be. With advanced global training and years of experience treating chronic pelvic pain, we specialize in identifying the underlying causes of pelvic floor muscle tension and tailoring treatment to your unique needs.

Our approach goes beyond symptom management. Through evidence-based techniques such as manual therapy, biofeedback, and relaxation strategies, we help restore pelvic muscle balance, reduce pain, and give you tools for long-term relief.

Women across Burnaby, Vancouver, and the Lower Mainland trust Ova for compassionate, specialized care when it comes to complex pelvic floor conditions like Levator Ani Syndrome.

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❓FAQs About Levator Ani Syndrome and Pelvic Floor Physiotherapy

Levator Ani Syndrome is a condition where the pelvic floor muscles stay overly tight, causing chronic or recurring pain in the rectal or pelvic region. The discomfort is often described as a dull ache or pressure that can worsen when sitting, lying down, or during bowel movements.
The exact cause can vary. It may develop after pelvic trauma, surgery, childbirth, or infection, or as a result of chronic muscle tension from stress or guarding against pain. It’s also more common in women with conditions like irritable bowel syndrome (IBS), endometriosis, vulvodynia, or painful intercourse.
Common symptoms include:
- Deep rectal or pelvic pain that may radiate to the hips, thighs, or lower back
- Pain during or after intercourse
- A feeling of pressure or fullness in the pelvis
- Constipation or difficulty emptying the bowels
- Urinary urgency or frequency
Pelvic floor physiotherapy is one of the most effective, non-invasive treatments. It focuses on releasing muscle tension, improving coordination, and retraining the pelvic floor to function normally. Techniques may include manual therapy, gentle stretching, relaxation training, and biofeedback to help you regain control of your muscles.
No, not in this case. Kegels are designed to strengthen weak muscles, but in Levator Ani Syndrome, the problem is overactivity and tightness. Doing Kegels without proper assessment can make symptoms worse. A pelvic floor physiotherapist will guide you in gentle relaxation and breathing techniques instead.
Yes. Stress activates the fight-or-flight response, which increases muscle tension, including in the pelvic floor. Managing stress through breathing exercises, mindfulness, and nervous system regulation is often a key part of recovery.
Yes. Depending on your symptoms, your doctor may recommend muscle relaxants, trigger-point injections, nerve stimulation, or sex therapy. However, pelvic floor physiotherapy is considered the foundation of treatment and is often combined with these approaches for the best results.
If you experience chronic pelvic or rectal pain, constipation, urinary urgency, or pain during intercourse, you should see a pelvic floor physiotherapist. Early intervention helps prevent symptoms from becoming chronic and supports faster, longer-lasting recovery.

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