The functional anatomy of the female pelvic floor and stress continence control system

Abstract

This paper provides an overview of the functional anatomy of the structures responsible for controlling urinary continence under stress. The stress continence control system can be divided into two parts: the system responsible for bladder neck support, and the system responsible for sphincteric closure. Age- and injury-related changes in each of these systems are discussed. Understanding the pathophysiology of incontinence on the anatomical level will help to lead to identification of specific defects, thereby allowing better individualized treatment for the incontinent patient.

Fig. 1

Lateral view shows the components of the urethral support system. Note how the levator ani muscles support the rectum, vagina, and urethrovesical neck. Also note how the endopelvic fascia beside the urethra attaches to the levator ani muscle. A contraction of the muscle would lead to elevation of the urethrovesical neck.

Fig. 2

Photo of the space of Retzius. White arrows shows the arcus tendineus levator ani and the black arrows the arcus tendineus fasciae pelvis.

Fig. 3

Anatomy of the urethra shown in longitudinal section.

Fig. 4

Components of the stress continence control system. VLA = vaginolevator attachment; LA = levator ani muscles; D = detrusor muscle; US = urethral sphincter; CU = compressor urethrae; UVS = urethrovaginal sphincter; AT = arcus tendineus fasciae pelvis; PUL = pubourethral ligament; IC = ischiocavernosus muscle; and BC = bulbocavernosus muscle.