Coccygeus is a sheet of muscle and fibrous tissue of the pelvis. Together with levator ani, it comprises the pelvic diaphragm that forms the inferior wall of the true pelvis. Some anatomy resources describe this muscle as ‘ischiococcygeus’ and a part of the levator ani, but it may also be referred to as a separate muscle named coccygeus.
It extends between the ischium of the hip bone and the last two regions of the vertebral column; sacrum and coccyx. Due to its particular location and the gravitational force acting on the internal organs during bipedal gait, coccygeus helps to support the pelvic viscera within the pelvis. It also has a minor role to flex the coccyx. Both of these actions are controlled by the last two sacral spinal nerves; S4 and S5.
|Insertion||Inferior end of sacrum, coccyx|
|Actions||Supports pelvic viscera, flexes coccyx|
|Innervation||Anterior rami of spinal nerves S4 & S5|
|Blood supply||Inferior vesical, inferior gluteal and pudendal arteries|
This article will describe the anatomy and functions of the coccygeus muscle.
Origin and insertion
Coccygeus is a triangular musculotendinous sheet of muscle containing an apex and a base. The apex originates from the pelvic surface of the ischial spine, including the tip. Most of the muscle fibers insert via its base into the lateral margins of the coccyx and the inferior end of sacrum, at the level of the fifth segment (S5).
The remaining fibers converge in the midline, completing the triangular shape. The aponeurotic portion of the muscle forms the sacrospinous ligament of the pelvis. Therefore, this ligament is considered to be a remnant or degenerated part of the coccygeus muscle.
However, the coccygeus might not be muscular at all in certain individuals. In these cases, coccygeus is completely tendinous and fused with the sacrospinous ligament of the pelvis.
Coccygeus lies within the plane of the pelvic outlet. It is located posterosuperiorly to iliococcygeus, which is a part of the levator ani muscle complex. Some resources argue that coccygeus is actually a part of levator ani, rather than a distinct muscle.
Coccygeus is also in contact with the lower border of piriformis, forming a canal in the greater sciatic foramen through which pelvic arteries and nerves travel between the pelvis and gluteal region. The most important neurovascular structures passing through this canal are the internal pudendal artery (pelvic portion), inferior gluteal artery and pudendal nerve.
In addition, coccygeus is also directly pierced by several neurovascular structures. These include the nerves to levator ani, which then course across the anterior surface of coccygeus, and the perineal branch of the fourth sacral nerve. The latter eventually provides cutaneous innervation to the skin between the anus and coccyx.
The fifth sacral ventral ramus of the coccygeal plexus also pierces coccygeus from below. Together with a branch of the fourth sacral ventral ramus and the coccygeal ventral ramus, the fifth sacral ventral ramus forms a trunk on the pelvic surface of coccygeus. This trunk continues to descend along the pelvic surface, curves around the lateral margin of coccygeus and pierces it on its way towards the pelvis.
Coccygeus is primarily innervated by the anterior rami of fourth sacral spinal nerve (S4), but receives minor contributions from the fifth sacral spinal nerve (S5).
The main function of coccygeus is mainly supportive. It takes part in forming a relatively horizontal pelvic diaphragm, assisting levator ani to support the pelvic viscera. The contraction of coccygeus pulls the anatomical structures within the pelvis and perineum anterosuperiorly, helping levator ani to occlude the physiological hiatuses and prevent the prolapse of internal organs.
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Coccygeus also weakly aids puborectalis to control defecation and urination, especially when intra-abdominal pressure is raised, such as while coughing. During childbirth, and sometimes defecation, the coccyx bone is temporarily pushed posteriorly. After the given process is complete, contraction of coccygeus flexes the coccyx and pulls it anteriorly to the initial position.