Pelviperineology

Figure 1. — Mechanism for restoration of continence with midurethral anchoring. Puborectalis (PRM) stretches the posterior anorectal wall forwards. The pubourethral ligaments (PUL) anchor pubococcygeus muscles (PCM) which fuse posteriorly to form LP (levator plate). PUL laxity will weaken the ability of LP to contract and be tensioned. LP tensioning is a pre-requisite for backward stretching of the rectum (R), and downward rotation around PRM by the longitudinal muscle of the anus (LMA). The small arrows represent the LP/LMA rotational vectors. It is this rotation which assists anorectal closure and forms the anorectal angle. F = fascial attachment of LP to rectal wall.