Levator ani muscles consist of pubococcygeus, coccygeus and ileococcygeus muscles on each side which together form a muscular floor to the pelvis. The striated muscle of levator ani is under voluntary control but is a unique striated muscle in having a resting tone. As with other striated muscles its strength can be increased by exercise as with pelvic floor physiotherapy. Contraction of the muscles results in a forward elevation of the pelvic floor which is important in their role in continence. This forward elevation helps to increase the angulation between bladder and urethra anteriorly and rectum and anal canal posteriorly. Increase in this angulation is one of the fundamental mechanisms which aid continence. Thus, the healthy pelvic floor muscle will, at rest, provide support and assistance with continence. When the intra-abdominal pressure rises levator ani muscles contract and provide additional support and outlet resistance to the bladder and rectum. This reflex response to intra-abdominal pressure rises also requires an intact innervation. Damage to the pelvic floor muscle innervation is likely to impair the pelvic floor muscle responses.
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