Levator ani syndrome (LAS) is a condition of the pelvic floor. The pelvic floor is a group of muscles that support your organs and stability, allow you to use the restroom, and are involved in sexual appreciation.

Many things can go wrong with the pelvic floor, but with this condition the muscles are very tight (hypertonic) or uncoordinated. More specifically, it causes tightness of the levator ani muscles, which are located around the pelvic openings such as the vagina, urethra, or anus.

The levator ani muscles help you perform bowel movements and control fecal continence (holding in poop). Therefore, this condition is characterized by chronic rectal pain or pain in the back area of the pelvis. This rectal pain may occur during bowel movements, but LAS is not directly related to having a bowel movement. 

The pain can be severe, chronic, persistent, and may last for long amounts of time. The pain may feel as though it is deeper inside the pelvis, and can increase in severity over time. It may also be felt in waves. Additionally, levator ani syndrome can cause the following symptoms:

• Constipation
• Difficult bowel movements
• Pelvic pain
• Pain with sex
• Abdominal pain
• Pain in the groin
• Pain in the genitals
• Painful periods
• Bladder pain
• Pain with urination
• Pain when sitting

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Levator ani syndrome doesn’t have a known cause. While it is a condition of tight levator ani muscles, what causes those tightened muscles is uncertain.

Some individuals, however, are more likely to develop levator ani syndrome and tightness in their pelvic floor muscles.

This includes those who have a history of hemorrhoids, inflammatory bowel disease, or chronic constipation. Those assigned female at birth are also more likely to develop this condition, as well as those who have experienced a vaginal birth.

Additionally, while the specific cause of this condition is unknown, there are other factors that can create tightened pelvic floor muscles (not just in the levator ani muscles). Posture, bathroom habits, stress, pelvic trauma, prolonged sitting, and other factors can contribute to the tightening of your pelvic floor.

A pelvic floor physical therapist will be able to talk these factors through with you, identify which may be affecting you specifically, and help correct many of those causes with behavioral modifications. We’ll discuss more ways pelvic floor therapists can help with LAS in the next section!

Levator ani syndrome is not a condition that will simply go away. Unfortunately, because this condition can be confusing (having no direct identifiable cause) it often goes untreated or even undiagnosed for many. This is especially so as diagnosis involves a lengthy process of ruling out all other possible contributors to your rectal pain first.

As for treatment, suggestions typically involve temporary relief from injections or at-home remedies. Even though pelvic floor physical therapy is a very suitable form of treatment—and this condition directly involves the pelvic floor muscles—it is often forgotten or simply an unknown option. 

Not all doctors may be aware that pelvic floor physical therapy is an option for treatment, and therefore may not send patients with LAS symptoms to try it. However, because it is a condition of the pelvic floor muscles, physical therapy can prove very useful in reducing the symptoms associated with levator ani syndrome.

Don’t be afraid to advocate for your own health and pursue physical therapy if you feel it can be suitable for your needs.

You should especially consider seeking a pelvic floor therapist if you have already received negative tests or screening for your rectal pain, have not recently given birth, and have not had a recent surgery or injury that could create your pain. Having pain outside of all these factors may point to levator ani syndrome.

So, how can pelvic floor physical therapy help?

Firstly, one of the most successful forms of treatment for this condition is biofeedback, a treatment that will help you better understand and control your pelvic floor muscles.

As pelvic floor therapists are experts in this region of the body (and the body in general) they will be able to help you understand what the pelvic floor is, where those muscles are, what they feel like, and how they should be functioning. These muscles should be able to both contract and relax—in the case of LAS, they will struggle to relax.

To alleviate this issue, your physical therapist can utilize a variety of treatments. They will guide you through exercises that help you feel the location of your pelvic floor muscles and gain better control of them. They’ll likely also use manual therapy to help increase mobility and flexibility of those tightened muscles.

Another important part of treatment is relaxation. You may be surprised to know that physical therapists may teach you methods of relaxation! One common method used by experts is diaphragmatic breathing.

This technique may seem simple, but breathing in this specific way can help relax the pelvic floor muscles, as they naturally rest when the diaphragm contracts.

Your physical therapist can also provide pain-relieving treatments. As this chronic condition can cause pain throughout the pelvic region, it may help to experience treatments such as dry needling, cupping, tissue scraping, and other methods of relieving your body pain.

Additionally, as this condition involves tight pelvic floor muscles, it can be helpful to understand other factors that can create tightened muscles. As mentioned before, certain postures, bathroom habits, or environmental factors can contribute to tight pelvic floor muscles—the main issue involved with LAS.

Your physical therapist will help identify what habits may be contributing to your tight muscles, and suggest behavioral modifications to alleviate those possible contributors.

This can include things like sitting on the toilet for too long, straining often, and other things of that nature. They may also recommend that you make lifestyle changes to improve hydration or fiber intake, which can make bowel movements easier.

If you are someone experiencing pain from what you suspect is levator ani syndrome, definitely don’t put off seeking treatment. While this condition is not life-threatening, it does threaten the quality of your life.

Chronic pain is not something that you just have to live with! Pelvic floor physical therapy could be the answer for you—take the first steps with a free discovery call!

Our physical therapists at Hive Therapy and Wellness take a holistic approach to your care. They’ll create a unique plan of care that is curated to your individual needs, and utilize treatments best suited for your condition. Some treatments often used by our experts at Hive include the following:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback