NAME

DESCRIPTION

FUNCTIONS

Tendinous Arch of Levator Ani (TALA)

This bilateral structure attaches to superior body of the pubic bone lateral to the symphysis and superior lateral to the Tendinous Arch of Pelvic Fascia and the pubococcygeus muscle. Runs laterally as the thick band across the central aspect of the Obturator Internus muscle fascia to attach posteriorly on the ischial spine.

Provides attachment for the anterior part of the pubococcygeus and the entire iliococcygeus muscles of the levator ani.

Tendinous Arch of Pelvic Fascia (TAPF)

This arch is bilateral and attaches to superior body of the pubic bone lateral to the symphysis and inferior medial to the Tendinous Arch of the Levator Ani and superior to the puboccocygeus muscle. This fibrous bands runs posteriorly along the edge of the urogenital hiatus and connects medially to visceral structures in the hiatus. The band ends posteriorly at the ischial spine with the TALA.

Provides support for the visceral structure lying in the urogenital hiatus and closes areas between the viscera in this region and the medial edge of the hiatus. Restricts hypermobile movements in all directions of the bladder neck, urethra, and vagina in female and the prostate and membranous urethra in males.

Pubovesical

This short strong bilateral ligament attaches lateral to the pubic symphysis on the inferior aspect of the pubic body and inferior to the TAPF. It has two and maybe 3 bands. A superior band runs horizontally and an inferior band vertically. These two bands may be connected by a thin third band. In females, the superior band attaches to the sides of the bladder neck and TAPF while the inferior band attaches to the urethra and vagina complex. It is also referred to as the paraurethral and pubourethral ligaments in females. In males, the pubovesical ligament is commonly called the puboprostatic ligament. See below for description and function.

In females, this ligament holds the bladder, urethra and vagina upward and anteriorly. Because of the attachment of the urethra and vagina and because this ligament connects to the TAPF, it will restrict hypermobile posterior, inferior, sideward and rotational movements of these structures.

Sacrogenital

This bilateral thick, fibromuscular ligament connects the sides of the lower uterus, cervix and upper vagina in the female and the sides of the prostate in the male to the S1-S4 segments of the sacrum and the sacrospinous ligament.

Holds the lower uterus, cervix, upper vagina, prostate posteriorly while restricting hypermobile anterior, upward, downward, sideward and rotational movements.

Lateral ligament of bladder

This bilateral endopelvic fascial fold lies deep to the overlying peritoneum. It attaches to the posterior lateral aspect of the bladder and lateral wall of the pelvis. These bilateral fibrous bands run lateral and posteriorly towards the sacrum to join the sacrogenital ligament.

Holds the body of the bladder posteriorly, restricting hypermobile anterior, upward, downward, sideward and rotational movements.

Urachus

This fibromuscular cord attaches to the apex of the urinary bladder and runs superiorly along the anterior abdominal wall to the umbilicus under the peritoneum. It forms the middle umbilical ligament.

Holds the anterior most part of the bladder in a upward and forward position. It would resist downward and posterior movement of the bladder but not sideward or rotational movements.

Anococcygeal ligament

A short, strong, elongated central ligament in median part of the anal triangle of the perineum that connects the posterior aspect of the external anal sphincter to the coccyx bone.

Provides support for the anus and holds it posteriorly, restricting anterior movement of the anus and anal canal. Provides a secure attachment for contraction of the external anal sphincter to voluntarily close the anal opening.