Levator Ani Syndrome

doctor with patient
Tetra images/Getty Images

Did you doctor recently diagnose you with levator ani syndrome? Or are you experiencing chronic anal pain and trying to figure out what is going wrong while waiting for your appointment? This overview will give you some information as to what levator ani syndrome is, what its symptoms are, how it is diagnosed, and what options there are for treatment.

What Is Levator Ani Syndrome?

Levator ani syndrome (or "levator spasm") is a form of chronic proctalgia.

Chronic proctalgia is a health condition in which people experience chronic rectal pain that comes in two forms: levator ani syndrome and unspecified functional anorectal pain.

There is a distinction between the two. People who have levator ani syndrome report tenderness in the levator muscle of the pelvis when it is touched during a rectal examination.

It is estimated that levator ani syndrome affects approximately 7 percent of all women and 6 percent of all men. The reasons why a person may develop the syndrome are not clear.

Research has found that dyssynergic defecation — a condition in which there is dysfunction in the way pelvic floor muscles operate – may play a role in the development of the syndrome. A person may also be at higher risk for developing levator ani syndrome after childbirth or surgery of the spine, anus, or pelvic area.


People who have levator ani syndrome experience chronic and prolonged pain high up in their rectum.

The pain is typically experienced and described as a dull ache or sense of pressure. The pain and discomfort are generally worsened when the person is sitting and eased when they are standing up or lying down.


Like other functional gastrointestinal disorders (FGDs), levator ani syndrome is diagnosed after other health conditions have been ruled out.

This means that you will only undergo any diagnostic tests that your doctor deems necessary to rule out other disorders.

The diagnosis is then made according to Rome III criteria for chronic proctalgia. This states that the individual must experience episodes of "chronic or recurrent rectal pain or aching" that last for at least 20 minutes. The individual must also experience tenderness on the puborectalis muscle (a part of the levator ani muscle group) when touched.

Treatment Options 

Traditional treatment options for levator ani syndrome included the use of sitz baths or digital massage by a qualified physical therapist. Neither of these treatments has been shown to be particularly effective in easing symptoms.

Electrogalvanic stimulation and biofeedback have been shown to be more effective choices for some patients. Studies indicate that biofeedback may have a bit of an advantage in terms of effectiveness.

A potential treatment option for levator ani syndrome that is currently being investigated is Botox. To date, the studies have been small and have yielded mixed results. As Botox is generally seen as a safe treatment option for a variety of health problems, it will be interesting to see if researchers continue to pursue this line of inquiry.

There is at least one documented case in which a patient found relief after three acupuncture treatments. However, the doctors admit that more study is required to determine if this is an effective treatment.

A Word From Verywell

If you are experiencing chronic anal pain or rectal discomfort, make an appointment with your doctor for a proper diagnosis. After a diagnosis of levator ani syndrome, be sure to talk to your doctor about possible treatment options. 


Bharucha A, Trabuco E. Functional and Chronic Anorectal and Pelvic Pain Disorders Gastroenterology Clinics of North America 2008 37: 685-696.

Bibi S, Zutshi M, Gurland B, Hull T. Is Botox for Anal Pain an Effective Treatment Option?  Postgraduate Medical Journal. 2016;128(1):41-5.  doi:10.1080/00325481.2015.

Chiarioni G, Asteria C, Whitehead W. Chronic Proctalgia and Chronic Pelvic Pain Syndromes: New Etiologic Insights and Treatment Options. World Journal of Gastroenterology. 2011;17(40):4447-4455. doi:10.3748/wjg.v17.i40.4447.

The Rome Foundation. Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders. Appendix A. http://www.romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf

Saleemi HT, Faooque H, Choudhury S, Zhang J. Poster 27 Acupuncture Treatment for Levator Ani Syndrome: A Case Report. PM&R. 2016;8(9S):S169. doi:10.1016/j.pmrj.2016.07.070.