Pelvic Floor Anatomy
The maintenance of the correct integrity of the pelvic floor is fundamental for the physiology of this complex anatomical region, as it is involved in functions such as defecation, urination, sexual activities, especially in women, and in puerperium. In f
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Pelvic Floor Anatomy Augusto Orlandi and Amedeo Ferlosio
3.1
Introduction
The maintenance of the correct integrity of the pelvic floor is fundamental for the physiology of this complex anatomical region, as it is involved in functions such as defecation, urination, sexual activities, especially in women, and in puerperium. In fact, the pelvic floor closes the pelvis and holds organs (uterus, rectum, urethra, bladder, and prostate) inside the body. Although there is good anatomical knowledge of the region, the neurological and biomechanical functions of the pelvic floor are not well understood and knowledge of these is continuously evolving. Consequently, correct assessment of pelvic floor anatomy is essential to understand the pathogenesis and surgical correction of pelvic disturbances. For simplification, we have divided this chapter into the following three sections: bony pelvis, musculature, fasciae and aponevrosis, and somatic innervation.
3.2
The Bony Pelvis
The pelvis is divided into the major pelvis (part of abdominal cavity) and the minor or true pelvis [1]. The latter is frontally delimited by the pubic symphysis, and by the coccyx and sacrum at the back. The anatomical limits are considered to be a line from the promontory of the sacrum to the superior margin of the pubic symphysis (the superior strict of canal of partum in woman),
A. Orlandi () Department of Biomedicine and Prevention, Anatomic Pathology Institute, Tor Vergata University, Rome, Italy e-mail: [email protected] A. L. Gaspari, P. Sileri (Eds), Pelvic Floor Disorders: Surgical Approach, Updates in Surgery DOI: 10.1007/978-88-470-5441-7_3, © Springer-Verlag Italia 2014
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A. Orlandi, A. Ferlosio
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Fig. 3.1 The human bony pelvis seen from the front (top) and from below (bottom), showing the bones and main ligament structures of the pelvis supporting the pelvic floor
closed laterally by the spine of the ischium and the superior ramus of the pubis forward and seen from below from ischial tuberosity (Fig. 3.1, top and bottom). The main ligamentous structures are the anterior and lateral sacrococcygeal ligaments, the sacrospinous ligament, the sacrotuberous ligament, and the arcuate pubic ligament [2].
3.3
The Musculature, Fasciae, and Aponevrosis
From a surgical point of view, when considering access to the pelvic floor
3 Pelvic Floor Anatomy
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ischiocavernosus muscle bulbocarvenosus muscle
gluteus maximus muscle
Fig. 3.2 Pelvic floor anatomy in women (top), and the urogenital diaphragm in men (bottom)
starting from the cutis in a gynecological position (Fig. 3.2, top), the perineal region can be divided in two parts: the superficial and deeper planes. The superficial plane coincides with the fascia of Cruveilhier, which continues with abdominal structures and adheres to the thigh, while the deeper plane coincides with the fascia of Colles [3]. The space between the two ischial tuberosities laterally and the pubic symphysis anteriorly is closed by the so-called urogenital diaphragm, which is composed mainly of the deep
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