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Levator ani muscle

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Attachments, innervation and functions of the levator ani muscle.
Levator ani muscle (Musculus levator ani)

The levator ani is a broad muscular sheet located in the pelvis. Together with the coccygeus muscle and their associated fascias it forms the pelvic diaphragm. The levator ani is collection of three muscles: puborectalis (puboanalis), pubococcygeus, and iliococcygeus.

The function of the entire levator ani muscle is crucial, in that it stabilizes the abdominal and pelvic organs. It literally stops your organs from falling straight out of your pelvis and abdomen!

Key facts about the levator ani muscle
Origins Puborectalis: Posterior surface of bodies of pubic bones (also known as puboanalis)
Pubococcygeus: Posterior surface of bodies of pubic bones (lateral to puborectalis)
Iliococcygeus: Tendinous arch of interal obturator fascia, Ischial spine
Insertions Puborectalis: None (forms 'puborectal sling' posterior to rectum)
Pubococcygeus: Anococcygeal ligament, Coccyx, Perineal body and musculature of prostate/ vagina
Iliococcygeus: Anococcygeal ligament, Coccyx
Innervation Nerve to levator ani (S4); Pubococcygeus also receives branches via inferior rectal/ perineal branches of Pudendal nerve (S2- S4)
Blood supply Inferior gluteal, inferior vesical and pudendal arteries
Function Stability and support of the abdominal and pelvic organs, resistance against increased intra-abdominal pressure, opening and closing of the levator hiatus

This article will describe the anatomy function of the three muscles forming the levator ani.

  1. Origins and insertions
  2. Innervation
  3. Blood supply
  4. Function
  5. Clinical aspects
  6. Sources
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Origins and insertions

The levator ani is formed 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. Also known as the puboanalis muscle.
  • 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.

Feeling puzzled? Learn the origins, insertions, innervations and functions of the levator ani 10x faster with our trunk wall muscle anatomy chart. 


It is primarily supplied by nerve to levator ani (S4). To a small degree the pudendal nerve (S2-S4) contributes to its innervation as well.

Dive into the anatomy of the pelvic muscles with our video tutorials, articles, quizzes, and diagrams.

Blood supply

Blood supply to levator ani comes from the branches of the inferior gluteal, inferior vesical and pudendal arteries.


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.

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.

Test yourself on pelvic floor muscles here:

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