Experiencing Rectal Pain? You May Have

Levator Ani Syndrome

Affecting both women and men, levator ani syndrome, also known as rectal pain, causes pain within the rectal area and other areas of the pelvic floor. Patients should be encouraged to know that treatment for this condition is possible.

Understanding Rectal & Pelvic Pain

What is Levator Ani Syndrome?

Levator Ani Syndrome is a muscle-based pelvic pain due to chronically contracted pelvic muscles. It has many names and can be associated with pelvic floor muscle dysfunction, chronic proctalgia fugax, or chronic pelvic pain syndrome. Levator Ani Syndrome typically describes pain in the rectum or the bottom and back of the pelvis.

Symptoms of Levator Ani Syndrome

Sometimes patients with levator ani syndrome can have referred pain patterns in the lower abdomen, as well as anterior pelvic floor muscle dysfunction symptoms such as genital pain. Patients also often have the following symptoms:

Rectal Pain Is Not in Your Head

What Causes Levator Ani Syndrome?

In levator ani syndrome, the levator ani muscles of the pelvic floor are short, contracted, and weak. This contracted state does not allow for the levator muscles to support its surrounding structures and leads to a decrease in blood flow to the area.

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    The decrease in blood flow leads to an acidic environment which stimulates an inflammatory cascade.

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    The inflammatory cascade causes an “inflammatory” soup in the pelvis and surrounding area, in addition to inflammation around the nerves.

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    This cascade is ultimately what leads to the pain symptoms described above and lack of muscle coordination for the pelvic floor muscles in levator ani syndrome.

Levator Ani Syndrome

Risk Factors

There are both local and systemic factors that contribute to causing the symptoms of levator ani syndrome. Locally, unconscious tensing of the pelvic floor muscles from stress and anxiety, contribute to the symptoms. Often this is combined with certain “triggers” or risk factors.

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    Chronic constipation or loose stool

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    Poor toileting habits usually started as a young child

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    A history of hemorrhoids or an anal fissure

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    History of Low Back Pain or Lumbar Spine pathology

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    A history of colorectal or gynecological surgery

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    Genetic predispositions such as the nervous system being hyperexcitable

Is Your Rectal Pain Levator Ani?

Diagnosing Levator Ani Syndrome

Sometimes, there is an absence of visible symptoms when tests are conducted and this can be frustrating to both patients and medical practitioners and can delay a diagnosis and treatment plan. Diagnosing chronic pelvic pain syndrome and the issues that are causing it requires an in-depth examination of both the nerves and muscles within the pelvis, learning of your medical history, and getting a full picture of your symptoms and lifestyle.

Here’s what you can expect when you are a patient at Pelvic Rehabilitation Medicine:

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    Step One – First, our providers will ask questions about your medical history and listen to your symptoms to get a full picture of what is going on with you.

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    Step Two – Next, an external exam of your hips, abdomen, and posterior sacrum.

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    Step Three – Next, your pelvic nerves are evaluated externally with a soft cotton tip.

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    Step Four – Next, with your consent, gel is placed on a gloved finger and an internal exam is performed to allow us to evaluate the nerves and muscles within the pelvis. There is no speculum required as we are evaluating the pelvic floor muscles and nerves not the organs.

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    Step Five – Sometimes patients will need Imaging to help us understand if there is an associated cause of the pelvic nerve and muscle pain and dysfunction found on exam.

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    Step Six – Oftentimes, treatment can be started the same day as there is no down time. Our patients have been suffering with pelvic pain symptoms for 6+ months. We like to get them on the road to feeling better as soon as we can as the longer the symptoms are present the harder it is for us to resolve them.

Treatment Options for Levator Ani Syndrome

Once a proper diagnosis has been given, we offer a proprietary office-based procedure to treat levator ani syndrome. Treatment for levator ani syndrome involves re-training both the pelvic muscles and the nervous system. This treatment consists of a series of pelvic nerve and muscle treatments to directly target spastic pelvic floor muscles, inflammation in the pelvis, and nerve pain. Depending on what is causing your rectal pain, other modalities may be needed in addition to our treatment.

Frequently Asked Questions

Experiencing chronic pelvic pain can be debilitating and discouraging, but our team of pelvic pain specialists will listen to you, validate your experiences and symptoms, and partner with you on your rehabilitation journey.

The prognosis depends on the underlying cause as well as the duration of symptoms, but with our multimodal approach to treatment, we help our patients restore function and experience relief for their pain.

The levator ani muscles are a sling or muscles that go from the pubic symphysis in the front of the body to the coccyx in the back. Directly they hold up the bladder and prostate, and uterus and vagina, as well as the descending rectum. Because the pain occurring in the rectal muscle can feel like a spasm this condition can sometimes be called Levator Spasm Syndrome. These spasms are usually episodic and last no longer than 20 minutes and are often unrelated to a bowel movement.

They can feel different for every patient. Common symptoms associated with pelvic floor muscle spasm are a pain with intercourse or post-intercourse soreness, urinary urgency/frequency/incomplete emptying/urge incontinence, bowel constipation/pain with bowel movements/sensation of rectal fullness/rectal burning. Or the symptoms could be vaguer such as sensations of “flicker” or “vibration” in perineum, vagina or rectum.

We recommend scheduling an appointment with one of our pelvic pain specialists if you have been experiencing the symptoms of levator ani syndrome for 6 months or longer.

You’ll meet with one of our pelvic pain specialists, who focus solely on pelvic pain. We’ll start with reviewing your full health history, including a discussion of your symptoms. This will help us to understand what you’ve been experiencing, so we can work to identify the source of your pain.
Next, we’ll conduct a full pelvic exam. Externally, we will look at your hips, abdomen, and posterior sacrum. Internally, we will evaluate the nerves and the muscles within the pelvic area. This full exam is necessary , as it will help our pelvic pain specialists understand the connection between your symptoms, and your nerve and muscle pain and dysfunction. There is no speculum, so the exam is gentle and more comfortable than that of, for example, gynecological exams you may have experienced in the past.
We will discuss our findings with you and come up with a comprehensive treatment plan TOGETHER. We want you to know that your pain is validated and that we are here to work with you on getting you back to the life you deserve.

Next, we’ll conduct a full pelvic exam. Externally, we will look at your hips, abdomen, and posterior sacrum. Internally, we will evaluate the nerves and the muscles within the pelvic area. This full exam is necessary , as it will help our pelvic pain specialists understand the connection between your symptoms, and your nerve and muscle pain and dysfunction. There is no speculum, so the exam is gentle and more comfortable than that of, for example, gynecological exams you may have experienced in the past.

We will discuss our findings with you and come up with a comprehensive treatment plan TOGETHER. We want you to know that your pain is validated and that we are here to work with you on getting you back to the life you deserve.

Speak With A Professional Today.