Detailed muscular structure and neural control anatomy of the levator ani muscle: a study based on female human fetuses

Timoh, Krystel Nyangoh; Moszkowicz, David; Zaitouna, Mazen; Lebâcle, C.; Martinovic, Jéléna; Diallo, Djibril; Crézé, Maud; Lavoué, Vincent; Daraı̈, Émile; Galand, Benoît; Bessède, Thomas

doi:10.1016/j.ajog.2017.09.021

Cited by 24 publications

(18 citation statements)

References 24 publications

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“…In addition, smooth muscle fibers in the anterolateral portion of the rectum extended from the longitudinal muscle and formed hypertrophic tissue. Several previous studies called this tissue the “hiatal ligament” (Muro et al, 2014; Muro et al, 2018; NyangohTimoh et al, 2018; Shafik, 1999; Tsukada et al, 2016). It was in contact with the inner surface of the levator ani.…”

Section: Discussionmentioning

confidence: 99%

“…The rectococcygeal muscle is thickened smooth muscle tissue located posterior to the rectum. Several previous studies recognized a structure located circumferentially around the rectum (not in the region anterior to it) and called it the “hiatal ligament” (Arakawa, Hayashi, Kinugasa, Murakami, & Fujimiya, 2010; Murakami et al, 2002; Muro et al, 2014; Muro et al, 2018; NyangohTimoh et al, 2018; Shafik, 1999; Tsukada et al, 2016). It contacts the inner surface of the levator ani and is recognized as intermediary with the pelvic viscera.…”

Section: Discussionmentioning

confidence: 99%

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The series of smooth muscle structures in the pelvic floors of men: Dynamic coordination of smooth and skeletal muscles

et al. 2020

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Introduction Recent studies have revealed the extended nature of smooth muscle structures in the pelvic floor, revising the conventional understanding of the “perineal body.” Our aim was to clarify the three‐dimensional configuration and detailed histological properties of the smooth muscle structures in the region anterior to the rectum and anal canal in men. Materials and methods Four male cadavers were subjected to macroscopic and immunohistological examinations. The pelvis was dissected from the perineal side, as in the viewing angle during transperineal surgeries. Serial transverse sections of the region anterior to the rectum and anal canal were stained with Masson's trichrome and immunohistological stains to identify connective tissue, smooth muscle, and skeletal muscle. Results There was a series of smooth muscle structures continuous with the longitudinal muscle of the rectum in the central region of the pelvic floor, and three representative elements were identified: the anterior bundle of the longitudinal muscle located between the external anal sphincter and bulbospongiosus; bilateral plate‐like structures with transversely‐oriented and dense smooth muscle fibers; and the rectourethral muscle located between the rectum and urethra. In addition, hypertrophic tissue with smooth muscle fibers extended from the longitudinal muscle in the anterolateral portion of the rectum and contacted the levator ani. Conclusions The series of smooth muscle structures had fiber orientations and densities that differed among locations. The widespread arrangement of the smooth muscle in the pelvic floor suggests a mechanism of dynamic coordination between the smooth and skeletal muscles.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The series of smooth muscle structures in the pelvic floors of men: Dynamic coordination of smooth and skeletal muscles

et al. 2020

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“…In response to their stimulation, through the central nervous system, it causes changes in the tone of some related striated muscle fibers. Since PFMs consist of skeletal muscle fibers, but also smooth muscle [40,41], it appears that the greater potential impact of SI could be directed to the autonomic nervous system, responsible for the stiffness regulation of fascial tissues via the contractile ability of myofibroblasts, which are connective cells with smooth muscle-like contractile properties, altered global muscle tone, and a change in local vasodilatation and tissue viscosity. Additionally, one of the elements of working with the body, according to the SI method, is the so-called pelvic lift, performed during each of the ten sessions.…”

Section: Discussionmentioning

confidence: 99%

The Rolf Method of Structural Integration and Pelvic Floor Muscle Facilitation: Preliminary Results of a Randomized, Interventional Study

Kasper-Jędrzejewska

Jędrzejewski

Ptaszkowska

et al. 2020

JCM

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The management of pelvic floor dysfunctions might need to be based on a comprehensive neuro-musculoskeletal therapy such as The Rolf Method of Structural Integration (SI). The aim of the study was to evaluate the pelvic floor muscle (PFM) after the tenth session of SI by using surface electromyography (sEMG). This was a randomized, interventional study. Thirty-three healthy women were randomly assigned to the experimental (SI) or control group. The outcome measures included PFM bioelectrical activity, assessed using sEMG and endovaginal probes. An intervention in the SI group included 60 min of SI once a week, and teaching on how to contract and relax PFMs; in the control group, only the teaching was carried out. In the SI group, a significant difference was found between the PFM sEMG activity during “pre-baseline rest” (p < 0.014) and that during “rest after tonic contraction” (p = 0.021) in the supine position, as were significant increases in “phasic contraction” in the standing position (p = 0.014). In the intergroup comparison, higher PFM sEMG activity after the intervention “phasic contraction” (p = 0.037) and “pre-baseline rest” (p = 0.028) was observed in the SI group. The SI intervention significantly changes some functional bioelectrical activity of PFMs, providing a basis for further research on a new approach to PFM facilitation, particularly in clinical populations.

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“…and ) has been called the deep transverse perineal muscle (Henle, ; Zhai et al, ), whereas the part laterally spreading on the superior surface of the levator ani (indicated by the square in Figs. and ) has been called the hiatal ligament (Shafik, ; Muro et al, ; Tsukada et al, ), smooth muscle‐mediated interface (Arakawa et al, ), covering fascia of the levator ani (Murakami et al, ), and the medial part of the levator ani (Nyangoh Timoh et al, ). Most previous studies have reported these smooth muscle structures separately.…”

Section: Discussionmentioning

confidence: 99%

Spatial distribution of smooth muscle tissue in the male pelvic floor with special reference to the lateral extent of the rectourethralis muscle: Application to prostatectomy and proctectomy

et al. 2018

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The anatomy of the rectourethralis muscle is essential for performing radical prostatectomy and proctectomy. The rectourethralis muscle is known to continue to the rectal wall posteriorly and to the membranous urethra anteriorly. However, the lateral extent of the rectourethralis muscle remains unclear. This study aimed to verify the hypothesis that the rectourethralis muscle laterally extends and directly adheres to the levator ani. Eight male cadavers were used for macroscopic dissection, and three male cadavers were used for immunohistological analysis using anti-smooth muscle and anti-skeletal muscle antibodies. The rectourethralis muscle laterally extended smooth muscle fibers both superoposteriorly and inferoanteriorly toward the levator ani. The smooth muscle fibers sandwiched the levator ani superoanteriorly and inferoanteriorly. A few smooth muscle fibers of the rectourethralis muscle inserted into the levator ani. This study clarified the spatial distribution of the rectourethralis muscle and its detailed positional relationship with the levator ani. The findings are valuable especially to urologists and anorectal surgeons for dissecting an optimal layer around the urethra and the rectum, and for avoiding rectal or urethral injuries during surgery. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.

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Detailed muscular structure and neural control anatomy of the levator ani muscle: a study based on female human fetuses

Cited by 24 publications

References 24 publications

The series of smooth muscle structures in the pelvic floors of men: Dynamic coordination of smooth and skeletal muscles

The series of smooth muscle structures in the pelvic floors of men: Dynamic coordination of smooth and skeletal muscles

The Rolf Method of Structural Integration and Pelvic Floor Muscle Facilitation: Preliminary Results of a Randomized, Interventional Study

Spatial distribution of smooth muscle tissue in the male pelvic floor with special reference to the lateral extent of the rectourethralis muscle: Application to prostatectomy and proctectomy

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