Urine and bowel continence

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Del curso dictado por Universiteit Leiden

Anatomy of the Abdomen and Pelvis; a journey from basis to clinic.

302 calificaciones

Universiteit Leiden

Anatomy of the Abdomen and Pelvis; a journey from basis to clinic.

302 calificaciones

In this anatomy course you will explore the organs involved in our food digestion and discover the common causes of abdominal and pelvic pain. The latest graphics and animations will help you to find new insights and understanding of this part of the body, that has been the focus of anatomical research for centuries and presently arouses renewed scientific interest. You will explore the 3D anatomy of the organs from a basic level, providing thorough anatomical understanding, to its advanced application in surgical procedures. This course will challenge you to discover and help you to understand the anatomy of the abdomen and pelvis in all its aspects, ranging from its embryological underpinnings, via digital microscopy to gross topography and its clinical applications. The course is unique in that it continuously connects basic anatomical knowledge from the lab with its medical applications and current diagnostic techniques. You’ll get the chance to discuss anatomical and clinical problems with peers and experts in forum discussions and you will receive guidance in exploring the wealth of anatomical information that has been gathered over the centuries. Follow us on an exciting journey through the abdomen and pelvis where you digest your food but also where new life starts!

De la lección

Protecting the internal organs

The abdominal body wall and the pelvis are the topics of this week. What happens if you push hard to pass a stool, or in reverse, how do you prevent unwantedly passing a stool when you sneeze or cough hard? It may not seem the most attractive area of the body, but the rectum and anus hold many intricacies and even nowadays new things are discovered! Weak areas in the body wall are a frequent cause of problems, for instance they can lead to inguinal hernias. You will learn about their complicated anatomy. And finally, we will dive deep in the pelvis and learn about its hidden gems: the internal genitals.

The hidden importance of the pelvic floor1:34

Urine and bowel continence5:02

Conoce a los instructores

Marco De Ruiter, PhD
Professor of Clinical and Experimental Anatomy
Leiden University Medical Centre
Paul Gobée, MD
Assistent professor of Anatomy
Leiden University Medical Centre
Beerend P. Hierck, PHD.
Associate professor of developmental biology
Leiden University Medical Center
Daniël Jansma, MSc
E-Learning developer
Leiden University Medical Centre
Bas Boekestijn, MD
Trainee Radiology
Leiden University Medical Centre
Friso Jansen
Drs.
Leiden University Medical Centre

Uncontrolled leakage of urine or stool is a common problem, and

in many countries it is considered a taboo.

Often people who live with incontinence feel shame, and

some will even limit their social relations.

There are many causes and various forms of incontinence.

In this video,

we only pay attention to functional anatomical aspects of the pelvic floor,

in controlling incontinence during physical movement or activity.

The inability to control urine flow during these circumstances

is known as stress incontinence.

We have learned in other lessons that the pelvic floor is a kind of active muscular

trampoline, that contracts when the intra-abdominal pressure increases.

The pelvic floor is a complex structure consisting of striated smooth muscles,

and fibrous tissues.

In order to make it simple, we can divide it into two diaphragms.

The anterior, urogenital diaphragm, and the posterior, pelvic diaphragm.

Let's start with the pelvic diaphragm.

It is a funnel shaped muscle, that consists of a levator ani muscle and

a coccygeus muscle.

They are attached to the fascia of the muscle of the thigh, that is situated at

the inner side of the pelvic wall, the internal obturator muscle.

The deepest and

smallest part of this funnel is the junction of the rectum with the anus.

Below this attachment, a circular sphincter is present.

This is the external anal sphincter muscle.

When it contracts, the anus is closed.

Next to the external sphincter of the anus,

an internal muscle can be identified.

The most important difference between these two muscles, is that the external

sphincter is a striated muscle, and is under the control of our will.

The internal sphincter is a thickening of the circular muscle layer of the guts,

and consist of involuntary smooth muscle cells.

During the day, we are continence by our internal sphincter.

If the anal pressure is increased to a high level, we become aware of it, and

will contract our external sphincter,

until the moment we have found a rest room.

As the anal pressure can increase considerably,

a third closing system is present.

In this figure, we have an inferior view on the pelvic diaphragm.

So we look from a position between the legs, towards the pelvis.

The most inner muscle fibers of the pelvic diaphragm originate from the pubic bone,

and encircle the junction of the rectum with the anus.

When these muscle fibers contract, they compress the episidural

layers of the rectum and the anus, and prevent unwanted emptying.

The easiest way to understand this function

is a garden hose with running water.

When you are cleaning your car on a beautiful Saturday morning,

the squirting stops immediately, when the hose is kinked.

When we look again at the pelvic floor,

we also notice a gap in the pelvic diaphragm, in front of the anus.

In this area, openings of the urogenital organs are present.

These organs have to be fixated, and

therefore, this gap is filled with the second diaphragm.

And here, we have a beautiful view of the urogenital diaphragm.

Although its appearance is in first instance is different from the pelvic

diagram, it consists of striated muscles, smooth muscles, and fibrous tissue.

The closing mechanism of the bladder, with its urethra is very comparable with

the discussed closing mechanisms of the anus.

The combined collaboration of internal and external urethral sphincters within

this diaphragm, resist the pressure waves in the bladder, and close the urethra.

Summarizing the function of the pelvic floor.

We can distinguish two muscles that contract without conscious control.

And these muscles can contact for a very long time,

without becoming tired, but they cannot resist very high pressures.

The three voluntary striated muscles, however, can resist high pressures,

but only to postpone urination or defecation for a short period.

In the next exercises and readers,

you will be provided with more details of this diaphragm.

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