A 34-year-old woman is admitted to the hospital complaining of urinary incontinence. MRI examination reveals that one of the skeletal muscles of the pelvis has a significant tear. Which of the following muscles is the most significant in terms of maintaining continence?

Of the answer choices listed, the pubococcygeus is the muscle that is most directly associated with the arcus tendineus fascia pelvis and connective tissues of the vagina and the support of the bladder. The obturator internus, piriformis, and coccygeus do not form parts of the levator ani and provide no direct support to the urogenital organs, nor do they have any role in urinary incontinence. The iliococcygeus does form part of the levator ani, but it is located lateral to the pubococcygeus and therefore does not play a direct role in maintaining urinary continence.