Levator Ani Syndrome


What is levator ani syndrome?

Levator ani syndrome is caused by spasm of the levator ani muscle, a muscle in the lower pelvis which creates the pelvic floor, surrounds the rectum and attaches to the pelvic bones.

What are the symptoms of levator ani syndrome?

Individuals with levator syndrome generally experience a chronic or recurrent, vague, dull, aching rectal pain or pressure that lasts for 20 minutes or longer. The pain is often worse with sitting than with standing or lying down.

These symptoms are different than those for proctalgia fugax where patients experience a sudden, sharp, severe intermittent pain in the anal area lasting several seconds to minutes.

How is levator ani syndrome diagnosed?

Levator syndrome may be diagnosed after a thorough history and physical examination in the office by your colorectal surgeon. Patients with levator syndrome will report chronic or recurrent rectal pain as described above. Digital rectal exam may reveal overly contracted muscles and pelvic floor pain during the exam. Other conditions such as hemorrhoid, fissure, abscess, proctitis and cancer should be excluded and this may involved a proctoscopy, colonoscopy, x-ray or other imaging tests. Dr. Zaghiyan will discuss all of these options with you after a thorough evaluation in her office in Los Angeles.

How is levator ani syndrome treated?

The condition can be very frustrating, because treatments are not equally effective in everyone. The first step in treatment is generally levator massage, an office-based procedure performed by Dr. Zaghiyan whereby the pelvic floor muscles are massaged through the rectum. The procedure generally is repeated weekly for 6 weeks. During this time, patients are also recommended to soak in a warm tub once or twice daily to relax the pelvic floor muscles.

Other options include biofeedback therapy to teach pelvic floor relaxation or electrogalvanic therapy where a probe is placed through the anus to apply a gentle electrical pulse to the levator ani muscles to help relax the muscles. The procedure is generally performed 3 times per week for 2-3 weeks.

If these treatments are unsuccessful, other options include pudendal nerve block (injection of local anesthetic to anesthetize the nerve controlling the pelvic floor and anal sphincter muscles) or botulinum toxin (Botox) injection to relax the muscles.

Make an appointment with Dr. Zaghiyan today to for a thorough evaluation and individualized treatment plan.