Female pelvic anatomy is a complex combination of muscles, ligaments, nerves, and blood
vessels that act dynamically to provide support for the urethra, bladder, uterus, and rectum. An
understanding of normal mechanisms of pelvic support are essential in the evaluation of women
with voiding complaints, urinary incontinence, and bowel dysfunction related to pelvic floor
relaxation. Thus, the treatment of female urinary incontinence often involves recognition and
treatment of concurrent pelvic pathophysiology such as cystocele, uterine prolapse, enterocele,
rectocele, and perineal laxity. Identification of the various components of pelvic floor
dysfunction is aided by diagnostic tools such as video urodynamics and magnetic resonance
imaging of the pelvis. This chapter will focus on normal female pelvic anatomy, including
the supporting structures relevant to voiding dysfunction and incontinence, as well as the
pathophysiology of pelvic floor relaxation, with a description of the various components of
pelvic organ prolapse.