What Is Levator Ani Syndrome?

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Has you doctor just diagnosed you with levator ani syndrome? Or are you experiencing chronic anal pain and are trying to figure out what is going wrong while you are 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 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 arorectal pain. What distinguishes the two is that that people who have levator ani syndrome report tenderness in the levator muscle of the pelvis when it is touched during a rectal examination.

Levator ani syndrome is estimated that levator ani syndrome affects approximately 7% of all women and 6% of all men. The reasons why a person would develop the syndrome are not clear. There is some new research that is finding that dyssynergic defecation, a condition in which there is dysfunction in the way that the muscles of the pelvic floor are operating,  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.

Levator ani syndrome has also been called "levator spasm."

Symptoms of Levator Ani Syndrome

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 of levator ani syndrome is generally worsened when the person is sitting and eased when they are standing up or lying down.

How Is Levator Ani Syndrome Diagnosed?

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, which 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 for Levator Ani Syndrome

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

Two newer options, that of 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.

A Word from Verywell

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


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

Bibi, S., et.al. "Is Botox for anal pain an effective treatment option?" Postgraduate Medical Journal 2015 Aug 26:1-5 [Epub ahead of print].

Chiarioni, G., Asteria, C. & Whitehead, W. "Chronic proctalgia and chronic pelvic pain syndromes: New etiologic insights and treatment options" World Journal of Gastroenterology 2011 17:4447-4455.

Rao, S. et.al. "Clinical Trial: Effects of Botulinum Toxin on Levator Ani Syndrome: A Double Blind, Placebo Controlled Study" Alimentary Pharmacology & Therapeutics 2009 29:985–991.

"Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders" Appendix A

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