A Real Pain in the Butt: Levator Ani Syndrome

Struggling with pain in your butt—literally? Unfortunately, pelvic floor pain is a daily, frustrating struggle for many. This pain can often go untreated for too long. Levator ani syndrome is a specific type of pelvic floor condition that most commonly presents as pain along the back end of the pelvic floor, around the rectum. Thankfully, with tailored treatment, people suffering from this pain can finally find relief. Learn more about a real pain in the butt: Levator Ani Syndrome here.

The levator ani muscle group consists of three sections. Together, the muscles form a funnel-looking sheet that attaches to structures of the pelvic floor, including the rectum, coccyx, and sex organs.

When broken down to its Latin roots, levator ani simply means “lift” and “anus.” These muscles keep the pelvic floor organs supported and contained within the pelvic floor. The muscles also assist with sexual, rectal, and urinary function.

The term levator ani syndrome has been used since the 1800s, but throughout this time, there has been confusion over what makes this condition different from other pelvic floor conditions. Medical specialists have used different terms to describe the same issue, as well as the same term to describe different pelvic floor conditions.

So what makes a diagnosis of levator ani syndrome unique? The hallmark of levator ani syndrome is that tender points of the levator ani muscles are the exclusive source of the familiar pain. This must mean that no other pathologies of the pelvic floor (e.g., piriformis syndrome, prostate inflammation, UTI, organ prolapse) recreate the familiar pain. If the familiar pain can not be reproduced by pressing along the levator ani muscle fibers, then levator ani syndrome may not be the underlying issue. Someone may have multiple pelvic floor conditions at once, but those other issues wouldn’t be the cause of the specific pain that originates from the levator ani muscles.

Levator ani syndrome pain is usually localized exclusively around the rectum. The levator ani muscles rarely have referral pain patterns that extend beyond the rectal region.

This pain can feel like a dull ache, rectal pressure, and/or burning. The pain tends to last for 30 minutes or more, and those struggling with levator ani syndrome often have been dealing with this over a chronic period. In contrast, proctalgia fugax, a condition closely related to levator ani syndrome, only lasts seconds to minutes.

Levator ani syndrome pain is most commonly worsened with sitting and relieved with standing or lying down. Some people have described the pain as feeling like they are sitting on a golf ball. Symptoms can also worsen with sexual activity, bowel movements, and stress.

The originating cause of levator ani syndrome is not well established, but factors related to its onset include tendon irritation, long periods of sitting, stress, sexual intercourse, bowel movements, childbirth, and surgical procedures.

Stress, in particular, is widely discussed as a major factor associated with levator ani syndrome.

Chronic stress, anxiety, and nervousness are often associated with chronic muscle tension and dysfunction. This is especially true with jaw muscles and pelvic floor muscles. Whole-body nervous system tension can heavily influence the levator ani muscle group and can keep these muscles tight for no good reason.

Thankfully, levator ani syndrome is not a life-threatening illness, which is a relief to hear for the many people who struggle with this issue for years with no answers. This pain can be relieved with a well-rounded treatment plan. Physical therapists, particularly those who have gone through special training to treat pelvic floor conditions, are essential providers in caring for levator ani syndrome.

Treatment for levator ani syndrome focuses on eliminating the taut bands in the levator ani muscle group and then reteaching the muscles how to properly activate and relax.

–         Trigger point release (through massage, dry needling, and/or trigger point injections)

–         Warm baths

–         Muscle relaxants

–         Biofeedback exercises to learn how to use and relax the muscles

Reducing stress can significantly improve levator ani syndrome, yet providers often overlook this treatment strategy. Learning how to relax the nervous system from a full-body standpoint and finding healthy ways to cope with stress can make a significant difference in levator ani syndrome treatment. This often requires seeing a psychotherapist or behavioral therapist as well to learn unique stress-relieving tools.

With focused treatment, those struggling with levator ani syndrome can finally have relief and take a sitting break with no pain. Talk to your physical therapist today if you think you may be struggling with levator ani syndrome.

Resources

Bharucha AE, Lee TH. Anorectal and Pelvic Pain. Mayo Clinic Proceedings. 2016;91(10):1471-1486. doi:https://doi.org/10.1016/j.mayocp.2016.08.011

Levator Ani Syndrome Treatment | Trigger Point Therapy. Pelvic Pain Help. Published February 23, 2015. Accessed May 17, 2026. https://pelvicpainhelp.com/levator-ani-syndrome-spasm-2/