Pelvic floor anatomy

The pelvic floor is a complex mechanical apparatus composed by the levator ani, superficial perineal muscles, pelvic nerves, endopelvic fascia, and ligaments. The pelvic anatomy is somewhat challenging to both surgeons and anatomists. It is a narrow and deep region that encompasses intestinal, gynecologic, and urologic viscera, vessels, nerves, and fascial attachments. It is designed for content suspension and to promote coordinated action during bladder and rectal emptying. Support for the pelvic organs originates from connections to the pelvis and associated muscles. The pelvic muscles encompass five groups: levator ani, anal sphincter complex, pelvic sidewall, and anterior perineal muscles. Damage to structural and functional interactions of the pelvic floor can potentially lead to multi-compartmental dysfunction. Also, debilitating pelvic floor disorders such as pelvic organ prolapse and incontinence are usually related to injuries and deterioration of muscles, nerves, and ligaments that support and maintain normal pelvic function. The anorectum and pelvic floor are interconnected by the fascia and ligaments, which provide support for endopelvic viscera. In females, the pelvic floor is considered part of the birth canal and stretching and tearing of these structures during vaginal delivery are often underestimated causes of pelvic floor dysfunction. In addition, pelvic floor function can be affected by variation in bowel habits, particularly chronic excessive straining. Understanding pelvic floor anatomy is essential to fully diagnose and adequately treat these dysfunctions.