Imaging of the Pelvic Floor
Abdel Karim M. El Hemaly, Laila A.E.S. Mousa, Ibrahim M. Kandil and Khaled A Shehata
Affiliation: Faculty of Medicine, Al Azhar University, Cairo, Egypt.
Keywords: Collagen, internal urethral sphincter (IUS), internal anal sphincter (IAS), three dimension ultrasound (3DUS),
magnetic resonance imaging (MRI).Collagen, internal urethral sphincter (IUS), internal anal sphincter (IAS), three dimension ultrasound (3DUS),
magnetic resonance imaging (MRI).
Urinary continence depends on, an intact internal urethral sphincter (IUS) with a high alpha-sympathetic tone
gained by learning in childhood both create high urethral pressure. The IUS is a collagen-muscle tissue cylinder that extends
from the bladder neck to the perineal membrane in both sexes. Childbirth trauma causes injury to the vagina and the
intimately lying IUS. It lacerates the collagen frame of the IUS. A weak torn IUS will not stand sudden rise of abdominal
pressure and urine leaks, stress urinary incontinence (SUI). Imaging with three-dimension ultrasound (3DUS) and MRI
demonstrate the torn IUS and show the site and extent of the injury. Torn upper part of the IUS causes funneling and apparent
descent of the bladder neck and leads to overactive bladder. Torn lower part leads to genuine SUI. Injury to the
whole length leads to mixed- type of urinary incontinence and apparent shortening of the urethra with collapsed torn
Fecal continence depends on a closed anal canal that depends on the integrity of both anal sphincters, the internal anal
sphincter (IAS) and the external anal sphincter (EAS). It also depends on intact reactive nervous system and on an acquired
high alpha-sympathetic tone at the IAS gained by training in early childhood. The IAS is a collagen-muscle tissue
cylinder that surrounds the anal canal with the EAS surrounds it in its lower part. Torn EAS is obvious, but only imaging
with 3DUS and MRI show an open anal canal with torn IAS in cases of fecal incontinence.
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