Hammock principle

Hammock is a concept  of the functional anatomy of the structures of the small pelvis important for women´s continence. The hammock principle was first formulated by the American pathologist DeLancey.

According to the hammock principle, the urethra is supported by structures forming a kind of funnel, on which it can lean. The increased intra-abdominal pressure then presses the urethra against this hamate and stress incontinence does not occur. It is formed by a sheath that is suspended by the endopelvic fascia to a reinforced strip of this fascia, the arcus tendineus fasciae pelvis (ATFP). The ATFP runs from the spina sciatic to the lower edge of the symphysis. This hinge is the cause of the characteristic butterfly-shaped cross-section of the vagina (H shape with the middle bar displaced dorsally to the rectum). Its curved course is a consequence of other structures of the supporting and suspension apparatus.

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