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 may be causing your symptoms and what can be done about them.

What Is Levator Ani Syndrome?

Levator ani syndrome is a form of chronic proctalgia, a condition resulting in chronic rectal pain.

It is distinguished from the other form of chronic proctalgia - unspecified functional anorectal pain - in that 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% of all women and 6% of all men.

Symptoms of Levator Ani Syndrome

In levator ani syndrome the patient experiences chronic and prolonged pain often described as a dull ache or sense of pressure high up in the rectum. The pain and discomfort of the condition 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. Therefore, you would 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, along with tenderness on the puborectalis muscle, which is a part of the levator ani muscle group.

Treatment Options

The following forms of treatment have been traditionally recommended for levator ani syndrome:

In the past, the disorder has been viewed as being one that is hard to treat. More recent work suggests some benefit of electrogalvanic stimulation and biofeedback for some patients, with biofeedback showing 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.


Barucha, A., et.al. "Functional Anorectal Disorders" Gastroenterology 2006 130:1510-1518.

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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