Treating Levator Ani Syndrome with Pelvic Floor Physical Therapy

By Dr. Zarina Vitebsky, DPT, MSPT, PRPC, TPS, LPF, DN on 10/27/2023

Overview

Explanation of Levator Ani Syndrome (LAS)

Levator Ani Syndrome (LAS) is a condition that affects the pelvic floor muscles, specifically the levator ani muscle. This muscle is responsible for supporting the pelvic organs and controlling bowel movements. When the levator ani muscle becomes tight or spasms, it can cause a range of symptoms and discomfort.

Prevalence and symptoms

LAS is a relatively common condition, with an estimated 7-15% of the population experiencing symptoms at some point in their lives. It is more common in women than men, and tends to occur in individuals between the ages of 30-60 years old.

The most common symptoms of LAS include pelvic pain, discomfort or pressure in the rectum, and difficulty with bowel movements. Some individuals may also experience urinary symptoms, such as urgency or frequency.

Importance of treatment

While LAS is not a life-threatening condition, it can significantly impact an individual's quality of life. The symptoms can be debilitating and affect daily activities, such as work, exercise, and social interactions. Seeking treatment for LAS is important to alleviate symptoms and improve overall well-being.

Additionally, if left untreated, LAS can lead to other complications such as pelvic floor dysfunction and chronic pelvic pain. It is essential to address the root cause of the symptoms and prevent further issues from arising.

Introduction to pelvic floor physical therapy (PFPT)

Pelvic floor physical therapy (PFPT) is a specialized form of physical therapy that focuses on the muscles, ligaments, and connective tissues of the pelvic floor. It is a non-invasive and conservative treatment approach that aims to improve the function and strength of the pelvic floor muscles.

PFPT can be an effective treatment option for LAS as it targets the underlying cause of the symptoms. It involves a combination of manual techniques, exercises, and education to help relax and strengthen the pelvic floor muscles, alleviate pain and discomfort, and improve bowel and bladder function.

Understanding the Pelvic Floor

Anatomy of the Pelvic Floor Muscles

The pelvic floor is a group of muscles that form a sling-like structure at the bottom of the pelvis. These muscles include the levator ani, coccygeus, and other smaller muscles. The levator ani muscles are further divided into the puborectalis, pubococcygeus, and iliococcygeus muscles. These muscles are responsible for supporting the pelvic organs, controlling bowel and bladder function, and maintaining sexual function.

Functions of the Pelvic Floor

The pelvic floor muscles have several important functions in the body. They provide support for the pelvic organs, including the bladder, uterus, and rectum. They also play a role in controlling bowel and bladder function, as well as sexual function. Additionally, these muscles help to stabilize the pelvis and support the spine.

Role of the Levator Ani Muscles in LAS

Levator ani syndrome (LAS) is a condition that occurs when the levator ani muscles become tight or spasmed, causing pain and discomfort in the pelvic region. These muscles are responsible for supporting the pelvic organs and controlling bowel and bladder function, so when they are not functioning properly, it can lead to symptoms of LAS.

How PFPT Can Target the Pelvic Floor Muscles

Pelvic floor physical therapy (PFPT) is a specialized form of physical therapy that focuses on the muscles of the pelvic floor. Through a combination of exercises, manual therapy, and education, PFPT can help to target and treat the levator ani muscles in LAS. This may include techniques such as pelvic floor relaxation exercises, trigger point release, and biofeedback to help improve muscle function and reduce pain and discomfort in the pelvic region.

Assessment and Evaluation

Initial consultation with a PFPT specialist

The first step in treating levator ani syndrome with pelvic floor physical therapy (PFPT) is to schedule an initial consultation with a specialist. This may be a physical therapist who specializes in pelvic floor dysfunction or a doctor who has experience in treating this condition. During this consultation, the specialist will gather information about your symptoms, medical history, and any previous treatments you have tried. This will help them develop a personalized treatment plan for you.

Physical examination and medical history review

After the initial consultation, the specialist will conduct a physical examination and review your medical history. This may include a pelvic exam to assess the strength and tone of your pelvic floor muscles. They may also perform a digital rectal exam to check for any abnormalities in the levator ani muscle. Additionally, they will review your medical history to identify any underlying conditions that may be contributing to your symptoms.

Assessment of pelvic floor muscle strength and tone

One of the key components of PFPT for levator ani syndrome is assessing the strength and tone of the pelvic floor muscles. This is typically done through a combination of manual muscle testing and biofeedback. The specialist will use their hands to assess the strength and coordination of your pelvic floor muscles, and may also use a device to measure muscle activity and provide visual feedback.

Identification of trigger points and areas of tension

Another important aspect of PFPT for levator ani syndrome is identifying trigger points and areas of tension in the pelvic floor muscles. These are areas of muscle tightness or spasm that can contribute to pain and discomfort. The specialist will use their hands to locate these trigger points and may also use techniques such as myofascial release or trigger point release to help relax and release tension in the muscles.

Treatment Techniques

Relaxation Exercises for the Pelvic Floor Muscles

Pelvic floor physical therapy for levator ani syndrome often involves relaxation exercises to help release tension in the pelvic floor muscles. These exercises may include diaphragmatic breathing, progressive muscle relaxation, and visualization techniques. The goal is to teach patients how to consciously relax their pelvic floor muscles, which can help reduce pain and discomfort.

Manual Therapy Techniques to Release Tension and Trigger Points

Manual therapy techniques, such as myofascial release and trigger point therapy, can be used to release tension and tightness in the pelvic floor muscles. This involves applying pressure to specific points in the muscles to help them relax and improve blood flow. These techniques can also help reduce pain and improve overall muscle function.

Biofeedback Training to Improve Muscle Control and Coordination

Biofeedback is a technique that uses sensors to measure muscle activity and provide visual or auditory feedback to the patient. In pelvic floor physical therapy, biofeedback can be used to help patients learn how to control and coordinate their pelvic floor muscles. This can be especially helpful for those with levator ani syndrome, as it can improve muscle function and reduce symptoms.

Electrical Stimulation to Strengthen Weak Muscles

In some cases, pelvic floor physical therapy may include the use of electrical stimulation to strengthen weak pelvic floor muscles. This involves using a small electrical current to stimulate the muscles, which can help improve muscle tone and function. This can be particularly beneficial for those with levator ani syndrome, as weak muscles can contribute to symptoms such as pelvic pain and incontinence.

Stretching and Strengthening Exercises for the Pelvic Floor Muscles

Finally, pelvic floor physical therapy for levator ani syndrome may also include specific stretching and strengthening exercises for the pelvic floor muscles. These exercises can help improve muscle flexibility, strength, and endurance, which can in turn reduce symptoms and improve overall pelvic floor function. Your physical therapist will work with you to develop an individualized exercise plan based on your specific needs and goals.

Lifestyle Modifications

Importance of Proper Posture and Body Mechanics

One of the key components of pelvic floor physical therapy for levator ani syndrome is addressing posture and body mechanics. Poor posture and improper body mechanics can put unnecessary strain on the pelvic floor muscles, leading to increased tension and pain. Physical therapists can work with patients to identify and correct any postural imbalances or habits that may be contributing to their symptoms. This may include exercises to strengthen the core and improve overall body alignment.

Dietary Changes to Reduce Inflammation and Improve Bowel Movements

Inflammation in the pelvic region can exacerbate symptoms of levator ani syndrome. Therefore, making dietary changes to reduce inflammation can be an effective treatment approach. This may include avoiding trigger foods, such as caffeine and spicy foods, and incorporating anti-inflammatory foods, such as leafy greens and fatty fish, into the diet. Additionally, physical therapists may recommend increasing fiber intake and staying hydrated to improve bowel movements and reduce strain on the pelvic floor muscles.

Bladder and Bowel Retraining Techniques

Bladder and bowel dysfunction are common symptoms of levator ani syndrome. Physical therapists can teach patients techniques to retrain their bladder and bowel habits, such as scheduled voiding and relaxation techniques. This can help reduce urgency and frequency of urination and bowel movements, as well as decrease strain on the pelvic floor muscles.

Stress Management Techniques to Reduce Tension in the Pelvic Floor Muscles

Stress and tension can contribute to the development and exacerbation of levator ani syndrome. Therefore, incorporating stress management techniques into treatment can be beneficial. This may include deep breathing exercises, mindfulness techniques, and relaxation techniques, such as progressive muscle relaxation. By reducing overall stress and tension in the body, patients may experience a decrease in pelvic floor muscle tension and pain.

Maintenance and Follow-Up

Importance of consistency in PFPT treatment

Consistency is key in any form of physical therapy, and this is especially true for pelvic floor physical therapy (PFPT) in treating levator ani syndrome (LAS). The pelvic floor muscles are like any other muscle in the body and require regular exercise and training to maintain strength and function. Skipping appointments or not following through with home exercises can hinder progress and prolong the treatment process.

Home exercises and self-care techniques

Along with attending regular PFPT sessions, it is important for patients to also incorporate home exercises and self-care techniques into their treatment plan. These exercises and techniques are specifically tailored to the individual's needs and can help improve muscle strength, flexibility, and overall function of the pelvic floor muscles. They also provide patients with a sense of control and empowerment in managing their condition.

Monitoring progress and making adjustments to treatment plan

During follow-up appointments, the therapist will assess the patient's progress and make any necessary adjustments to the treatment plan. This may include modifying exercises, increasing or decreasing the frequency of appointments, or incorporating new techniques. It is important for patients to communicate any changes or concerns they may have so that the therapist can make appropriate adjustments.

Long-term management of LAS with PFPT

While PFPT can effectively treat LAS, it is important for patients to continue with maintenance exercises and follow-up appointments even after symptoms have improved. This will help prevent future flare-ups and maintain the strength and function of the pelvic floor muscles. The therapist may also provide tips and strategies for managing symptoms in daily life, such as proper posture and relaxation techniques.

If you are experiencing LAS or pelvic floor dysfunctions associated with LAS, please 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.

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