Levator Ani Syndrome: One Way to Name the Pain
By Andrea Meade, Reg. PT
The human pelvis is sometimes referred to as a ‘high-traffic area’. It houses a number of different systems: urinary system, digestive system, musculoskeletal system, reproductive system, as well as elements of the circulatory and nervous systems. These systems are in close proximity and share nerves, connective tissue, and blood supply. This and our human experiences – stress, emotions and physical endeavours – all come together to make the pelvis a highly complex area. It’s not surprising that many different symptoms can arise when one or more systems are not functioning well.
Pelvic floor muscle dysfunction occurs when the muscles of the pelvic floor are under stress or strain, and can create a variety of symptoms, including pain and difficulty with urination, defecation and/or sexual function. As such, pelvic pain conditions go by a variety of different names, each of which are coined to more accurately describe the anatomical structures involved.
‘Levator Ani Syndrome’ was named to identify the symptoms related to dysfunction of the levator ani muscle group, which makes up the majority of the pelvic floor muscle bulk. the levator ani muscles span from the pubic bone (in the front of the pelvis) to the tailbone in the back. More specifically, the levator ani is a combination of three smaller pairs of muscles: the pubococcygeus muscles, the iliococcygeus muscles and the puborectalis muscles. The muscles work as a team on the right and left sides of the body to provide structural support for the rectum and anus. In fact, the name ‘levator ani’ is from the latin verb ‘levare’ (to lift) and ‘ani’ (ring, referring to the anal sphincter). These muscles also provide some support to the bladder, urethra, vagina (in women) and prostate (in men).
If the levator ani muscles are dysfunctional -i.e. overactive or ‘in spasm’ – they can become short, tight and tender, leading to any of the following symptoms:
Rectal pain that can radiate to nearby areas such as groin, lower abdomen, or buttocks
A sensation of fullness or pressure in the rectum (the classic ‘golfball’ descriptor)
Difficulty tolerating the sitting position
Symptoms aggravated (or relieved) by a bowel movement
Symptoms aggravated by sexual activity
Levator Ani Syndrome is a medical diagnosis which is given in the absence of other findings, leading the medical practitioner to label the condition based on what the patient is experiencing, not necessarily on any measurable or objective test results. The search for objective findings can be a source of stress and frustration for people suffering from this bothersome condition, which can perpetuate the tension and tightness in the offending muscles.
Pelvic health physiotherapists who have been specially trained to assess and treat the pelvic floor muscles can easily identify sore, tight, poorly-coordinated muscles in the pelvic floor through manual palpation (skilled touch) and careful observation and measurement. Treatment may include soft tissue release, desensitization techniques for irritated nerves. massage, muscle retraining, exercise, biofeedback, and relaxation and stress management techniques.
Levator Ani Syndrome doesn’t have to be a pain in the backside or undercarriage forever. As tissues heal and muscle balance is restored, activity tolerance and physical fitness also improves. With the right care, most patients experiencing symptoms of Levator Ani Syndrome can expect to learn a self-management routine and return to their favourite activities within a reasonable timeframe.
References:
1. Fidoe, S. (2019 November 14). The Pelvic Floor. Retrieved from https://teachmeanatomy.info
2. Pelvic Rehabilitation Medicine. (2017, November 27). Levator Ani Syndrome. Retrieved from https://www.pelvicrehabilitation.com
3. Pars pubococcygeus – male [Digital Image] Retrieved from http://www.anatomyexpert.com/app/structure/5331/1692/