Pelvic Floor Anatomy
• Peritoneum
• Endopelvic fascia
• Urogenital diaphragm (perineal membrane) and Levator ani muscles
• Bulbocavernosus, Ischiocavernosus, Superficial transverse perineal muscles, Perineal body, External anal sphincter
• Skin

Mechanism of Support and Prolapse
• Constriction --- outlet
• Suspension --- ligament and endopelvic fascia
• Flap-valve closure --- levator plate and genital hiatus
• “Boat-in-dry dock” --- Norton P.

Anatomy of Support
• Pelvis
• Pelvic diaphragm
• Arcus tendineus levator ani (ATLA)
• Arcus tendineus fasciae pelvis (ATFP)
• Paravaginal fascia
• U-shaped muscle layer
(pelvic sling, or Hammock-like layer)

Endopelvic fasciae
• Fasciae and ligament ---smooth muscles & areolar connective tissue
• Felt-like meshwork (fibrous tissue, sheets of fibroareolar tissue)
• Cardino-uterosacral lig. Complex, pubocervical fascia. Rectovaginal septum (Denonvilliers’ fascia), periurethral fascia (Raz), urethropelvic lig. (Raz).

Pelvic floor (Pelvic diaphragm)
• Coccygeus muscles
• Levator ani muscles :
　pubococcygeus (S3-S5)
　iliococcygeus (S3-S5)
　puborectalis (S3-S4) --- Kegel’s PFE
• Levator plate & genital hiatus

Support of pelvic outlet
• Compressor urethrae and urethrovaginal sphincter muscle
• Urogenital diaphragm or perineal membrane
• External genital muscles --
　　　　　　　　　　　　　Bulbocavernosus
　　　　　　　　　　　　　Ischiocavernosus
　　　　　　　　　　　　　Superficial transverse perineal muscles
• Perineal body

Theory of urinary incontinence
• Pressure transmission ratio ---
• Integral theory --- Ulmsten
• Hammock theory --- DeLancey JOL

Weak pelvic floor muscles ---