A dynamic coordinated system maintains the integrity of the pelvic floor. Normal control of the pelvic floor develops through learned behavior to provide for storage and evacuation in the bladder and anorectum. Because of the high prevalence of disorders of urinary incontinence,<sup>24 Fantl J.A., Newman D.K., ollin J. , y al.   Urinary incontinence in adults: Acute and chronic management Rockville, MD: US Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research (March 1996.).  Clinical Practice Guideline, No. 2, 1996 Update. AHCPR Publication No. 96-0682.

Haga clic aquí para ir a la sección de Referencias</sup> anal incontinence,<sup>75 Sultan A.H. Anal incontinence after childbirth Curr Opin Obstet Gynecol 1997 ;  9 : 320-324

Haga clic aquí para ir a la sección de Referencias</sup> pelvic organ prolapse,<sup>51 Olsen A.L., Smith V.J., Bergstrom J.O. , y al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence Obstet Gynecol 1997 ;  89 : 501-506  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> and combined pelvic support disorders<sup>34 Jackson S.L., Weber A.M., Hull T.L. , y al. Fecal incontinence in women with urinary incontinence and pelvic organ prolapse Obstet Gynecol 1997 ;  89 : 423-427  [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> in women, an understanding of the complex anatomy responsible for maintaining normal support is important. In a previous discussion of the anatomy of stress urinary incontinence, Strohbehn and DeLancey<sup>72 Strohbehn K., DeLancey J.O.L. The anatomy of stress incontinence Oper Tech Gynecol Surg 1997 ;  2 : 5-16

Haga clic aquí para ir a la sección de Referencias</sup> reviewed the anatomy of the pelvic floor. Some of the concepts reviewed in this article are derived and modified from that original review.

Voluntary storage of urine and enteric contents occurs despite sudden changes in abdominopelvic pressures that accompany daily activities such as laughing, sneezing, coughing, positional changes, walking, bending, and standing. Pressures in the bladder of a healthy woman change from the supine to standing position by approximately 9 mm Hg (12 cm H₂O), whereas maximal intraurethral pressures increase by a greater amount, 14 mm Hg.<sup>32 Henrikkson L., Ulmsten U., Andersson K.E. The effect of changes of posture on the urethral closure pressure in healthy women Scand J Urol Nephrol 1977 ;  11 : 201-206

Haga clic aquí para ir a la sección de Referencias</sup> This difference in pressure between the bladder and urethra during the simple activity of standing is the result of coordinated reflexes that allow a woman to remain continent despite a stress added to the bladder. To maintain continence, the increased pressure in the urethra must be sustained while the individual remains standing. When intra-abdominal pressure increases, such as during a cough, anatomic compensations at the bladder outlet must precede or occur simultaneously to counter additional rises in bladder pressure.

In support of the pelvic floor, each anatomic structure provides a functional contribution. Conceptually, it is useful to divide pelvic floor anatomy artificially into passive and active structures (Table 1)<sup>72 Strohbehn K., DeLancey J.O.L. The anatomy of stress incontinence Oper Tech Gynecol Surg 1997 ;  2 : 5-16

Haga clic aquí para ir a la sección de Referencias</sup> Examples of passive structures include the pelvic bones and connective tissue. Active support structures include neuromuscular structures that result in sustained (tonic) and intermittent voluntary pelvic floor muscle contractions during activity. The active support structures include the neurologic “wiring” to the pelvic floor muscles and the muscles themselves. The sections that follow review the different structures that contribute to passive and active support of the pelvic floor. The anatomy of bladder, urethra, and anorectum is reviewed with respect to pelvic floor support and continence.