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Levator Ani - want to learn more about it?

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Levator Ani

The levator ani forms the main part of the pelvic diaphragm, the cranial layer of the pelvic floor. However, contrary to your initial impression, the levatori ani is not in fact a single, but a collection of three muscles: puborectalis, pubococcygeus, and iliococcygeus. All three of them are innervated by branches of the sacral plexus as well as the pudendal nerve. The role of the entire levator ani muscle is crucial, in that it stabilizes the abdominal and pelvic organs. As crude as it may sound, it stops your organs from falling straight out of your pelvis and abdomen.

This article will describe all the three muscles forming the levator ani, focusing on its origins, insertions, and respective functions. Relevant clinical aspects will also be discussed.

Key facts about the levator ani muscle
Puborectalis

Origin: pubic symphysis

Insertion:: tendinous band posterior to the rectum

Innervation: sacral plexus, pudendal nerve

Action: stability of the abdominal and pelvic organs, opening and closing of the levator hiatus

Pubococcygeus

Origin: pubic symphysis

Insertion: tendinous center of the perineum, anococcygeal body, coccyx

Innervation: sacral plexus, pudendal nerve

Action: stability of the abdominal and pelvic organs, opening and closing of the levator hiatus

Iliococcygeus

Origin: fascia of the obturator internus

Insertion:: coccyx

Innervation: sacral plexus, pudendal nerve

Action: stability of the abdominal and pelvic organs, opening and closing of the levator hiatus

Clinical implications Descending perineum syndrome, prolapse, levator ani syndrome

Anatomy

Origins and Insertions

It is made up of the following three muscles:

  • Puborectalis muscle: originates lateral from the symphysis on both sides and encircles the rectum (anorectal junction) which causes a ventral bend between the rectum and anal canal. Partly it is interwoven with the external anal sphincter.
  • Pubococcygeus muscle: runs from the pubic bone (lateral of the origin of the puborectalis muscle) to the tendinous center of the perineum, anococcygeal body and tailbone. In men, medial muscle fibers are partly connected to the prostate.
  • Iliococcygeus muscle: extends more laterally from the fascia of obturator internus muscle to the tailbone. As a whole the levator ani builds a V-shaped structure. Both levator arms limit a triangle opening (levator hiatus) which is divided by prerectal fibers into the urogenital hiatus (ventral) and anal hiatus (dorsal). The urogenital hiatus is the pathway for the urethra and, in women, the vagina. The rectum runs through the anal hiatus.

Innervation

It is primarily supplied by direct branches of the sacral plexus (S3-S5). To a small degree the pudendal nerve contributes to its innervation as well.

Function

Through its tonic activity, the levator ani stabilizes the abdominal and pelvic organs on the one hand and controls the opening and closing of the levator hiatus on the other hand.

Recommended video: Levator ani muscle
Origins, insertions, innervation and functions of the levator ani muscle.

While in quiescent state, the urethra and the rectum are mechanically closed at the levator hiatus. The muscle relaxes at the beginning of urination and defecation. By this means the levator ani muscle plays a crucial role in the preservation of urinary and bowel continence.

Clinical Aspects

The levator hiatus is a potential weak spot of the pelvic floor musculature, especially in women. Through increased intra-abdominal pressure (e.g. pregnancy, obesity or even chronic cough) the pelvic floor can be impaired and damaged in the long term. This may cause a descent of the perineum (descending perineum syndrome, DPS) up to a complete prolaps of the vagina or rectum. Consequences are urinary and bowel incontinence.

Approximately 6% of the population suffer under intermittent painful muscle spasms of the levator ani (levator ani syndrome). These can occur at any time and are often accompanied by a feeling of pressure and tension in the anorectal region. To this day the etiology remains unclear. Both neuralgia of the pudendal nerve and psychosomatic components are in discussion.

Levator Ani - want to learn more about it?

Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster.

Sign up for your free Kenhub account today and join over 852,397 successful anatomy students.

“I would honestly say that Kenhub cut my study time in half.” – Read more. Kim Bengochea Kim Bengochea, Regis University, Denver

Show references

References:

  • D. Drenckhahn/J. Waschke: Taschenbuch Anatomie, 1.Auflage, Urban & Fischer Verlag/Elsevier (2008), S.299-300
  • M. Schünke/E. Schulte/U. Schumacher: Prometheus – LernAtlas der Anatomie – Allgemeine Anatomie und Bewegungssystem, 2.Auflage, Thieme Verlag (2007), S.160-161, 178-187
  • J. Kirsch et. al.: Taschenlehrbuch Anatomie, 1.Auflage, Thieme Verlag (2010), S.434-436
  • R.Tunn/E. Hanzal/ D. Perucchini: Urogynäkologie in Praxis und Klinik, 2.Auflage, De Gruyter (2009), S.29-36
  • H. Rohde: Lehratlas der Proktologie, 1.Auflage, Thieme Verlag (2006), S.183-184

Author & Layout:

  • Achudhan Karunaharamoorthy
  • Christopher A. Becker

Illustrators:

  • Puborectalis muscle - cranial view - Liene Znotina
  • Pubococcygeus muscle - cranial view - Liene Znotina
  • Levator ani muscle - cranial view - Liene Znotina
© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are protected by German and international copyright laws. All rights reserved.

Related Atlas Images

Muscles of the pelvic floor

Rectum and anal canal

Levator ani muscle level

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