Levator Ani

General information

The levator ani is a broad muscular sheet situated in the pelvis and is made up of three different muscles: the puborectalis, pubococcygeus, and iliococcygeus. The levator ani and the coccygeus make up the pelvic diaphragm.

Literal meaning

Lifter of the ring.

Interesting information

The levator ani is a very important structure in the pelvic and abdomen as it stops the organs from falling out of place and stabilises the entire region.

Origin

Puborectalis: Posterior surface of bodies of pubic bones.

Pubococcygeus: Posterior surface of bodies of pubic bones (lateral to puborectalis).

Iliococcygeus: Tendinous arch of internal obturator fascia, Ischial spine.

Insertion

Puborectalis: None (forms 'puborectal sling' posterior to rectum)

Pubococcygeus: Anococcygeal ligament, coccyx, perineal body and musculature of prostate/vagina.

Iliococcygeus: Anococcygeal ligament, coccyx.

Function

Stability and support of the abdominal and pelvic organs, resistance against increased intra-abdominal pressure, opening and closing of the levator hiatus.

Nerve supply

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.

Relevant research

Evidence shows less shortening of the levator ani muscle during contraction at 37 weeks of gestation is associated with major levator ani muscle defects postpartum.

Siafarikas, F., Staer-Jensen, J., Hilde, G., Bø, K., & Ellström Engh, M. (2015). The levator ani muscle during pregnancy and major levator ani muscle defects diagnosed postpartum: a three- and four-dimensional transperineal ultrasound study. BJOG: an international journal of obstetrics and gynaecology, 122(8), 1083–1091.

Levator ani exercises

None