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Thepelvic floor orpelvic diaphragm is an anatomical location in the human body[1] which has an important role in urinary and anal continence, sexual function, and support of the pelvic organs.[2] The pelvic floor includes muscles, both skeletal and smooth, ligaments, and fascia[3] and separates between thepelvic cavity from above, and theperineum from below.[4][5] It is formed by thelevator ani muscle andcoccygeus muscle, and associatedconnective tissue.[6]
The pelvic floor has twohiatuses (gaps): (anteriorly) theurogenital hiatus through which theurethra andvagina pass, and (posteriorly) the rectal hiatus through which theanal canal passes.[7]
Some sources do not consider "pelvic floor" and "pelvic diaphragm" to be identical, with the "diaphragm" consisting of only the levator ani and coccygeus, while the "floor" also includes theperineal membrane anddeep perineal pouch.[8] However, other sources include thefascia as part of the diaphragm.[9] In practice, the two terms are often used interchangeably.[10]
Thepelvic cavity of thetrue pelvis has the pelvic floor as its inferior boundary (and thepelvic brim as its superior boundary). Theperineum has the pelvic floor as its superior boundary.[4]
Posteriorly, the pelvic floor extends into theanal triangle.[citation needed]
It is important in providing support for pelvicviscera (organs), e.g. thebladder,intestines, theuterus (in females), and in maintenance ofcontinence as part of theurinary andanal sphincters. It facilitates birth by resisting the descent of the presenting part, causing the fetus to rotate forward to navigate through the pelvic girdle. It helps maintain optimal intra-abdominal pressure.[7]
The pelvic floor is subject to clinically relevant changes that can result in:
Pelvic floor dysfunction can result after treatment for gynecological cancers.[12]
Damage to the pelvic floor not only contributes to urinary incontinence but can also lead to pelvic organ prolapse. Pelvic organ prolapse occurs in women when pelvic organs (e.g. the vagina, bladder, rectum, or uterus) protrude into or outside of the vagina. The causes of pelvic organ prolapse are not unlike those that also contribute to urinary incontinence. These include inappropriate (asymmetrical, excessive, insufficient) muscle tone and asymmetries caused by trauma to the pelvis. Age, pregnancy, family history, and hormonal status all contribute to the development of pelvic organ prolapse. The vagina is suspended by attachments to the perineum, pelvic side wall and sacrum via attachments that include collagen, elastin, and smooth muscle. Surgery can be performed to repair pelvic floor muscles. The pelvic floor muscles can be strengthened withKegel exercises.[13]
Disorders of the posterior pelvic floor includerectal prolapse,rectocele,perineal hernia, and several functional disorders, includinganismus.Constipation due to any of these disorders is called "functional constipation" and is identifiable by clinical diagnostic criteria.[14]
Pelvic floor exercise (PFE), also known asKegel exercises, may improve the tone and function of the pelvic floor muscles, which is of particular benefit for women (and less commonly men) who experiencestress urinary incontinence.[15][13] However, compliance with PFE programs often is poor,[15] PFE generally is ineffective for urinary incontinence unless performed withbiofeedback and trained supervision,[13] and in severe cases it may have no benefit. Pelvic floor muscle tone may be estimated using aperineometer, which measures the pressure within the vagina.[16] Medication may also be used to improve continence.[17] In severe cases, surgery may be used to repair or even to reconstruct the pelvic floor.[17] One surgery which interrupts pelvic floor musculature in males is aradical prostatectomy. With the removal of theprostate, many males experienceurinary incontinence post operation; pelvic floor exercises may be used to counteract this pre and post operation. Pre-operative pelvic floor exercising significantly decreases the prevalence of urinary incontinence post radical prostatectomy.[18] Prostatitis and prostatectomies are two contributors toerectile dysfunction; following a radical prostatectomy studies show that erectile dysfunction is improved by pelvic floor muscle training under the supervision of physical therapists certified in pelvic floor rehabilitation.[19]
Perineology or pelviperineology is a specialty dealing with the functional troubles of the three axes (urological, gynecological and coloproctological) of the pelvic floor.[20]
This article incorporates text in thepublic domain frompage 420 of the 20th edition ofGray's Anatomy(1918)
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