Levator Ani

The Levator Ani is a muscle of the pelvis.

Anatomical Attachments:

• Origin: Attaches to the pelvic surface of the pubis to the ischial spine.

• Insertion: Attaches to the coccyx, anococcygeal raphe and merges with the other muscle and attaches to a point of the perineum.

Action: Supports the viscera, helps to prevent incontinence during a sudden inter abdominal pressure such as coughing or sneezing, assists in forceful fecal elimination as well as contraction of the anus and vagina.

Nerve Supply: Pudendal Nerve, Inferior rectal nerve and inferior gluteal nerve (S3, S4).

Vascular supply: Internal pudendal, inferior rectal and inferior gluteal arteries.

• Primary: The pain primarily refers to the center of the coccyx, and it frequently includes the anal region and the inferior part of the sacrum.
• Satellite or associated triggers: Gluteus maximus.

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Trigger Point Signs and Symptoms: Pain is experienced around the anus, sacrum, coccyx, vagina, and/or low back. Of all the pelvic floor muscle dysfunctions, it would appear that the levator ani is the most widely observed and discussed. Individuals experiencing levator ani dysfunction have difficulty sitting or lying supine. The pain is exacerbated by defecation or in the female population, by sexual intercourse.

Trigger Point Activating and Perpetuating Factors: Persistent emotional stress, sitting with slumped posture, direct trauma or surgery to the buttock or pelvic region.

Differential Diagnosis: (Segmental, Subluxation, Somatic dysfunction) S1 S2 S3 S4 or S5 radiculopathy, Coccygodynia (Coccygeal nerve compression), Coccygeal spasm, Coccygeal fracture, Levator ani syndrome, Tension myalgia of the pelvic floor, Pregnancy, Spontaneous Abortion (Miscarriage), Proctalgia fugax, Hemorrhoids, Polyps, Anal fissure, Colorectal cancer, Crohn’s Disease, Diverticular disease, Fecal impaction or Constipation, Proctitis, Prostitic hypertrophy (Enlarged prostate), Prostatitis, Prostate cancer, Vaginal cancer, Vaginismus, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

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