Treatments for levator ani syndrome

CategoryExamplesLevel of EvidenceComments
Behavior therapyBiofeedback to improve defecation dynamicsBMost effective treatment for LAS in single RCT14
Muscle relaxantElectrogalvanic stimulationBMore effective than massage in single RCT14; benefits decrease in long-term
Muscle relaxantDiazepamCPoorly effective in the long-term; addictive potential
Muscle relaxantDigital massage of puborectalis muscleDNo standardized methodology; often provided with sitz bath
AnticholinergicBotulinum toxin A injectionBIneffective as transvaginal or transanal injection in three RCTs1113
Anti-inflammatoryPelvic floor muscle steroid InjectionDEqually effective as physiotherapy in pilot RCT15
AntidepressantsAmitriptylineDUnclear mechanism of action; diverse dosage
NeuromodulationSacral neuromodulationDConflicting results in small observational studies
  • LAS = levator ani syndrome; RCT = randomized controlled trial