Causes of Levator Ani Syndrome
Levator ani syndrome can be caused by various factors, including:
Muscular Tension: Chronically increased muscle tension or spasms of the levator ani muscles are thought to be the main cause of levator ani syndrome. This can be due to actions that strain the pelvic floor muscles such as chronic constipation.
Trauma or Injury: Trauma to the pelvic floor muscles can occur due to childbirth, surgery, or prolonged sitting, leading to damage to the nerves that provide innervation to the levator ani muscles.
Psychological Stressors: Stress, anxiety, and other psychological factors can contribute to pelvic pain syndromes like levator ani syndrome. These factors can lead to muscle tension and exacerbate pain symptoms.
Symptoms of Levator Ani Syndrome
You may not have any symptoms. However, if you do, the symptoms may gradually develop and worsen over time. The common symptoms of levator ani syndrome are chronic rectal or pelvic pain that is associated with increased muscle tenderness or spasm. Other symptoms include:
- Pain or discomfort when sitting for prolonged periods of time placing increased pressure on the pelvic area
Pain associated with bowel movements, sexual intercourse, and/or urination
Impact of Levator Ani Syndrome
Levator ani syndrome can lead to several conditions:
- Chronic Pelvic Pain: Persistent or recurring pain in the pelvic region is the hallmark symptom of levator ani syndrome. This pain is typically dull, aching, or cramping in nature and may worsen with certain activities or positions.
- Pelvic Floor Dysfunction: Persistent tension or dysfunction of the pelvic floor muscles can contribute to generalized pelvic floor dysfunction. This can affect bowel and bladder function, sexual function, and overall pelvic stability.
- Urinary Symptoms: The increased tension in the pelvic musculature can lead to a range of urinary symptoms including increased frequency, urgency, hesitancy, incontinence, or incomplete bladder emptying.
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Diagnosis of Levator Ani Syndrome
Diagnosing levator ani syndrome typically involves:
Medical History: Discussion of symptoms, past medical conditions, and any history of injury to the pelvic muscles.
Physical Examination: Assessment focusing on the pelvic area including palpation of the pelvic muscles to assess for tenderness or muscle spasms. A digital rectal exam (DRE) may be utilized to evaluate causes of levator ani syndrome.
Diagnostic Imaging: Imaging such as pelvic ultrasound, CT scans, or MRI scans to visualize pelvic structures and detect structural causes of pelvic pain.
Prognosis of Levator Ani Syndrome
The prognosis of levator ani syndrome (LAS) varies widely among individuals. With appropriate management strategies including physical therapy, stress reduction techniques, and sometimes medications, many individuals experience improvement in symptoms and quality of life, although some may require ongoing management to control recurrent symptoms.1
Treatment of Levator Ani Syndrome
Treatment options include:
Conservative Treatments: Non-surgical approaches include:
Medications: Such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants for pain management.
Physical Therapy: Exercises to strengthen pelvic floor muscles under the guidance of a specialized pelvic floor physical therapist that will teach exercises to relax and strengthen the levator ani muscles.
Dietary Modifications: For individuals with bowel symptoms associated with levator ani syndrome, dietary changes such as increasing fiber intake, staying hydrated, and avoiding triggering foods may help improve bowel function and reduce symptoms.
Acupuncture or Chiropractic Care: Some patients find relief through alternative therapies.
Surgical Intervention: When conservative measures are ineffective or symptoms worsen, surgery
may be considered:
Surgical Options: Surgery is rarely considered for levator ani syndrome and is usually reserved for cases where conservative treatments have failed and there is a clear structural problem contributing to symptoms. Possible surgical options include myomectomy or sphincterotomy.
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References
- Dunphy, L., Wood, F., Mubarak, E. S., & Coughlin, L. (2023). Levator Ani Syndrome Presenting with Vaginal Pain. BMJ case reports, 16(5), e255190. https://doi.org/10.1136/bcr-2023-255190
- Elkadry E, Barker L. Myofascial pelvic pain syndrome in females: Clinical manifestations and diagnosis. In: Up To Date, Connor RF (Ed), Wolters Kluwer. (Accessed on July 22, 2024.)
