Endopelvic Fascia is a Core Component of the Pelvic Support System
Yes, endopelvic tissue (endopelvic fascia) is definitively included as a fundamental structural element of the pelvic support system in adult females. 1
Anatomical Role and Function
The endopelvic fascia serves multiple critical support functions:
The endopelvic fascia forms a fibrous visceral sheath that covers both the bladder and upper vagina, binding these structures together as an integrated support unit. 2
The fascia provides passive pelvic floor support as part of the connective tissue framework, working in concert with active muscular support from the pelvic floor muscles. 3
Endopelvic fascia contributes directly to the support of both the uterus and vagina as part of the overall pelvic organ support architecture. 4
Integration with Other Support Structures
The endopelvic fascia functions as part of a dual mechanical system:
The supporting system includes the levator ani muscle, the arcus tendineus fasciae pelvis (where endopelvic fascia attaches), and the adipose cushion pillow working together. 2
The suspension system involves neurovascular structures with associated endopelvic fascia condensation that suspends pelvic organs posterolaterally. 2
The arcus tendineus fasciae pelvis serves as a critical attachment point for endopelvic fascia, and failure at this attachment site specifically causes lateral cystocele formation. 5
Clinical Significance
Understanding endopelvic fascia is essential for prolapse management:
Discrete defects in endopelvic fascia can be identified and surgically rectified to cure prolapse, making recognition of these defects clinically actionable. 4
Alterations in the fascial extracellular matrix may lead to weakening of the fascia and subsequent development of prolapse. 4
Surgical techniques for prolapse repair specifically anchor mesh between the arcus tendineus of the endopelvic fascia to restore support. 6
Pubocervical fascia failure (a component of endopelvic fascia) at its cervical ring insertion causes apical cystocele, while failure at the arcus tendineus fasciae pelvis attachment causes lateral cystocele. 5
Imaging Visualization
Modern imaging modalities can directly assess endopelvic fascia:
MRI with its high soft-tissue contrast resolution allows direct visualization of pelvic floor muscles and fascia, enabling detection of support defects such as displaced lateral and apical vaginal walls. 1
The use of endorectal coil may help better visualize the supporting ligaments in the pelvis, though this is not routinely performed due to invasiveness and potential tissue distortion. 1