Levator ani syndrome (LAS) is a musculoskeletal pain syndrome involving the pelvic floor, thought to be caused by spasm or scarring of the levator ani muscles.
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Clinical presentation
Levator ani syndrome is characterized by recurrent pain, pressure or discomfort in the region of the rectum, sacrum, and coccyx. The pain typically gets worse on sitting and resolves by standing or lying down.
The symptoms of levator ani syndrome also may worsen following:
- trauma
- stress
- long distance travels
- parturition
- surgical procedures (e.g. low anterior resection, hysterectomy)
- sexual intercourse
- defecation
Pathology
The exact cause of levator ani syndrome is unknown.
Practical points
The diagnosis is suggested mainly by the history, clinical examination, and the exclusion of other disorders that can produce recurrent or chronic proctalgia.
The diagnosis of levator ani syndrome is considered ‘highly likely’ if symptom criteria are satisfied and traction on the puborectalis muscle reveals tight levator ani muscles with focal tenderness or pain.
The diagnosis is ‘possible’ if symptoms occur in the absence of physical findings.
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