Treatments for levator ani syndrome
| Category | Examples | Level of Evidence | Comments |
|---|---|---|---|
| Behavior therapy | Biofeedback to improve defecation dynamics | B | Most effective treatment for LAS in single RCT14 |
| Muscle relaxant | Electrogalvanic stimulation | B | More effective than massage in single RCT14; benefits decrease in long-term |
| Muscle relaxant | Diazepam | C | Poorly effective in the long-term; addictive potential |
| Muscle relaxant | Digital massage of puborectalis muscle | D | No standardized methodology; often provided with sitz bath |
| Anticholinergic | Botulinum toxin A injection | B | Ineffective as transvaginal or transanal injection in three RCTs11–13 |
| Anti-inflammatory | Pelvic floor muscle steroid Injection | D | Equally effective as physiotherapy in pilot RCT15 |
| Antidepressants | Amitriptyline | D | Unclear mechanism of action; diverse dosage |
| Neuromodulation | Sacral neuromodulation | D | Conflicting results in small observational studies |
LAS = levator ani syndrome; RCT = randomized controlled trial