Episiotomy during childbirth, intended to protect the anal sphincter, may fail to do so. Furthermore damage to the anal sphincter complex may occur without complete perineal tear.We hypothesise that these particular injuries may occur due to posterior displacement of the anus leading to distraction of the anal sphincter complex from an anterior attachment to the perineal membrane. However, the anatomical basis for this has not been well defined.
To investigate the relationship between the anal sphincter and the perineal membrane. Materials and methods High-resolution MRI scans of a female cadaver perineum were performed. The imaging findings were correlated with the anatomical structure identified on dissection and histological examination.
The perineal membrane was easily identified on MR imaging. Fibres from the perineal membrane could be seen to attach to the anal sphincter complex at the apex of the perineal body. This was confirmed on histological examination and was a deeper layer than that of the decussation of the superficial transverse perineal muscle with the superficial part of the external anal sphincter.
The upper ano-rectal canal and apex of the perineal body have demonstrable attachment to the free margin of the perineal membrane postero-lateral to the lower vagina. This attachment would resist posterior displacement of the anal canal.