This Library holds Anatomy drawings that help you visualize the more common pelvic floor concerns we manage. In addition to reviewing these diagrams, we invite you to follow the related links to learn more about these conditions.
Pelvic Floor Anatomy
Pelvic Floor Anatomy
Normal Anatomy With Uterus
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Normal Anatomy Without Uterus
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Original Images Courtesy of BARD Medical - Subject to Copyrights
Labeling Enhanced for Educational Purposes by D. K. Veronikis, MD
Utero-Vaginal Prolapse
Utero-Vaginal Prolapse Progression
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Original Images Courtesy of BARD Medical - Subject to Copyrights
Labeling Enhanced for Educational Purposes by D. K. Veronikis, MD
The image on the left reflects the normal positioning of the Uterus in the pelvic floor. Moving from left to right, the image on the far right shows an advanced case of Uterine Prolapse. Additionally, there is weakening of the vaginal tissues in front of the uterus as well as around the uterus which allows the uterus to fall into the vaginal canal. Also note that this prolapse (dropping) has impacted the bladder and rectum. Complete repair of this specific prolapse condition must include fixing the apex by either supporting or removing the uterus, but also repairing the support to the remaining pelvic floor organs; the vagina, bladder, rectum and perineum.
Articles:What Is Uterine Prolapse? |
Media:Prolapse Surgical ImagesVIDEO: Uterine Preservation |
Post-Hysterectomy Vaginal Vault Prolapse
Vaginal Vault Prolapse (Post-Hysterectomy)
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Original Images Courtesy of BARD Medical - Subject to Copyrights
Labeling Enhanced for Educational Purposes by D. K. Veronikis, MD
The image on the left reflects the normal positioning of the Vaginal Cuff in the pelvic floor after a Hysterectomy. Moving from left to right, the image on the far right shows an extreme case of Vaginal Vault Prolapse. Additionally, there is weakening of the vaginal tissues supporting the Anterior Vaginal Wall. This pressure, in the advanced case, from the prolapse creates a “kink”, an obstruction, with the urethra which leads to difficulty with bladder evacuation. Additionally, there is weakening of the vaginal tissues supporting the Posterior Vaginal Wall. This pressure, in the advanced case, from the prolapse creates a “pouch” in the bowel wall, an obstruction, with the weak perineum which leads to difficulty with bowel evacuation.
Furthermore, the is weakening of the Vaginal Cuff as well as the Anterior and Posterior Vaginal Wall supportive structures has permitted the development of an enterocele, peritoneal cavity hernia into the pelvis. This type of hernia defect will eventually with peritoneal pressure push the small and sometimes large bowel into this peritoneal pouch which can be seen in the advanced case. The stretch on the bowel and mesentery will create a back ache that responds to rest and laying down.
Complete and proper repair of this specific prolapse condition must include fixing the vaginal apex (the cuff), the enterocele, as well as the caliber to the vaginal canal and repairing the support to the remaining pelvic floor organs; the bladder, urethra, rectum and perineum. Singular pelvic floor defects are a rare occurrence.
Additional Resources:
Vaginal Vault Prolapse |
Vaginal Vault Prolapse Surgical Images |
Enterocele (Small Bowel Hernia)
Small Bowel Hernia Progression
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Cystocele (Dropped Bladder)
Cystocele Progression With Uterus
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Original Images Courtesy of BARD Medical - Subject to Copyrights
Labeling Enhanced for Educational Purposes by D. K. Veronikis, MD
The image on the far left reflects the normal position of the Anterior Vaginal Wall and of the bladder. Moving from left to right, the image on the far right shows an advanced case of anterior vaginal wall prolapse with the uterus in place. Additionally, the advanced prolapse of the anterior vaginal wall has obstructed the urethra which may cause challenges with obstructed urination or symptoms of Incontinence. With advancing prolapse (as indicated on the far right) the bladder will protrude thru the vaginal opening and will be perceived as a bulge. Singular pelvic floor defects are a rare occurrence. For the benefit of explanation we will consider Cystocele in isolation. A Cystocele is a defect of the support of the anterior vaginal wall and is part of Utero-Vaginal Prolapse.
Cystocele Progression Without Uterus
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Original Images Courtesy of BARD Medical - Subject to Copyrights
Labeling Enhanced for Educational Purposes by D. K. Veronikis, MD
The image on the far left reflects the normal position of the Anterior Vaginal Wall and of the bladder. Moving from left to right, the image on the far rights hows an advanced case of anterior vaginal wall prolapse. Additionally, the advanced prolapse of the anterior vaginal wall has obstructed the urethra which may cause challenges with obstructed urination or symptoms of Incontinence. With advancing prolapse (as indicated on the far right) the bladder will protrude thru the vaginal opening and will be perceived as a bulge. Singular pelvic floor defects are a rare occurrence. For the benefit of explanation we will consider Cystocele inisolation. A Cystocele is a defect of the support of the anterior vaginal wall and is a type of Vaginal Prolapse.
Additional Resources:
Rectocele (Rectal Hernia)
Rectocele Progression With Uterus
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Original Images Courtesy of BARD Medical - Subject to Copyrights
Labeling Enhanced for Educational Purposes by D. K. Veronikis, MD
Rectocele Progression Without Uterus
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The image on the far left reflects the normal position of the posterior vaginal wall and of the rectum. Moving from left to right, the image on the far right shows an advanced case of posterior vaginal wall prolapse. Additionally, the advanced prolapse of the posterior vaginal wall can stretch the normal location of the rectum causing challenges with fecal elimination. With advancing prolapse (as indicated on the far right) the rectum will protrude the vaginal opening and will be perceived as a bulge. Singular pelvic floor defects are a rare occurrence. For the benefit of explanation we will consider Rectocele an isolation. A Rectocele is a defect of the support of the posterior vaginal wall and is a type of Vaginal Prolapse.
Additional Resources:
Choices for Hysterectomy without Ovarian Removal
Hysterectomy Types – Separate and distinct from the ovaries
Normal Anatomy With Uterus
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Complete Hysterectomy
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Supracervical (Partial) Hysterectomy
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Original Images Courtesy of BARD Medical - Subject to Copyrights
Labeling Enhanced for Educational Purposes by D. K. Veronikis, MD
The image to far left shows normal anatomy with a complete uterus (uterine body and cervix). The center image depicts a hysterectomy which is removal of only the uterine body and cervix. The image to the far right shows a partial hysterectomy, defined as removal of only the uterine body. These definitions hold true regardless of surgical modality for hysterectomy or partial/supracervical. Removal of the tubes and ovaries, regardless of surgical approach, is called a salpingectomy and oophorectomy. The term hysterectomy has never implied removal of the tubes and ovaries. Tubes and ovaries are not shown in these anatomic illustrations.
Additional Resources:
Stress Urinary Incontinence
Stress Urinary Incontinence With Uterus
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The image to far left shows normal anatomy with urine in the bladder. The urethra is suspended from the pubic symphysis by the intact Pubo-Urethral ligaments. The center image depicts the urethra under the influence of pressure such as laughing, coughing and sneezing or lifting. The position the urethra is maintained by the intact Pubo-Urethral ligaments and NO stress urinary incontinence or leakage occurs. The image on the far right depicts the urethra under the influence of pressure such as laughing, coughing and sneezing or lifting. The position the urethra is NOT maintained as the Pubo-Urethral ligaments are NOT intact and stress urinary incontinence or leakage occurs when pressure is applied from laughing, coughing and sneezing or lifting releasing small amounts of urine to leak.
Stress Urinary Incontinence Post-Hysterectomy
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Original Images Courtesy of BARD Medical - Subject to Copyrights.
Images Modified for Educational Purposes by D. K. Veronikis, MD
The image to far left shows normal anatomy with urine in the bladder. The urethra is suspended from the pubic symphysis by the intact Pubo-Urethral ligaments. The center image depicts the urethra under the influence of pressure such as laughing, coughing and sneezing or lifting. The position the urethra is maintained by the intact Pubo-Urethral ligaments and NO stress urinary incontinence or leakage occurs. The image on the far right depicts the urethra under the influence of pressure such as laughing, coughing and sneezing or lifting. The position the urethra is NOT maintained as the Pubo-Urethral ligaments are NOT intact and stress urinary incontinence or leakage occurs when pressure is applied from laughing, coughing and sneezing or lifting releasing small amounts of urine to leak.
