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Levator Ani Syndrome

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Facts about Levator Ani Syndrome (spasm)


  • Levator ani syndrome (spasm) is a chronic “charley-horse” up inside the pelvis.
  • It is experienced as painful, chronic rectal pain and can make life very miserable.
  • When someone presses on the levator muscle, it usually hurts a lot.
  • Once levator ani syndrome occurs it usually has a life of its own because it is fed by tension, anxiety, pain and protective guarding.
  • It may be aggravated by sitting, bowel movements, sexual activity and stress.
  • The levator ani muscle is a major muscle up inside the pelvis that raises and lowers the anal sphincter and tightens and relaxes for a number of bodily functions.
  • Until recently there has been no effective treatment for it.
  • The Wise-Anderson Protocol has treated many patients with levator ani syndrome with the treatment described in the sixth edition of A Headache in the Pelvis.

Relieving Levator Ani Syndrome With The Wise-Anderson Protocol Developed At Stanford

  • Our published research on muscle based pelvic pain: In a 2009 Stanford study of our work published in the Journal of Urology, it was documented that the relationship between levator ani pain and trigger points.
  • In our 2009 Journal of Urology trigger point study, we documented that trigger points in the levator ani and other pelvic muscle that remain in place for years can refer pain to different places in the body.
  • Pain from levator ani syndrome in selected patients, even when it lasts for years, can get better with proper treatment.
  • A major focus of the Wise-Anderson Protocol is helping to relieve pain in the levator ani muscle.
  • The Wise-Anderson Protocol trains patients to release trigger points in the levator and other pelvic muscles and to relax the muscles related to levator pain.

History and description of Levator Ani Syndrome

In the 1950’s the term levator ani syndrome was used to describe a disorder that involved pain in the rectal area with no evidence of pathology. Both men and women can suffer from this kind of pain, on either an intermittent or constant basis. This diagnosis is an imprecise one because the diagnosis implies that the problematic pain is found exclusively in the levator ani muscle which is found up inside the pelvic floor. In fact, what is called levator ani syndrome is more properly called pelvic floor dysfunction or simply pelvic pain syndrome because in this condition, many of the muscles of the pelvic floor can be painful and not just the levator muscle.

Sitting Triggers or Makes Symptoms Worse.

sitstandSitting typically triggers symptoms or makes symptoms worse. For those with intermittent pain, pain can be set off by sitting, standing, or lying down. Some patients also complain of constipation, post bowel movement pain or relief, tailbone and/or low back pain. It is estimated that more of these patients are women, and that this condition seems to affect people at midlife.

When a digital-rectal examination is performed, pain is elicited by pressing on a small area within the levator ani muscle as well as other internal muscles. The tissue feels like a tight band. Often, though not always, the tenderness is more on one side.

Levator ani syndrome is infrequently associated with urinary symptoms and/or pain during or after sex although these symptoms can co-exist with a diagnosis of levator ani syndrome. While proctologists/colorectal surgeons (doctors who specialize in disorders of the colon and rectum) naturally tend to see patients with levator ani syndrome, gastrointestinal doctors, urologists, and physical therapists also see such patients.

Different names are given to muscle based pelvic pain including the name Levator Ani Syndrome.

triggerpointIn our experience, the symptoms of prostatitis in men are sometimes diagnosed as levator ani syndrome and sometimes levator ani syndrome is called prostatitis depending on the orientation or knowledge of the diagnosing physician. Sometimes it is called coccygodynia, levator ani spasm syndrome, proctalgia fugax, proctodynia, pelvic floor dysfunction, pelvic floor myalgia or chronic pelvic pain syndrome. In the research below, we refer to prostatitis as a muscle based pain syndrome in the same way as levator ani syndrome is a muscle based disorder. In essence the treatment of both in our protocol is the same.

Because of the lack of communication between different specialties of medicine and training of physicians, muscle based pelvic pain, whether felt in the back or front of the pelvic floor is diagnosed as levator ani syndrome in men and women, prostatitis (in men), pelvic floor dysfunction in men and women, chronic pelvic pain syndrome in men and women, and coccygodynia in men and women, among other diagnostic categories. This has led to much confusion among patients and doctors. Our research is based on our treatment of muscle based pelvic pain conditions regardless of the name of the disorder.

How We Can Help

Our 6-day clinic has been successful in training a large majority of patients to use the Wise-Anderson Protocol to reduce the pelvic floor tenderness by repetitively releasing the spasm, trigger points and restriction in the levator ani muscle and other muscles of the pelvic floor numerous times per week, using the Internal Trigger Point wand that we have developed.

The regular relaxation of the pelvic muscles and the reduction of nervous system arousal using Paradoxical Relaxation is a central part of the treatment that is done in conjunction with training our patients in internal and external physiotherapy self treatment. Training patients in physiotherapy self treatment and pelvic floor relaxation is the central goal of the 6 day clinic. When patients are able to do internal self treatment, they typically become free of the need for further professional help.