2. 1. 2. 3. 4. 5. 2 3. 3 4. 1.5 () 4 5. 100 120- 180 120- 180
1.5 2 99 5 6. 1. 1200 2. 3. 4. 5. D D 6. 7. 6 7. 7 8. 2025 ()1015 8
9. 1 9 10. 10 11. 1. 2. 11 12. 12 13. 50025 13 14. 20 2.54 34 1
1520 14 15. 10%-30% 2011 15 16. 55 16 17. 17 18. ICS 18 19. 19 20.
1. 2. 3. 4. 5. 3 4 20 21. 8 88 812 3812 3812 21 22. 1948(Kegel) 80%
() (,,,,)70% 22 23. ( 12) 12 90() 5 23 24. (): 24 25. 1. 2. 3. 4.
5. 6. 25 26. - :(1)(2)(3) 26 27. - (1):(2) (1) :(2) 27 28. 28 29.
Levator ani arisesThe levator ani is a broad, thin muscle ,
situated on the side of the pelvis .It is attached to the inner
surface of the side of the lesser pelvis, and unites with its
fellow of the opposite side to form the greater part of the floor
of the pelvic cavity.It supports the viscera in pelvic cavity, and
surrounds the various structures which pass through it.In
combination with the coccygeus muscle , it forms the pelvic
diaphragm .The levator ani is divided into three
parts:Iliococcygeus musclePubococcygeus musclePuborectalis muscle
Origin and insertion of fibersThe levator ani arises, in front,
from the posterior surface of the superior ramus of the pubis
lateral to the symphysis ; behind, from the inner surface of the
spine of the ischium ; and between these two points, from the
obturator fascia .Posteriorly, this fascial origin corresponds,
more or less closely, with the tendinous arch of the pelvic fascia,
but in front, the muscle arises from the fascia at a varying
distance above the arch, in some cases reaching nearly as high as
the canal for the obturator vessels and nerve.The fibers pass
downward and backward to the middle line of the floor of the
pelvis; the most posterior are inserted into the side of the last
two segments of the coccyx ; those placed more anteriorly unite
with the muscle of the opposite side, in a median fibrous raph
(anococcygeal raph), which extends between the coccyx and the
margin of the anus .The middle fibers are inserted into the side of
the rectum , blending with the fibers of the Sphincter muscles;
lastly, the anterior fibers descend upon the side of the prostate
to unite beneath it with the muscle of the opposite side, joining
with the fibers of the sphincter ani externus and transversus
perinei , at the central tendinous point of the perineum .The
anterior portion is occasionally separated from the rest of the
muscle by connective tissue.From this circumstance, as well as from
its peculiar relation with the prostate , which it supports as in a
sling, it has been described as a distinct muscle, under the name
of Levator prostat .In the female the anterior fibers of the
Levator ani descend upon the side of the vagina . 29 30. 30 31. 1.
2. 4. 9. 1-38. 1-37. 5- 153. 5. 6. 10. 31 32. 2010.1 2005,12
www.bladderbowel.gov.au 32 33. 33
