Pelvic Floor Anatomy



Pelvic floor architectural defects are related to parity, aging, hysterectomy, and chronic straining. The muscles and the supportive connective tissue can be torn, stretched, or denervated. Basic understanding of pelvic floor anatomy is essential to understanding 2D, 3D, and 4D anatomy as visualized by pelvic floor ultrasonography. The goal of the current chapter is to use the suspension bridge analogy and simple representative drawings to communicate to readers complex pelvic floor anatomy and function.


Pelvic floor Levator ani muscle Perineal body Endopelvic fascia Pubocervical Rectovaginal Uterosacral 


  1. 1.
    NIH state-of-the science conference statement on prevention of fecal and urinary incontinence in adults. NIH Consens State Sci Statements. 2007;24(1):1–37.Google Scholar
  2. 2.
    Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol. 2003;188(1):108–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.CrossRefPubMedGoogle Scholar
  6. 6.
    Aigmueller T, Dungl A, Hinterholzer S, Geiss I, Riss P. An estimation of the frequency of surgery for posthysterectomy vault prolapse. Int Urogynecol J. 2010;21(3):299–302.CrossRefPubMedGoogle Scholar
  7. 7.
    Quiroz LH, Munoz A, Shippey SH, Gutman RE, Handa VL. Vaginal parity and pelvic organ prolapse. J Reprod Med. 2010;55(3–4):93–8.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Ricci JV, Thom CH. The myth of a surgically useful fascia in vaginal plastic reconstructions. Q Rev Surg Obstet Gynecol. 1954;11(4):253–61.Google Scholar
  9. 9.
    Gitsch E, Palmrich AH. Operative anatomie. Berlin: De Gruyter; 1977.CrossRefGoogle Scholar
  10. 10.
    Albright T, Gehrich A, Davis G, Sabi F, Buller J. Arcus tendineus fascia pelvis: a further understanding. Am J Obstet Gynecol. 2005;193(3):677–81.CrossRefPubMedGoogle Scholar
  11. 11.
    DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166(6 Pt 1):1717–24.. discussion 1724-8CrossRefPubMedGoogle Scholar
  12. 12.
    Campbell RM. The anatomy and histology of the sacrouterine ligaments. Am J Obstet Gynecol. 1950;59(1):1–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Range RL, Woodburne RT. The gross and microscopic anatomy of the transverse cervical ligaments/. Am J Obstet Gynecol. 1964;90:460–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Richardson AC, Edmonds PB, Williams NL. Treatment of stress urinary incontinence due to paravaginal fascial defect. Obstet Gynecol. 1981;57(3):357–62.PubMedGoogle Scholar
  15. 15.
    DeLancey J. Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol. 2002;187(1):93–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Chesson RR, Schlossberg SM, Elkins TE, Menefee S, McCammon K, Franco N, et al. The use of fascia lata graft for correction of severe or recurrent anterior vaginal wall defects. J Pelvic Surg. 1999;5(2):96–103.Google Scholar
  17. 17.
    Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Oelrich T. The striated urogenital sphincter muscle in the female. Anat Rec. 1983;205(2):223–32.CrossRefPubMedGoogle Scholar
  19. 19.
    DeLancey JO, Toglia MR, Perucchini D. Internal and external anal sphincter anatomy as it relates to midline obstetric lacerations. Obstet Gynecol. 1997;90(6):924–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Shobeiri SA, Chesson RR, Gasser RF. The internal innervation and morphology of the human female levator ani muscle. Am J Obstet Gynecol. 2008;199(6):686.e1–6.CrossRefGoogle Scholar
  21. 21.
    Hsu Y, Fenner DE, Weadock WJ, DeLancey JO. Magnetic resonance imaging and 3-dimensional analysis of external anal sphincter anatomy. Obstet Gynecol. 2005;106(6):1259–65.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Lawson JO. Pelvic anatomy. I. Pelvic floor muscles. Ann R Coll Surg Engl. 1974;54(5):244–52.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Kearney R, Sawhney R, DeLancey JOL. Levator ani muscle anatomy evaluated by origin-insertion Pairs. Obstet Gynecol. 2004;104(1):168–73.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Margulies RU, Hsu Y, Kearney R, Stein T, Umek WH, DeLancey JOL. Appearance of the levator ani muscle subdivisions in magnetic resonance images. Obstet Gynecol. 2006;107(5):1064–9.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Shobeiri SA, Leclaire E, Nihira MA, Quiroz LH, O’Donoghue D. Appearance of the levator ani muscle subdivisions in endovaginal three-dimensional ultrasonography. Obstet Gynecol. 2009;114(1):66–72.CrossRefPubMedGoogle Scholar
  26. 26.
    Taverner D, Smiddy FG. An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm. Dis Colon Rectum. 1959;2(2):153–60.CrossRefPubMedGoogle Scholar
  27. 27.
    Nichols DH, Milley PS, Randall CL. Significance of restoration of normal vaginal depth and axis. Obstet Gynecol. 1970;36(2):251–6.PubMedGoogle Scholar
  28. 28.
    Shobeiri SA, Rostaminia G, White DE, Quiroz LH. The determinants of minimal levator hiatus and their relationship to the puborectalis muscle and the levator plate. BJOG. 2013;120(2):205–11.CrossRefPubMedGoogle Scholar
  29. 29.
    Guaderrama NM, Liu J, Nager CW, Pretorius DH, Sheean G, Kassab G, et al. Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol. 2005;106(4):774–81.CrossRefPubMedGoogle Scholar
  30. 30.
    Wallner C, van Wissen J, Maas CP, Dabhoiwala N, DeRuiter MC, Lamers WH. The contribution of the levator ani nerve and the pudendal nerve to the innervation of the levator ani muscles; a study in human fetuses. Eur Urol. 2008;54(5):1136–42.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyGynecologic Subspecialties, INOVA Women’s Hospital, Virginia Commonwealth UniversityFalls ChurchUSA
  2. 2.Department of BioengineeringGeorge Mason UniversityFairfaxUSA

Personalised recommendations