Living with Levator Ani Syndrome: A Surprising Barrier to Your Daily Life
Have you ever experienced a nagging, sometimes sharp pain ore pressure deep in your pelvis around your bottom? If that sounds familiar, you might be dealing with Levator Ani Syndrome. What’s surprising is how something that seems so localized can affect your entire daily routine—making simple tasks like sitting feel like major hurdles. As someone who has dedicated my career to pelvic health, holding a Doctor of Physical Therapy degree and dual board certification (WCS and PRPC), I’ve seen firsthand how often people struggle with this syndrome without knowing its name or cause. But there is good news: pelvic physical therapy can offer a path to relief that’s more accessible than most people realize.
Understanding Levator Ani Syndrome
At its core, Levator Ani Syndrome involves chronic or recurring pelvic and rectal pain originating from the levator ani muscles, a group of muscles that make up a crucial part of your pelvic floor. These muscles support pelvic organs, are part of your deep core strength, contribute to bowel and bladder control, and play a role in sexual function. When tension, spasms, or trigger points develop in these muscles, the resulting discomfort can become a constant annoyance—often flaring up when you least expect it.
Above is an illustration of the deep pelvic floor muscles- pubococcygeus, iliococcygeus, and puborectalis muscles-involved in levator ani syndrome.
Common Signs and Symptoms
A persistent ache or pressure type pain in the pelvis, vaginal, or rectal area.
Pain worsen with sitting
Discomfort or a feeling of fullness during or after bowel movements.
Trouble finding a comfortable position when resting or working.
Occasional urinary urgency, frequency, or difficulty starting the urine stream.
Low back or sacroiliac joint (SIJ) pain
Painful sex (vaginismus or dyspareunia)
Lower abdominal or groin pain
Why It’s Often Overlooked
Pelvic pain conditions, such as levator ani syndrome, often mimic other issues like proctalgia fugax or coccydynia. Many people dismiss pelvic pain, hoping it will resolve on its own, and consequently endure symptoms for months or even years before seeking help. Diagnosing pelvic pain can take 3–6 months, during which the body may become increasingly sensitized to pain and remain in muscle-guarding patterns. (1)
Why This Topic Deserves Attention
Ignoring pelvic pain can lead to more significant issues, including heightened muscle tension, emotional distress, and even limit your quality of life by avoiding things you love to do. Chronic pain often disrupts sleep, work, and relationships, which in turn exacerbates the cycle. By recognizing Levator Ani Syndrome early and getting help through things like pelvic physical therapy, you can break this cycle and get back your life.
The Role of Stress and Lifestyle
Stress, whether emotional or physical, can fuel muscle tension in any part of the body, including the pelvis. A study by van der Velde et al. found that involuntary pelvic floor muscle activity occurred in people with and without vaginismus when exposed to threatening situations, suggesting that pelvic floor clenching may be part of a broader defense response. (2) By managing stress and using relaxation techniques for both the body and specifically the pelvic region, you can reduce muscle tension throughout the body and help address levator ani syndrome from a holistic point of view.
Unpacking the Science Behind the Pain
To truly understand how to resolve this, it helps to know a bit about why these muscles spasm or tighten. The levator ani group (which includes the pubococcygeus, iliococcygeus, and puborectalis muscles) can become irritated or overly contracted due to:
Poor Posture: Chronic slouching or leaning forward can place continuous stress on the pelvic floor.
Trauma or Injury: Childbirth, pelvic surgeries, or other injuries can create scar tissue often leading to muscle imbalances.
Bowel Strain: Chronic constipation or straining during bowel movements can create abnormal tension and irritate these muscles.
Emotional Stress: Anxiety or stress can lead to a “clenched” pelvic floor, similar to how you might tense your shoulders under stress.
Prolonged Sitting: Desk jobs or long commutes reduce pelvic floor circulation, leading to stiffness and tension.
Understanding these causes is the first step in addressing Levator Ani Syndrome. From there, a focused, personalized plan specific to what your body and lifestyle need can address the tension in these muscles to allow for long term relief.
From Knowledge to Action: How Pelvic Physical Therapy Helps
Assessment and Personalized Plan
In my practice, the process starts with a comprehensive evaluation. We look at posture, alignment, movement patterns, and specific triggers in your life. We also will perform a pelvic exam—using our hands, no medical instruments —to assess muscle tone and coordination, identify spasms, and locate tender areas. By combining these findings with your medical history and social history, I can customize a therapy program that addresses not just the pain but also its underlying causes.
Hands-On Techniques
A significant part of pelvic physical therapy involves manual therapy:
Myofascial Release: Gentle soft tissue techniques to release any restrictions, knots, or trigger points in the muscles.
Internal and External Muscle Manipulation: Focused manual therapy to the pelvic floor to lengthen and relax the levator ani and surrounding structures. This is also a great way to train proper coordination in the muscles for relaxation.
Soft Tissue Mobilization: Massage-like techniques to improve blood flow, increase flexibility, and restore tissue elasticity to help you move more easily.
Specific Guided Exercises
Many clients are surprised that “exercises” in pelvic PT often revolve around relaxation and coordination rather than kegel focused workouts. Once we’ve addressed the tension, we might integrate:
Diaphragmatic Breathing: Encouraging the diaphragm to move freely helps coordinate pelvic floor relaxation.
Pelvic Drops or “Reverse Kegels”: Instead of tightening, these exercises focus on letting go of tension.
Stretching Exercises: Special stretches for the hips, lower back, and thighs to reduce strain on the pelvic muscles.
Stabilization and Strengthening Exercises: Training muscle groups like the gluteals or abdominals to better support the pelvis and allow the pelvic floor muscles to relax.
Postural Exercises: Improving your posture (i.e. getting your rib cage and pelvis to get “stacked) can help put your pelvic floor muscles at a better advantage of relaxing on its own.
This illustration shows how the diaphragm and pelvic floor work together for breathing, and how posture also plays an important role.
Education on Lifestyle Modifications
Pelvic PT is not just about what happens in the clinic. We prioritize lifestyle guidance:
Ergonomics: Adjusting your workspace set up to reduce continuous pressure on the pelvis.
Bowel and Bladder Habits: Strategies to avoid straining, including proper toileting posture and hydration.
Stress Management: Techniques like mindfulness, relaxation exercises, or even short walking breaks during the day to reduce overall muscle tension.
True Stories, Real Outcomes
Over the years, I’ve witnessed remarkable transformations. One patient came to our clinic after enduring pelvic pain for nearly a decade. Despite trying multiple interventions, nothing brought lasting relief. Through a carefully designed pelvic therapy regimen—combining hands-on treatment, lifestyle changes, and follow-up sessions—her discomfort gradually subsided. She now enjoys activities that once seemed impossible, from cycling to long road trips, all without chronic pain overshadowing her life.
What You Can Do Today
Listen to Your Body: If you notice persistent pain or discomfort, don’t brush it off as “normal.”
Seek a Specialist’s Opinion: Early consultation with a pelvic floor therapist can often prevent long-term issues.
Assess Your Daily Routine: Consider simple changes—like standing breaks at work or adding short walks.
Relaxation Practice: Whether it’s deep breathing or gentle yoga, consistent daily mindfulness and relaxation strategies can help keep tension at bay and prevent it from coming on in the future.
Stay Informed: Keep learning about pelvic health to make informed decisions about your healthcare.
Looking to the Future with Confidence
Many people find it hard to imagine a life without pelvic pain once Levator Ani Syndrome becomes part of their daily reality. However, modern pelvic physical therapy offers a proven roadmap to improved function and comfort. By addressing both the physical and lifestyle contributors to muscle tension, you can break the pain cycle—often without needing invasive procedures or long-term medications.
If you’re feeling unsure or overwhelmed, remember that you’re not alone. The body has an incredible capacity for healing, especially when guided by proper expertise and a willingness to make small but meaningful changes.
Taking the Next Step
Ready to reclaim a pain-free, active life? Our clinic stands at the forefront of pelvic floor rehabilitation, and we’re here to help. Whether you’ve just begun experiencing symptoms or have been managing them for years, pelvic physical therapy can make a significant difference. Reach out to schedule an evaluation and start your journey toward a more comfortable, fulfilling lifestyle.
Contact Us: Book an appointment or ask questions about your specific situation.
Share Your Story: Leave a comment or send a message if you’ve faced similar challenges—every voice matters and might help someone else feel less alone.
Explore Our Resources: Check out our other blog posts to learn more about pelvic health, posture tips, and at-home exercises.
Remember: You deserve to live free from the limitations of chronic pelvic pain. Levator Ani Syndrome can be managed effectively, and pelvic physical therapy is a practical, accessible way to start regaining control over your health.
Written By,
Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health
Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.
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References:
Dydyk AM, Gupta N. Chronic Pelvic Pain. 2023 Apr 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32119472.
van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(5):328-31. doi: 10.1007/s001920170035. PMID: 11716000.
