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 ---

陳進典　 中山醫學院附設醫院 婦產科