Merck Manual

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Levator Syndrome


Parswa Ansari

, MD, Hofstra Northwell-Lenox Hill Hospital, New York

Reviewed/Revised Jan 2023

Levator syndrome is episodic rectal pain caused by spasm of the levator ani muscle. Diagnosis is clinical. Treatment includes analgesics and sitz baths and sometimes physical therapy.

Proctalgia fugax (fleeting pain in the rectum) and coccydynia (pain in the coccygeal region) are variants of levator syndrome.

Symptoms and Signs of Levator Syndrome

Rectal spasm causes pain, typically unrelated to defecation, usually lasting < 20 minutes. The pain may be brief and intense or a vague ache high in the rectum. It may occur spontaneously or with sitting and can waken the patient from sleep. The pain may feel as if it would be relieved by the passage of gas or a bowel movement.

In severe cases, the pain can persist for many hours and recur frequently.

The patient may have undergone various rectal operations for these symptoms, with no benefit.

Diagnosis of Levator Syndrome

Treatment of Levator Syndrome

  • Analgesics, sitz baths

  • Sometimes electrogalvanic stimulation

Treatment of levator syndrome consists of explanations to the patient of the benign nature of the condition.

An acute episode may be relieved by the passage of gas or a bowel movement, by a sitz bath, or by a mild analgesic. When the symptoms are more intense, physical therapy may be effective.

Skeletal muscle relaxants or anal sphincter massage under local or regional anesthesia can be tried, but the benefit is unclear.

NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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