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Pelvic Floor Anatomy Colorectal Conference 7/21/05 Peter M. Kaye, M.D.

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Presentation on theme: "Pelvic Floor Anatomy Colorectal Conference 7/21/05 Peter M. Kaye, M.D."— Presentation transcript:

1 Pelvic Floor Anatomy Colorectal Conference 7/21/05 Peter M. Kaye, M.D.

2 The Pelvic Floor Musculotendinous hammock or sling Musculotendinous hammock or sling Termination of the pelvic outlet Termination of the pelvic outlet Muscles of the pelvis Muscles of the pelvis Anal sphincter complex Levator ani muscles Support the abdominal and pelvic organs Support the abdominal and pelvic organs Connect the pelvis to the vertebral column Connect the pelvis to the vertebral column Maintain continence Maintain continence

3 Anal Sphincter Complex Internal anal sphincter Internal anal sphincter Conjoined longitudinal muscle Conjoined longitudinal muscle External anal sphincter External anal sphincter

4 Internal Anal Sphincter Extension of the circular muscle layer of the rectum Extension of the circular muscle layer of the rectum Constant maximal contraction Constant maximal contraction 50-85% of resting anal tone 50-85% of resting anal tone Autonomic innervation Autonomic innervation Parasympathetic…..S2-4 Parasympathetic…..S2-4 Sympathetic……..thoracolumbar ganglia (L5) Sympathetic……..thoracolumbar ganglia (L5) Suggested that both parasympathetic and sympathetic innervation cause inhibition of contraction Suggested that both parasympathetic and sympathetic innervation cause inhibition of contraction

5 Conjoined Longitudinal Muscle Extension of the longitudinal muscle layer of the rectum, along with levator ani muscle fibers Extension of the longitudinal muscle layer of the rectum, along with levator ani muscle fibers Structural support, anchoring the anorectum to the pelvis Structural support, anchoring the anorectum to the pelvis

6 External Anal Sphincter Multiple layers of striated muscle Multiple layers of striated muscle Voluntary contractions to prevent fecal leak Voluntary contractions to prevent fecal leak 25-30% of resting anal tone 25-30% of resting anal tone Somatic innervation from the inferior rectal branch of the pudendal nerve (S2-3) and the perineal branch of S4 Somatic innervation from the inferior rectal branch of the pudendal nerve (S2-3) and the perineal branch of S4

7 Levator Ani Muscles Pubococcygeus Pubococcygeus Iliococcygeus Iliococcygeus Puborectalis Puborectalis Ischiococcygeus Ischiococcygeus

8 Puborectalis U-shaped, medial most located levator ani muscle U-shaped, medial most located levator ani muscle Pulls the anorectal junction anteriorly, forming the anorectal angle Pulls the anorectal junction anteriorly, forming the anorectal angle Pelvic floor muscle vs. sphincter muscle? Pelvic floor muscle vs. sphincter muscle?

9 Functional Anatomy Puborectalis and the anorectal angle allow for gross fecal continence Puborectalis and the anorectal angle allow for gross fecal continence Relieves pressure from the sphincter process Relieves pressure from the sphincter process The sphinter complex is responsible for gas and liquid continence The sphinter complex is responsible for gas and liquid continence Defecation Defecation Relaxation of the puborectalis Relaxation of the puborectalis Contraction of the other levator muscles Contraction of the other levator muscles

10 Functional Anatomy Rectal prolapse Rectal prolapse Laxity in sphincter complex and levator muscles Laxity in sphincter complex and levator muscles


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