Clinical Evaluation of Urinary and Fecal Incontinence in Women Requires Changes in the Perineal Body Assessment

Abstract

Background: The perineal body (PB) in women plays a role in urinary or fecal incontinence or combined urinary and fecal incontinence. In the general women’s population, the urinary incontinence prevalence is 48.4%, fecal incontinence affects women in 25.6%, and combines urinary and fecal incontinence is 9.4%—the defective PB causing these challenging symptoms is unknown. Surgical or obstetrical injury to this structure can be responsible for those symptoms. The cause of inadvertent damage is directly related to inappropriate teaching gross, topographic, and surgical anatomy. Urinary and fecal incontinence and their potential prevention are of interest to multi clinical specialties and anatomists of undergraduate, graduate, and postgraduate educators. Over the last 40 years, the gross, topographic, and clinical anatomy teaching and educational resources place the perineal body within posterior perineal musculatures in the vertical orientation. In this study, the perineal body’s exact anatomical location and orientation will be demonstrated and documented. Methods: Anatomical dissections were conducted on fresh human female adult cadavers to establish the perineal body gross and topographic anatomy in the prospective case series study type. The primary outcome measured the PB’s natural location and its orientation in women. The objective was to assess whether the PB was a part of the posterior perineum and, if not, where this structure’s natural location and orientation occurred. Findings: This study enrolled fifteen fresh-human-adult-female cadavers. Anatomical stratum-by-stratum dissection showed that the PB location was under the posterior-distal vaginal wall in the horizontal orientation. The PB was an oval-shaped, solid, muscular mass without the central tendon point or fascia. Horizontally, the PB median height was 4.2 cm ± 1.6 (SD). Interpretation: Urinary and fecal incontinence can be minimized by adopting the PB’s natural gross and topographic anatomy. The current study well-documented that PB’s location was under the posterior-distal vagina and not within the posterior perineal musculature (the vertical orientation). Additionally, this study presents the opportunity to develop a meaningful surgical intervention. Appropriate clinical evaluation of the PB in the horizontal orientation can strengthen the therapy for symptomatic, defective PB. The prognostic factor of surgical outcomes is to identify site-specific defects on the PB’s anterior and posterior surfaces before surgically re-establishing the PB integrity that can potentially cure female urinary, fecal incontinence, or combine urinary and fecal incontinence. Conclusions: This study’s findings are reproducible and imply that the perineal body is an internal muscular anatomical structure located under the posterior-distal vaginal wall in the horizontal orientation and rests on the rectovaginal septum with multiple extensions to adjacent anatomical structures. Clinicians should assess the perineal body in the horizontal orientation, and the clinical recommendation to evaluate the perineal body vertically should be invalidated. Implementing these study findings to the clinical use can play a significant role in urinary and fecal incontinence in women. The perineal body undergraduate, graduate, and postgraduate teaching should be revised. Additional clinical-scientific research on the perineal body is needed. Funding Statement: The study did not receive any grant. Declaration of Interests: None. Ethics Approval Statement: The deceased’s family provided consent to perform anatomical dissection research on the urogenital organs, and the family could withdraw the permission at any time. The local Bioethics Committee of the Medical University approved the study protocol (AKBE 146/12).