Levator Ani, Are You Okay, Ani?

She’s a real pain in your butt

It’s a bold statement, but I doubt Michael Jackson knew anything about perimenopause.

But every time I hear the song “Smooth Criminal” with the lyrics “Annie, are you okay? So, Annie, are you okay? Are you okay, Annie?” I think of my pelvic floor and butt muscles.

I love talking about things that are common but aren’t commonly discussed, so brave this writing adventure with me and learn what could be causing that pain in your butt feeling (other than the annoying guy in the checkout line).

Don’t be ashamed; I’ll be there with you every step of the way.

The Muscle You Didn’t Know You Had

The levator ani muscle is a butt muscle in your pelvic floor. The pelvic floor is a bowl-shaped group of muscles that support the bladder, uterus, and bowel. It’s human nature not to know about this muscle until you deal with a painful and spasming one.

Unfortunately, women have more issues with this muscle than a man in the mirror, thanks to our anatomy, childbirth experiences, and how we hold chronic stress. However, it’s important to learn about this muscle and how having a painful one can affect you.

Your pelvic floor muscles can be too tight, resulting in pain, discomfort, constipation, and muscle aches, or they can be too loose, resulting in bladder leaking and other issues. It may sound like something out of a thriller novel, but it’s just your pelvic floor. It’s responsible for many functions and holding your pelvic organs in place.

What Does Levator Ani Muscle Discomfort Feel Like?

Many perimenopause women complain of pain in their rectum when pooping, through the course of their day or evening, or during intercourse. The levator ani muscle can also cause vaginal pain.

It can feel:

• Sharp

• Shooting

• Sudden

• Ripping Sensation

• Slight Ache

• Tingling

• Burning

• Mild or Intense

• Constant or Intermittent

If you get a levator ani spasm, it will usually last for about 20 or so seconds. About the same length of time as a Charley horse or calf muscle spasm, but picture this in your anus/pelvic area. When it happens for the first time, it may freak you out and cause you to think your pelvic organs are about to drop out of your body.

Why Me? Did I Say “You’ve Been a Pain in My Butt” Too Many Times?

The medical world isn’t sure exactly what causes this, but some theories are tight pelvic floor muscles or inflammation. It’s not so black and white, there may be other issues involved.

If you’ve having this sensation all of the time or it is very painful, you’ll want to see your doctor to be evaluated for Levator Ani Syndrome, which is a medical condition. However, you are not alone if you have this painful butt syndrome. Doctors see this frequently. Butt, you don’t need to have Levator Ani Syndrome to have levator ani muscle issues. Levator ani muscle pain can strike at any time regardless of whether you are a P.Y.T (pretty young thing) or not.

Estradiol estrogen is anti-inflammatory, so when it declines during perimenopause, we lose that protection, and inflammation can increase.

The other thing that can happen is that as our estradiol estrogen declines, our skin thins and loses its elasticity. This can affect our anus and perineum as well as the vulva, vagina, and urethra. When we poop, the poop can tear the delicate skin around your butt hole and cause bleeding, pain, and discomfort. Even toilet paper can tear or irritate the skin if it becomes very delicate.

Add all of this to a tight levator ani muscle, and you have the recipe for constipation. Constipation is a common problem in perimenopause, which can cause pressure and pain of the levator ani muscle as you get more and more backed up. We tend to strain more when we get backed up and then it all becomes a vicious cycle.  

How Do I Fix This?

So what’s a girl to do other than to burn this disco out, cry, or get on the dance floor?

The first thing is to realize that you aren’t alone. You can say say say what you want, but I’ve talked to many women who experience this frequently yet have no idea what’s happening or know what to do about it.

It’s possible that this butt cramp is due to both inflammation and pelvic floor issues, so we’ll want to work with someone knowledgeable who can help.¹ A pelvic floor physical therapist can help you assess the situation, and she’ll wanna be starting something to improve your pelvic floor tone and fix this issue.

I’m guessing if you’re dealing with levator ani pain, this isn’t your only pelvic floor symptom – it’s possible you also have leaking, tight or loose pelvic floor muscles, pelvic pain, vulvodynia, and other pelvic floor conditions. A PT who specializes in the pelvic floor will be able to help you with all of it.

Going to a PT for your pelvic floor is an intimate experience as she’ll need to access your pelvic floor muscles by inserting her gloved finger into your vagina and pressing around to feel the muscles. This is the only way to access them.

Can you feel it?  Yes, especially when she hits a really sore spot, but it’s not bad. It’s a little bit awkward, if I’m honest, but the benefits of someone giving you a diagnosis and treatment plan is worth it. I’ve gone to two pelvic floor PTs in my life and both women have been amazing. You can find a PT in your area by visiting the Association of Physical Therapists and typing in “pelvic” in their provider finder at www.choosept.com.

If you remember the time, you went to a medical appointment only to discover it wasn’t a covered benefit, then you’ll definitely want to check that going to a PT will be covered by your insurance before you go. In addition to coverage considerations, some states require that you see your primary care physician to obtain a referral to a PT and other states allow you to self-refer to a PT. Access your state’s information.

By the time you’re done with your pelvic floor physical therapy sessions and exercises, you’ll be telling your PT, Billie Jean, that you love “The way you make me feel.”

Things You Can Do at Home to Help

If you don’t think you have Levator Ani Syndrome, which should be diagnosed by a physician, and can’t see a pelvic floor physical therapist in person, there are some online options as well as PTs on YouTube that can provide exercises and stretching. Hinge Health, an online PT company, may be an option for you through your health insurance carrier.

Sitting in a warm bath will help loosen and soothe your muscles. Another option is a sitz bath, which could help if you don’t want to sit in a full bath or don’t have access to a bathtub. I’ve used one of those old-fashioned hot water bottles, like you’d see on Little House on the Prairie, for years when my pelvic floor is spasming. Yoga and stretching may also help. A Theragun may be helpful for your leg muscles, but I would not apply it directly to your pelvic area.

Finally, be aware of how you are holding your body. Are you constricting it and making everything tight? For years, I didn’t realize that I was constantly squeezing my butt muscles when I was standing in stressful situations. Pay attention to your habits and see if there’s a connection between how you move and your pain levels.

With some care and attention, you can beat it.

Did you find all 19 Michael Jackson song titles in this article?

Click here if you need help finding all of the songs.

Be well, stay cool…

~ Shelby

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1. https://www.medicalnewstoday.com/articles/318763#Outlook