Fascia

Fascia envelopes levator ani, attaches it to bone at its origin and holds the two muscles together in the midline. The urethra, vagina and rectum perforate this midline fascia. Thus, the pelvic viscera are supported both by the leva-tor ani muscle below and the fascial attachments which are condensed in some areas and are often referred to as ligaments - the uterosacral, cardinal and round ligaments being examples. There has been much debate for over a century about the structure and function of the pelvic fascia. It is generally accepted that the pelvic floor has evolved as man has assumed the upright stature and this evolution has involved replacement of some of the muscular component of the pelvic floor with fascia to provide additional supportive strength to cope with the effect of gravity. Thus, any factor that influences the strength or integrity of pelvic floor fascia will influence the function of the pelvic floor. These factors may be congenital (such as hyperelasticity of the collagenous component of fascia) or environmental, such as stretching or tearing of fascia during childbirth or heavy lifting.

Weakness of the pelvic floor, which may result from impairment of function of either muscle or fascia, can result in uterovaginal prolapse. Prolapse is largely a result of loss of support from the pelvic floor but the pelvic floor dysfunction may produce other accompanying symptoms than those due to the displacement of the pelvic viscera. An understanding of the pathophysiology of pelvic floor dysfunction will help to develop an appropriate management strategy.

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