Ten female soft embalmed cadavers were dissected after a colorectal hands-on workshop to visualize components of the pelvic organ support system.
The puborectalis attached at the superior pubic ramus above the arcus tendineus fasciae pelvis. The anterior half of the iliococcygeus originated at the level of the arcus tendineus fasciae pelvis but descended from the arcus tendineus fasciae pelvis before it reached the ischial spine. The fibrous visceral sheath of the endopelvic fascia covered both the bladder and the upper vagina and bound these structures together. The levator ani muscle was separated into a horizontal and a vertical part at the medial attachment of the fibrous visceral sheath. A well-circumscribed adipose cushion pillow, in the ischioanal fossa and its anterior recess, supported the horizontal part of the levator ani muscle and pressed the vertical part against the pelvic viscera. Perivascular sheaths and pelvic nerve plexuses were reinforced by condensed endopelvic fascia, they suspended the pelvic organs posterolaterally.
The pelvic organ support framework consists of two mechanical structures: (1) the supporting system of the levator ani muscle, the arcus tendineus fasciae pelvis and the adipose cushion pillow, and (2) the suspension system of the neurovascular structures and the associated endopelvic fascia condensation.