Pelvic Floor Condition
Levator Ani Syndrome
By Dr. Anthony J. Gordon, Doctor of Acupuncture | Last reviewed September 2026
There is a dull ache or pressure high in your rectum, like sitting on a ball, that builds through the day and gets worse when you sit. Colonoscopy was normal. Hemorrhoid treatment did not help. Levator ani syndrome is pain from spasm and tension in the main muscle of the pelvic floor, and it responds well to direct treatment of that muscle.
Prefer to talk it through? Call (516) 597-5400. Most new patients are seen within one to two weeks.
Overview
Understanding Levator Ani Syndrome
The levator ani is the largest muscle group of the pelvic floor. It forms a sling from the pubic bone to the tailbone and supports the rectum, bladder and reproductive organs. Levator ani syndrome is chronic or recurring rectal pain caused by tension, spasm and trigger points in this muscle.
The pain is typically a dull ache or pressure high in the rectum, lasting 30 minutes or more and often much longer. It is usually worse with sitting and may ease when standing or lying down. It is different from proctalgia fugax, which causes brief, sharp episodes. Stress, prolonged sitting, straining, childbirth, pelvic surgery and trauma to the tailbone are common contributors.
A colorectal specialist or gastroenterologist should rule out hemorrhoids, fissures, abscess, inflammatory bowel disease and other causes. When those are clear, the levator ani is the target, and intrapelvic dry needling is one of the most direct ways to release it.
Levator Ani Syndrome at a Glance
Also called
Levator syndrome, chronic proctalgia, puborectalis syndrome
Where it is felt
High in the rectum, sometimes spreading to the tailbone, vagina, perineum or buttocks
Typical pattern
Dull ache or pressure lasting 30 minutes or more, worse with sitting
Typical workup results
Normal colonoscopy and anal exam, little relief from hemorrhoid treatment
Main drivers
Levator ani spasm and trigger points, sitting load, straining, stress
The Gap in Care
What Tests Check, and What They Can Miss
Colorectal evaluation is essential to rule out disease. When it is clear, the pain is usually muscular, and the levator ani is rarely examined directly.
What routine testing is looking for
- Hemorrhoids or anal fissures
- Abscess or fistula
- Inflammatory bowel disease
- Colon or rectal disease on colonoscopy
What often keeps symptoms going
- Spasm and trigger points in the levator ani
- Tension in the coccygeus and obturator internus
- Straining habits that load the pelvic floor
- Tailbone position and sitting pressure
- Stress-related pelvic floor tension
The levator ani is assessed by direct palpation.
Signs & Symptoms
Does This Sound Like You?
Symptoms vary from person to person. These are the patterns Dr. Gordon sees most often.
Dull rectal ache or pressure
A deep, heavy ache high in the rectum, often described as sitting on a ball.
Worse with sitting
Pain builds in a chair or car and eases when you stand or lie down.
Long-lasting episodes
Pain lasting 30 minutes, hours or all day.
Feeling of incomplete emptying
Sensing stool is still present after a bowel movement.
Tailbone or buttock pain
Pain spreading to the tailbone, low back or buttocks.
Pain with sex or bowel movements
Discomfort during intercourse or after bowel movements.
Root Causes
The Four Drivers Dr. Gordon Looks For
Most people have more than one of these in play. Finding which one leads makes treatment more efficient.
Levator ani spasm and trigger points
Tension in the levator ani produces the characteristic deep rectal ache and pressure.
Neighboring pelvic muscles
The coccygeus and obturator internus often tighten alongside the levator ani and add tailbone and hip pain.
Sitting and tailbone load
Prolonged sitting and tailbone position increase pressure on the pelvic floor.
Straining and stress
Straining with bowel movements and stress both raise pelvic floor tension.
Your First Visit
How Dr. Gordon Evaluates Levator Ani Syndrome
The initial evaluation runs 60 to 75 minutes. You leave with a clear picture of what is driving your symptoms, a written plan, a realistic timeline, and in most cases your first treatment.
Records and history review
Dr. Gordon reviews your colorectal or GI workup, including colonoscopy and anal exam findings, and your bowel history.
Tailbone, hip and buttock assessment
External assessment of the tailbone, sacrum, buttocks and hips for related tension.
External pelvic floor assessment
The pelvic floor muscles are examined from the outside, with no internal exam. With you draped for comfort, gentle pressure around the perineum, sit bones, tailbone and inner thighs checks tone, tenderness and trigger points.
Sitting and bowel habits review
Dr. Gordon looks at sitting time, cushion use, toilet habits and straining.
Plan and coordination
A clear plan, plus communication with your physician or pelvic floor PT when that helps your care.
When to see a physician first
- Fever or chills with pelvic or urinary symptoms
- Inability to urinate
- Visible blood in the urine or stool
- Sudden, severe pelvic or abdominal pain
- Unexplained weight loss
- New numbness in the saddle area or loss of bladder or bowel control
If you have any of these, contact your doctor or go to the nearest emergency department.
Bring to your first visit
Records
Recent lab results, imaging reports and specialist notes. These can also be faxed ahead.
Treatment history
A short list of what you have tried and what did or did not help.
Clothing
Something comfortable and loose fitting.
Treatment
How Dr. Gordon Treats It
These are the tools Dr. Gordon uses most often for levator ani syndrome, chosen from your exam findings.
Primary approach
Intrapelvic & Extrapelvic Dry Needling
Dr. Gordon holds ASE certification in both intrapelvic and extrapelvic dry needling. Intrapelvic dry needling directly releases trigger points in the levator ani and neighboring muscles. The needles go in through the skin of the buttock, perineum or inner thigh, never through the vagina or rectum.
Learn about pelvic floor treatmentNerve focus
Neuro-Functional Acupuncture
Electro-acupuncture along the sacral nerve pathways to calm pelvic floor reactivity.
See servicesBetween visits
Sitting Plan & Team Coordination
Cushion, sitting and toilet habit guidance, coordinated with your colorectal specialist or pelvic floor PT.
Referring provider? Contact the clinicWhat to Expect
A Typical Recovery Arc
Visits 1 to 3
Confirm and release
Dr. Gordon confirms the levator ani as the source and begins releasing it. Many people notice longer comfortable sitting time.
Visits 4 to 8
Reduce episodes
Rectal pressure becomes less frequent and less intense.
Visits 9 to 12 and beyond
Stay ahead of flares
Visits are spaced out with a plan for sitting and flare control.
Most patients are seen weekly or every other week during active care. Individual results vary with how long symptoms have been present and how reactive they are. Progress is reassessed at every visit.
Not sure how to describe it? Put your pain or discomfort into words before your visit
"Dr. Gordon is thoughtful, thorough and incredibly knowledgeable. He has significantly helped me with pain management and pelvic floor issues. I am grateful to have his expertise in my corner."
Dina Isola, Google Review
Levator Ani Syndrome Questions
Answers About Levator Ani Syndrome
Still unsure whether this is the right fit? Reach out before you book and Dr. Gordon will talk through your history with you.
Levator ani syndrome causes a dull ache lasting 30 minutes or more. Proctalgia fugax causes brief, sharp episodes lasting seconds to minutes.
No. The pelvic floor muscles are examined externally, with no internal exam. Treatment options are explained before anything begins, and nothing is done without your consent.
Hemorrhoids and fissures should be ruled out by your physician. Levator ani pain is typically deeper and duller.
Sitting puts direct pressure on the pelvic floor and tailbone, which aggravates a tight levator ani.
Many people improve within six to ten sessions, with reassessment along the way.
Yes. Stress commonly tightens the pelvic floor, and many people notice flares during stressful periods.
Before You Book
General Questions
The clinic is an out-of-network practice. The initial evaluation is $300 and follow-up visits are $250. After each visit you receive a detailed superbill to submit to your PPO plan for possible reimbursement. FSA and HSA cards are accepted, and the clinic can run a complimentary benefits check before your first appointment. The check is a courtesy, so please confirm your coverage with your plan. See Insurance & Fees for details.
The first evaluation is 60 to 75 minutes and usually includes treatment. Follow-up visits run 45 to 60 minutes.
Yes. Call (516) 597-5400 or send a message through the contact page. This is especially helpful if your case is complex and you want to understand the approach before committing to a full evaluation.
1508 Union Turnpike, Suite 133, North New Hyde Park, NY 11040, with free parking on site. The clinic is an easy drive from Manhasset, Great Neck, Garden City, Lake Success, Floral Park and Mineola. Early morning, evening and weekend hours are available.
Most people feel a quick muscle twitch or a deep ache that lasts a few seconds. That twitch is a normal sign the trigger point is releasing. Mild soreness for 24 to 48 hours afterward, similar to a hard workout, is common. Depth, angle and stimulation are adjusted to your comfort.
Both use the same fine, sterile, single-use needles. Dry needling targets specific trigger points and tight bands in muscle based on your exam. Neuro-functional acupuncture targets nerve pathways, often with gentle electrical stimulation, to calm nerve sensitivity. For levator ani syndrome, Dr. Gordon commonly uses both.
When performed by a trained, licensed provider with detailed knowledge of anatomy, it has a strong safety record. Tell Dr. Gordon if you take blood thinners, have a bleeding disorder, are pregnant or have a weakened immune system so he can plan accordingly.
It is a technique that reaches the deep pelvic floor muscles, including the levator ani, obturator internus and coccygeus, to release trigger points and restore normal muscle function. The needles go in through the skin of the buttock, perineum or inner thigh, never through the vagina or rectum. Dr. Gordon holds ASE certification in this technique, which few practitioners in New York have.
Yes. Your privacy and comfort come first. When undressing is needed for the area being treated, you are fully draped. Needles are placed through the skin only, and nothing is ever inserted into the vagina or rectum. You can pause or stop at any time.
Yes. Levator ani syndrome can affect people of every gender, and Dr. Gordon treats adults of all genders and identities.
It helps to have had a medical workup so serious causes have been checked. If you have not seen a physician for your pelvic symptoms yet, call the clinic to talk through the best order of steps.
About Dr. Anthony J. Gordon
Dr. Anthony J. Gordon is a Doctor of Acupuncture licensed in New York and board certified. He holds ASE certification in intrapelvic and extrapelvic dry needling, along with advanced certifications in Functional Dry Needling and Neuro-Functional Acupuncture. With more than 18 years of clinical experience and over 3,000 complex cases treated, he focuses on pelvic, spinal and orthopedic conditions that have not responded to standard care, and works closely with each patient's physicians and physical therapists.
Read Dr. Gordon's full bioBook an Evaluation for Levator Ani Syndrome
Book a full evaluation with Dr. Gordon and find out whether the levator ani is behind your pain.
Early morning, evening and weekend appointments available. Free on-site parking.
Symptoms
Common Symptoms of Levator Ani Syndrome
Further Reading
Rectal Pain With Normal Tests: Levator Ani Syndrome
From the blog: A deep rectal ache with a normal colonoscopy can come from the levator ani muscle. How GI doctors define levator ani syndrome, and where muscle care fits.