Levator ani syndrome: causes, symptoms, treatments

If you often feel a deep, aching discomfort in your pelvic area — especially when sitting — you may have levator ani syndrome, a condition linked to tension in your pelvic floor muscles.

“Patients often describe it like sitting on a golf ball or having heavy pressure in their pelvis,” says Holly Tipp, PT, DPT, a physical therapist at Hinge Health. “It’s a type of pelvic floor muscle spasm.”

While levator ani syndrome can be uncomfortable and frustrating, there are effective ways to manage it. “We typically recommend a mix of targeted exercises, movement-based strategies, and pelvic floor physical therapy,” says Dr. Tipp.

Here’s what to know about levator ani syndrome — including what it is, what causes it, and how to find relief, especially with targeted exercises recommended by Hinge Health pelvic health physical therapists.

What is levator ani syndrome?

Levator ani syndrome (also called pelvic myalgia) is a type of pelvic floor dysfunction that causes a dull ache or pressure deep in the pelvis or rectal area.

The levator ani is a group of muscles that form the base of your pelvic floor. These muscles support the organs in your pelvis and help you control your bladder and bowels. But like any muscle in the body, they can become tight or overactive, which in turn can lead to pain.

“There isn’t a single test for levator ani syndrome, which means it can sometimes be overlooked or misdiagnosed,” says Dr. Tipp.

Symptoms of levator ani syndrome

If you have levator ani syndrome, “you may feel like you have a ball or object deep within your pelvis,” says Dr. Tipp. Other symptoms include:

• Dull, aching pain in the pelvis, rectum, or anus

• Discomfort that comes and goes

• Pain that worsens with sitting and improves with standing or walking

• A feeling of incomplete bowel movements

• Pain during intimacy 

What is the difference between levator ani syndrome and proctalgia fugax? 

Levator ani syndrome is not the same as proctalgia fugax, which is another condition that causes rectal pain. “Proctalgia fugax is a brief, intense spasm around your anus that lasts seconds to minutes,” explains Dr. Tipp. “Levator ani syndrome tends to cause more ongoing discomfort, for 20 minutes or more at a time. The pain can happen when pressure is put on those muscles — such as during intimacy, bowel movements, or sitting.”

Causes of levator ani syndrome

Levator ani syndrome is rarely caused by one thing — several factors can contribute to this type of pelvic floor muscle tension, explains Dr. Tipp. Common causes include: 

• Overactive pelvic floor muscles. Also known as a hypertonic pelvic floor, this means the muscles are staying more tense than they should be. When they don’t fully relax, they can become irritated and painful over time — especially with activities like sitting or having a bowel movement.

• Stress and anxiety. Stress and anxiety — whether short-term, occasional, or a diagnosed anxiety disorder — can affect the connection between your body and mind. When you’re feeling anxious or under pressure, changes in your nervous system can trigger muscle contractions, even in your pelvic floor. 

• Previous pelvic trauma or injury. People who have experienced trauma or injury to the pelvic area may be more likely to experience pelvic floor dysfunction. "Childbirth — especially complicated births involving forceps, vacuum extraction, or prolonged pushing — can contribute to changes in the pelvic floor that may lead to levator ani syndrome," explains Dr. Tipp. An episiotomy (a cut between the vaginal opening and anus to make room during delivery) is another example. Falls that bruise your tailbone can also contribute to symptoms.

• Constipation. Frequent straining during bowel movements can irritate the pelvic floor muscles and lead to tension in this area, Dr. Tipp says.

• Prolonged sitting. When you sit, the surface puts pressure on your pelvic floor muscles, which can contribute to levator ani syndrome," says Dr. Tipp. "This pressure can increase depending on your sitting position."

How movement can help levator ani syndrome

If sitting or certain movements trigger pain for you, it’s understandable why you may want to avoid physical activity. But movement is medicine: gentle exercise can help ease muscle tension all across your body.

“Movement helps increase blood flow to the area and encourages tight muscles to relax,” says Dr. Tipp. Activities like walking, gentle stretching, and breathing exercises can also help calm your nervous system, which plays a role in muscle tension and pain perception. Movement also helps release feel-good hormones such as endorphins, which can help ease pain, Dr. Tipp says. 

Consider starting with gentle movement. Over time, you can gradually build up your activity level. The goal is to find your movement sweet spot — the level of activity that challenges your body without overdoing it or increasing pain.

These exercises help reduce tension in your pelvic floor and surrounding muscles. Breathing and relaxation-based movements are especially important, as they help your muscles release rather than staying stuck in a tight state. Seated glute stretch, seated back bend, and cat cow loosen up other muscles to take pressure off your levator ani muscles. Adding reverse Kegels into the mix can help prevent straining during a bowel movement, which can prevent even more tension from building up. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for levator ani syndrome

Levator ani syndrome is a chronic condition, so treatment focuses on pelvic floor relaxation and improving how the surrounding muscles work together. Strategies such as pelvic floor physical therapy and making simple lifestyle changes can help you feel more comfortable. Here’s what Hinge Health physical therapists recommend:

• Try physical therapy and targeted exercises. Targeted exercises, such as the ones above, can help release tension from your pelvic floor and other nearby supporting muscles. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a pelvic floor physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Gentle walking and pelvic floor exercises can help reduce overall tension by promoting blood flow to tense areas. Regular exercise helps get things moving, which can help address constipation.  

• Practice stress management and relaxation. Since stress contributes to pelvic floor tension (and full-body muscle tension), relaxation techniques like deep breathing, meditation, or progressive muscle relaxation (where you tense and then relax muscle groups one at a time) can help reduce muscle tightness. “This can improve your pelvic floor muscles’ range of motion, including your levator ani, and reduce pain,” says Dr. Tipp. 

• Take over-the-counter (OTC) medication as needed. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have pelvic floor pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Increase your dietary fiber and water intake. Try to consume 20-35 grams of fiber a day and drink plenty of water to keep bowel movements healthy and easy to pass. Drinking mineral water enhanced with magnesium may help give your bowels a extra boost. 

• Modify sitting habits. Before sitting down, gently adjust your position to reduce pressure on your pelvic floor. “This can help stretch the levator ani muscles and make sitting more comfortable,” explains Dr. Tipp.

• Apply heat therapy. Heat, either from a warm bath or a heating pad applied around the pelvic area, can help increase blood flow and relax tense muscles.

Tips to manage levator ani syndrome

You don’t just have to deal with discomfort from levator ani syndrome. Small, day-to-day adjustments — like how you sit, sleep, and move — can all help improve your comfort. Consider these pain management tips:

• Tweak your bedtime routine. Try a gentle yoga pose, such as happy baby or child’s pose, before bed, says Dr. Tipp. This can help relax both your body and your pelvic floor muscles. There’s no single “best” sleep position for pelvic pain, but if you’re uncomfortable, lying on your side with one or both knees bent may feel better.

• Sit more comfortably. If sitting is painful, try rolling up a towel and sitting on it. “It’s like building a little nest, so the sore area of your tailbone isn’t in contact with anything,” says Dr. Tipp. It also helps to avoid sitting for long periods — aim to stand up, walk around, or stretch every 30 minutes.

• Track your triggers. Keeping a symptom diary can help you spot patterns. “People often notice symptoms flare when they’re under more stress,” says Dr. Tipp. Once you identify these triggers, you can take steps to manage them — for example, practicing diaphragmatic breathing to reduce tension. “It helps release pelvic floor tension in real time,” Dr. Tipp says.

• Use a stool during bowel movements. Placing a small stool under your feet when you have a bowel movement can help reduce strain and make it easier to go, says Dr. Tipp.

Does levator ani syndrome go away?

Levator ani syndrome is considered a chronic condition, which means it may not go away completely. But with the right strategies, many people are able to manage symptoms effectively and feel much better over time.

“With the appropriate treatments — especially pelvic floor physical therapy — most people see significant improvement,” says Dr. Tipp. “The goal is to go longer and longer between flare-ups, or have less intense ones.”

You may still have occasional discomfort, but having tools and strategies in place can help you manage symptoms when they arise. “If you find tools or techniques that help, like a pelvic wand, it’s worth keeping them as part of your routine,” adds Dr. Tipp.

When to see a doctor

Levator ani syndrome often improves with pelvic floor physical therapy and self-management strategies. But if your pelvic or rectal pain is severe, getting worse, causing significant difficulty with daily activities or not improving after several weeks of conservative treatment, see a healthcare provider. 

You should also let your doctor know right away if you have: 

• Blood in stool or rectal bleeding

• Fever or signs of infection

• Unexplained weight loss

• New or sudden onset of severe symptoms

Your provider can examine you and make sure pain isn’t due to a cause that might require medical intervention, such as treatment for an infection. They can also prescribe certain medications, such as vaginal anti-anxiety suppositories, which can help your pelvic floor muscles relax.

PT tip: Use your breath to release tension

Incorporating diaphragmatic breathing into your daily routine and breathing through gentle pelvic floor stretches throughout the day can help reduce muscle tension and improve your comfort. “These breathing exercises can support your mental health and relax your pelvic floor,” says Dr. Tipp.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Gowda, S. N., & Bordoni, B. (2021). Anatomy, Abdomen and Pelvis, Levator Ani Muscle. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556078/

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