Levator Ani Syndrome and Proctalgia Fugax: What They Are and How Pelvic Floor Therapy Can Help
Pelvic pain can be distressing, unpredictable, and deeply frustrating. Two lesser-known but surprisingly common causes of rectal and pelvic pain are Levator Ani Syndrome (LAS) and Proctalgia Fugax (PF). Though they present differently, both involve dysfunction of the pelvic floor muscles and can significantly affect quality of life. Let's break down their origins, anatomy, and most importantly—how pelvic floor physical therapy offers real relief.
Understanding the Basics
Levator Ani Syndrome (LAS):
Levator Ani Syndrome is characterized by chronic or recurrent dull, aching pain or pressure in the rectum or perineum, often worsened by sitting or after bowel movements. The pain usually lasts 20 minutes or longer, and is frequently described as deep, internal, and persistent.
Proctalgia Fugax (PF):
Proctalgia Fugax, by contrast, causes brief, sharp, cramp-like episodes of pain in the rectum, typically lasting seconds to minutes. It often occurs at night and can wake people from sleep.
While LAS is more chronic and constant, PF is episodic and fleeting. However, both are rooted in dysfunction of the levator ani muscle group.
The Anatomy: Who’s Involved?
Levator Ani Muscle Group
The levator ani is a group of muscles forming the bulk of the pelvic floor, including:
Pubococcygeus
Puborectalis
Iliococcygeus
These muscles sling around the rectum, urethra, and (in females) the vagina, providing support to the pelvic organs and playing key roles in continence and sexual function.
Associated Structures
Coccygeus muscle: Often involved in tailbone-related pelvic pain.
External anal sphincter: May contract involuntarily or remain overactive in these syndromes.
Pelvic fascia: Surrounds and supports these muscles. Fascial restrictions can tether structures and create abnormal tension and pain.
What Causes LAS and PF?
These conditions are considered functional disorders—meaning there's no visible lesion or pathology, but the muscles and nerves aren't working in harmony. Some contributing factors include:
Chronic holding or clenching of pelvic floor muscles
Pelvic trauma or injury (childbirth, falls, surgery)
Fascial restrictions or scar tissue
Nerve irritation or hypersensitivity (pudendal nerve, inferior rectal branch)
Stress and autonomic nervous system dysregulation
Poor posture and core instability
Over time, this can lead to myofascial trigger points, muscle shortening, and loss of coordination. In LAS, this is often a slow, chronic buildup. In PF, it may be a sudden spasm triggered by stress, bowel movements, or even sitting.
The Role of Fascia and Structural Dysfunction
Fascia—the web-like connective tissue surrounding all muscles and organs—plays a major role in pelvic floor dysfunction. When fascia becomes tight, thickened, or adhered, it can alter the tension and glide of the muscles it encases.
In levator ani syndrome, fascial restrictions may:
Prevent normal muscle lengthening
Limit pelvic organ mobility
Contribute to asymmetric pelvic tension
Entrap nerves (such as the pudendal or sacral nerves)
This leads to a loop of pain, guarding, and dysfunction. The postural and fascial connections between the pelvis, spine, coccyx, and diaphragm are particularly important—dysfunction in one area can cascade into the next.
How Pelvic Floor Therapy Can Help
Pelvic floor physical therapy is the cornerstone of treatment for both LAS and PF. Since these are muscular and fascial disorders at their core, they respond best to hands-on, functional treatment. Here's what therapy may include:
✅ Myofascial Release
Therapists use gentle, targeted techniques to release trigger points in the levator ani, obturator internus, coccygeus, and surrounding fascia. Internal and external approaches may be used.
✅ Biofeedback
This technique helps patients become aware of and retrain how their pelvic floor muscles contract and relax, improving coordination and reducing overactivity.
✅ Manual Therapy for Coccyx and SI Joint
Since the levator ani attaches to the coccyx, tailbone mobility is essential. Therapists may perform coccyx mobilization to relieve tension or misalignment.
✅ Fascial Counterstrain
This technique targets strain in specific fascial chains and neurological reflex points, helping to calm the nervous system and reduce guarding and pain.
✅ Neuromuscular Re-education
Patients are retrained to properly recruit their pelvic floor, deep core, and breathing muscles. This corrects compensations and restores natural reflexes.
✅ Postural Correction and Diaphragmatic Breathing
Breathing and posture play a direct role in pelvic muscle tension. Therapy often includes core strengthening, spinal alignment, and rib cage mobility to support better pelvic mechanics.
✅ Trigger Point Dry Needling or Electrical Stimulation
In some cases, these adjunct therapies may be used to break up spasm and reset the muscle tone, especially in chronic LAS.
At-Home Strategies to Support Recovery
Warm baths or heating pads to reduce muscle spasm
Pelvic floor drop techniques (not Kegels!)
Avoid prolonged sitting—use cushions or alternate with standing
Stress management (yoga, mindfulness, gentle movement)
Consistent bowel habits—avoid straining, use a squatty potty
Final Thoughts
Levator Ani Syndrome and Proctalgia Fugax can feel mysterious and frustrating—but you’re not alone, and these conditions are highly treatable with the right care. Pelvic floor physical therapy addresses the muscular, fascial, structural, and neurological components behind the pain, offering a holistic and effective path forward.
If you’ve been struggling with deep rectal pain, pelvic aching, or sudden spasms, consider consulting a pelvic floor therapist. Relief is possible—and healing starts with understanding. Looking to optimize your well being with pelvic floor physical therapy? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.