Levator Syndrome: Symptoms, Causes, Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr Sravani Sakshi , Gynecologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Levator Syndrome is a chronic pelvic floor disorder characterized by recurring or persistent pain in the rectum, anus, or lower pelvis. The condition is thought to result from spasms or excessive tension of the levator ani muscles, which support the pelvic organs. Symptoms may vary in severity and can affect daily activities and quality of life. Early diagnosis and appropriate treatment can help relieve discomfort and improve pelvic floor function.

What are the Types Of Levator Syndrome?

Levator syndrome can be classified into two types: primary levator syndrome and secondary levator syndrome. Primary levator syndrome is characterized by chronic, intermittent rectal pain without any identifiable cause.

On the other hand, secondary levator syndrome is often associated with underlying conditions such as pelvic floor dysfunction or nerve damage. Understanding the type of levator syndrome you have is crucial for effective management and treatment.

Levator syndrome can manifest as rectal pain and discomfort due to spasms in the levator ani muscles, which are located in the pelvic floor.
Chronic levator syndrome is characterized by persistent pelvic pain and tenderness, often exacerbated by sitting for long periods or during bowel movements.
Acute levator syndrome presents with sudden and severe rectal pain, which may be accompanied by a feeling of fullness or pressure in the rectum.
Secondary levator syndrome can occur as a result of conditions such as irritable bowel syndrome (IBS), pelvic inflammatory disease (PID), or endometriosis, leading to pelvic floor muscle dysfunction.

What are the Symptoms of Levator Syndrome?

Levator syndrome can cause symptoms like rectal pain, aching, or pressure in the lower pelvis. Patients may also experience discomfort during or after bowel movements, as well as a sensation of incomplete emptying.

Other signs include a feeling of a lump or blockage in the rectum. These symptoms can be bothersome but are usually not a sign of a serious condition.

Pain and discomfort in the rectum or anus, especially when sitting for long periods of time, are common symptoms of levator syndrome.
Some individuals may experience a dull ache or pressure in the pelvic region that worsens with bowel movements, a key sign of levator syndrome.
Difficulty fully emptying the bowels or feeling like there is still stool left behind after a bowel movement can be indicative of levator syndrome.
Patients with levator syndrome may also notice a sensation of a foreign object or swelling in the rectal area, leading to increased discomfort.

What are the Causes of Levator Syndrome?

Other potential triggers include stress, poor posture, and nerve irritation in the lower back. Identifying and addressing these underlying causes can help manage levator syndrome symptoms effectively.

Levator syndrome can be caused by chronic constipation, which puts pressure on the levator ani muscles in the pelvic floor.
Inflammation or irritation of the levator ani muscles due to conditions like proctitis or anal fissures can lead to levator syndrome.
Pelvic floor muscle dysfunction, such as spasms or weakness, can contribute to the development of levator syndrome.
Prolonged sitting or straining during bowel movements can strain the pelvic floor muscles and trigger levator syndrome symptoms.
Psychological factors like stress and anxiety may exacerbate levator syndrome by increasing muscle tension in the pelvic region.

When to See a Doctor for Levator Syndrome?

Persistent rectal pain, pelvic discomfort, or symptoms affecting daily activities should be evaluated by a Gastroenterologist, Gynecologists, Colorectal Surgeon, or Pelvic Floor Specialist. Medical assessment helps exclude other causes of rectal pain and guides treatment.

You should see a doctor if you experience:

Recurrent rectal or pelvic pain
Pain while sitting for long periods
Persistent pelvic pressure

Seek prompt medical attention if:

Rectal bleeding occurs
Unexplained weight loss develops
Severe or worsening pain is accompanied by other concerning symptoms

These symptoms may indicate another underlying condition requiring further evaluation.

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How is Levator Syndrome Diagnosed?

Levator syndrome is diagnosed through a physical examination and by discussing your symptoms with a healthcare provider. They may also perform a digital rectal exam to check for muscle spasms or tenderness in the pelvic floor muscles.

Imaging tests like MRI or ultrasound may be ordered to rule out other conditions. It's important to communicate openly with your doctor to receive an accurate diagnosis and appropriate treatment.

Physical Examination: A healthcare provider may perform a physical examination to assess the pelvic area for tenderness, muscle spasms, and any other signs of levator syndrome.
Digital Rectal Examination: This procedure involves the insertion of a lubricated, gloved finger into the rectum to assess the tone and tenderness of the levator ani muscles.
Anorectal Manometry: Anorectal manometry is a test that measures the pressure and function of the muscles in the rectum and anal canal, which can help diagnose levator syndrome.
Proctography: Proctography, also known as defecography, is a radiologic imaging test that evaluates the anatomy and function of the pelvic floor muscles during defecation, helping to identify any abnormalities or dysfunctions that may contribute to levator syndrome.

What are the Treatment for Levator Syndrome?

Treatment options for levator syndrome may include lifestyle changes, such as dietary modifications and regular exercise, to help manage symptoms. Warm baths and pelvic floor physical therapy can also be beneficial.

In some cases, medications like muscle relaxants or nerve pain medications may be prescribed. Surgery is only considered in severe cases that do not respond to other treatments.

Warm sitz baths can help alleviate levator syndrome symptoms by promoting relaxation of the pelvic floor muscles, reducing pain and discomfort associated with the condition.
Physical therapy techniques such as pelvic floor muscle exercises and biofeedback training can strengthen the pelvic floor muscles and improve coordination, leading to better control and reduced symptoms of levator syndrome.
Dietary modifications, including increasing fiber intake and staying hydrated, can help regulate bowel movements and prevent constipation, which is a common trigger for levator syndrome flare-ups.
In some cases, medications such as muscle relaxants or nerve pain medications may be prescribed to help manage pain and discomfort associated with levator syndrome.

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What are the Risk Factors for Levator Syndrome?

Risk factors for levator syndrome include chronic constipation, diarrhea, high-stress levels, and pelvic floor dysfunction. Other contributing factors may include a sedentary lifestyle, obesity, and poor dietary habits. Individuals with a history of pelvic surgery, childbirth, or radiation therapy in the pelvic region may also be at an increased risk for developing levator syndrome.

Chronic constipation is a significant risk factor for levator syndrome, as the constant straining during bowel movements can lead to irritation and inflammation of the levator ani muscle.
Prolonged sitting or a sedentary lifestyle increases the risk of developing levator syndrome, as it can lead to decreased blood flow to the pelvic area and contribute to muscle tightness and discomfort.
A history of pelvic surgery, particularly procedures involving the rectum or anus, can predispose individuals to levator syndrome due to potential nerve damage or scarring that affects the pelvic floor muscles.
Psychological stress and anxiety may exacerbate levator syndrome symptoms, as heightened stress levels can lead to increased muscle tension in the pelvic region.

What is the Recovery Process for Levator Syndrome?

Recovery varies depending on symptom severity and response to treatment. Many individuals experience significant improvement with pelvic floor rehabilitation and lifestyle modifications.

Ongoing self-care and follow-up may help prevent symptom recurrence.

Recovery Includes

Pelvic floor rehabilitation exercises
Regular physical therapy sessions
Management of bowel habits
Stress reduction techniques
Routine follow-up visits
Long-term symptom monitoring

Frequently Asked Questions

1. How do I recognize the signs of levator syndrome?

Levator syndrome signs include rectal pain, aching, or pressure that worsens when sitting. Symptoms may also include constipation and relief after a bowel movement.

2. How Should I Care for Myself with Levator Syndrome? What Should I Do and Avoid?

Manage levator syndrome by improving bowel habits, sitting on a cushioned seat, taking warm baths, and avoiding spicy foods and excessive caffeine.

3. What are the Complications of Levator Syndrome?

Potential complications of levator syndrome include chronic pelvic pain, discomfort during bowel movements, and decreased quality of life.

4. What are the best ways to manage levator syndrome?

Levator syndrome can be managed with warm baths, dietary changes (more fiber), stool softeners, gentle exercise, and avoiding straining during bowel movements.

5. Can levator syndrome return even after successful treatment?

Yes, levator syndrome can recur even after successful treatment due to factors like underlying conditions or lifestyle habits. Regular follow-ups are important.