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Rugae

Rugae (singular: ruga) are anatomical folds or creases in the mucous membrane lining the internal surfaces of various hollow organs, most prominently observed in the stomach where they form prominent ridges when the organ is empty.^[1] These structures consist of redundant layers of mucosa and submucosa that enable organ distension, increase surface area for physiological processes like secretion and absorption, and facilitate mechanical functions such as mixing or gripping contents.^[2]^[3] Derived from the Latin word for "wrinkle," rugae are temporary and dynamic, flattening or unfolding in response to volume changes within the organ.^[4] In the gastrointestinal tract, gastric rugae are the most well-known example, appearing as prominent folds, often longitudinal, in the body and fundus of the stomach, with more regular longitudinal arrangement in the antrum, composed of columnar epithelium and supported by underlying smooth muscle layers.^[5] Their primary functions include accommodating up to 4 liters (1 gallon) of food and liquid by expanding the stomach's capacity and aiding in the physical breakdown of ingested material through contraction and gripping.^[6] Beyond the stomach, rugae occur in other sites, such as the hard palate where palatal rugae—typically three to five transverse ridges per side—assist in positioning the tongue during chewing and swallowing.^[7] In the female reproductive system, vaginal rugae form irregular transverse folds along the vaginal walls, enhancing elasticity to allow distension during intercourse, childbirth, and menstruation while supporting a healthy microbial environment.^[8]^[9] These variations highlight rugae's role in adapting organ function to mechanical and physiological demands across different body systems.^[5]

Introduction

Definition

Rugae are anatomical folds or wrinkles, typically irregular in form, that occur in the mucous membrane, or mucosa, and occasionally extend into the submucosa of various hollow organs.^[4] These structures manifest as longitudinal or transverse ridges, becoming prominently visible when the organ is in a relaxed or empty state.^[10] Composed primarily of the mucosal layer with potential involvement of the underlying submucosa, rugae exhibit a temporary nature, flattening or disappearing upon distension of the organ to accommodate expansion.^[11] This configuration inherently contributes to an increased internal surface area in the undilated condition.^[12] These folds reflect their appearance in the contracted state of the organ, with the term deriving from the Latin for "wrinkle."^[4] Such folds are observed across multiple organ systems, including the stomach, vagina, and urinary bladder, underscoring their widespread occurrence in mucosal linings of distensible viscera.^[13]

Etymology

The term "rugae" originates from the Latin word ruga, meaning "wrinkle," "fold," or "crease," particularly referring to a facial wrinkle or ridge.^[14] This root entered New Latin as a descriptor for anatomical features, with the plural form rugae first known in English anatomical contexts in 1683.^[4] In the evolution of medical terminology, rugae was adopted into English through Latin-based anatomical texts during the 18th century to denote irregular, wrinkled mucosal folds in organs.^[4] Today, rugae commonly describes these features in structures such as the gastric mucosa.^[4]

Anatomy

Gastric Rugae

Gastric rugae, also known as gastric folds, are prominent features of the stomach's inner lining, primarily located in the body and fundus regions, where they form longitudinal ridges running parallel to the lesser and greater curvatures from the cardia toward the pylorus.^[15]^[16] These folds are less evident or absent in the antrum.^[16] Structurally, gastric rugae consist of folds of the mucosa and submucosa layers, creating irregular, accordion-like ridges that are most pronounced when the stomach is empty and contract to facilitate expansion.^[17]^[10] Upon distension, these folds flatten and largely disappear, allowing the stomach to accommodate increased volume.^[17] Histologically, the rugae are lined by a simple columnar epithelium that includes surface mucous cells, with invaginations forming gastric pits that lead to underlying tubular gastric glands containing parietal cells for acid secretion and chief cells for pepsinogen production.^[18] The submucosal layer, rich in connective tissue, blood vessels, and the Meissner plexus, provides resilience and support to these folds.^[18] Embryologically, gastric rugae develop during fetal stages through gastric rotation and differential growth, driven by reciprocal interactions between the epithelium and surrounding mesenchyme that induce folding of the mucosal and submucosal layers.^[19]

Vaginal Rugae

Vaginal rugae, also known as rugae vaginales, are located on the anterior and posterior walls of the vagina, where they form transverse ridges arising from the median longitudinal vaginal columns. These shallow, numerous folds are more pronounced in the lower third of the vagina, enabling the organ to elongate and distend during physiological processes. The rugae consist of mucosal elevations separated by furrows, enhancing the vagina's overall elasticity and capacity for expansion. Histologically, the rugae are lined by stratified squamous non-keratinized epithelium, which rests on a basement membrane and overlies loose connective tissue in the lamina propria containing elastic fibers. This epithelial layer, typically 10–30 cells thick, exhibits cyclic changes influenced by hormones, with parabasal, intermediate, and superficial cell layers varying in glycogen content. The prominence of the rugae fluctuates with age and hormonal status; they become more developed under estrogen stimulation during puberty and pregnancy, while atrophying post-menopause due to reduced estrogen levels. Developmentally, vaginal rugae emerge during the embryogenic canalization of the vaginal canal between weeks 14 and 22 of gestation, primarily derived from the fused paramesonephric (Müllerian) ducts that form the upper two-thirds of the vagina. The epithelial component originates solely from Müllerian duct epithelium, with folding and thickening occurring around week 22 under early hormonal influences. These structures contribute to the vagina's distensibility, allowing accommodation during distending events.

Palatine Rugae

Palatine rugae, also known as plicae palatinae transversae, are transverse ridges located on the anterior portion of the hard palate, positioned bilaterally and extending posteriorly from the incisive papilla.^[20] These structures form a series of folds in the anterior third of the palate, immediately behind the incisive papilla, and are oriented perpendicular to the midpalatine raphe.^[21] Typically, there are three to five prominent rugae on each side, arranged in a slightly diverging manner laterally from the midline, with shapes that can be straight, wavy, or curved.^[20] Their lengths vary, often reaching up to 1 cm near the midline before becoming shorter and more irregular toward the sides.^[22] The patterns of these rugae are unique to each individual, resembling fingerprints in their stability and specificity, and remain consistent after tooth eruption.^[21] Histologically, the palatine rugae are covered by a layer of stratified squamous epithelium, which provides a protective barrier over the underlying structures.^[23] Beneath this epithelium lies the submucosa, containing minor salivary glands that contribute to oral lubrication, while the rugae themselves are supported by dense, irregular connective tissue anchored to the underlying bone.^[24] This connective tissue framework ensures the ridges' firmness and resilience.^[23] The ontogeny of palatine rugae begins during embryonic development, with initial formation occurring between 12 and 14 weeks of gestation, driven by genetically determined processes that establish their individual patterns.^[25] These patterns stabilize by the end of the fourth month in utero and persist throughout life unless disrupted by pathology.^[21]

Rugae in Other Organs

In the urinary bladder, the mucosal lining features fine, irregular folds known as rugae, which are most prominent when the organ is empty and flatten as it distends to accommodate urine.^[12] These rugae contribute to the bladder's capacity, typically allowing storage of up to 500 milliliters in adults.^[26] The lining consists of transitional epithelium, which stretches smoothly during filling.^[27] The gallbladder also exhibits rugae in its mucosal layer, appearing as fine folds primarily in the fundus and body regions, organized within a simple columnar epithelium.^[28] Unlike structures with deeper layers, these are shallow infoldings confined to the mucosa, as the gallbladder lacks a submucosa.^[28] In both the bladder and gallbladder, rugae represent simple mucosal folds without significant submucosal extension, contrasting with the deeper, submucosa-involved rugae in the stomach's columnar epithelium. These formations arise embryologically from endodermal folding during visceral development.^[29] Rugae are notably absent or minimal in the esophagus, highlighting site-specific variations in mucosal architecture. Like gastric rugae, those in these organs enhance distensibility.^[17]

Functions

Mechanical Role

Rugae serve a primary mechanical function in accommodating volume changes within hollow organs by unfolding to permit expansion without compromising structural integrity. In the stomach, for instance, these folds allow the organ to increase from an empty capacity of approximately 50 mL to 1-2 L when filled, enabling it to act as a reservoir for ingested material.^[30]^[10] Similarly, in the vagina, rugae facilitate distension during physiological events such as childbirth, where the vaginal walls can expand up to three times their resting diameter to accommodate passage.^[31]^[32] The elasticity of rugae is enabled by the underlying submucosal layer, which contains elastin and collagen fibers that support stretching and recoil, preventing tearing of the organ walls during distension. This connective tissue composition provides the biomechanical resilience necessary for repeated expansion and contraction across various organs.^[33]^[10] Rugae also modulate surface area by temporarily increasing the internal contact area with contents upon unfolding, which helps reduce wall tension and promotes even distribution of mechanical stress to avoid localized rupture under pressure. The patterned arrangement of these folds ensures uniform load-bearing, enhancing overall organ durability during volume fluctuations.^[10]^[32]

Physiological Role

In the stomach, gastric rugae play a key physiological role in digestion by enhancing the mixing of food with gastric secretions and increasing the contact area for enzymatic action. These folds allow for efficient distribution of chyme, promoting uniform exposure to pepsin and hydrochloric acid, which facilitates protein breakdown and pathogen neutralization. Additionally, the rugae contribute to glandular output efficiency by expanding the mucosal surface area, enabling greater secretion of gastric juice from parietal and chief cells without overdistension of the epithelium.^[6]^[5]^[34] In the vaginal canal, rugae support reproductive processes by facilitating the spread of lubrication across the mucosa, which reduces friction during intercourse and aids in sperm transport. The folds also enhance tissue resilience, allowing the vaginal wall to accommodate distension during sexual activity and labor while maintaining epithelial integrity and promoting recovery post-event. This lubrication mechanism involves increased surface area for glandular secretions, ensuring moisture retention essential for barrier function against infections.^[32]^[35] Palatine rugae in the oral cavity contribute to physiological processes involved in mastication and deglutition by aiding in food manipulation and bolus formation. The transverse ridges guide the tongue in positioning and compacting food particles, optimizing their cohesion for swallowing. Furthermore, these structures house mechanoreceptors that provide sensory feedback on texture and consistency, integrating with trigeminal nerve pathways to modulate chewing force and initiate reflexive swallowing.^[36]^[37] In the urinary system, particularly the bladder, rugae support uniform mucosal exposure to solutes during filling and help protect the transitional epithelium from irritation and osmotic stress, preserving barrier integrity and contributing to sensory signaling for voiding reflexes. Traditionally, rugae were thought to unfold progressively for efficient storage, but recent research as of November 2025 indicates that larger folds in the bladder wall play the primary role in low-pressure expansion and over 95% of urine expulsion during voiding, with rugae aiding in urothelial adaptation.^[38]^[39]^[40] Rugae exhibit adaptive responses to hormonal cues, such as estrogen's influence on vaginal rugae, where elevated levels maintain fold prominence and epithelial thickness to support lubrication and resilience. In contrast, hypoestrogenism leads to rugae flattening, altering these functions and highlighting the role of sex steroids in modulating rugal physiology across reproductive phases.^[41]^[42]

Clinical Significance

Pathological Conditions

Gastric rugae atrophy is a hallmark of chronic atrophic gastritis, often resulting from prolonged Helicobacter pylori infection or autoimmune processes, which lead to the loss of gastric folds and visible submucosal vessels on endoscopy.^[43]^[44] This atrophy reduces the stomach's distensibility, impairing its ability to expand during filling and contributing to symptoms like early satiety.^[45] In autoimmune gastritis, oxyntic gland destruction can progress to pernicious anemia due to intrinsic factor deficiency, further exacerbating mucosal thinning.^[45] Management includes H. pylori eradication to potentially reverse early atrophy, and emerging therapies like trametinib show promise for precancerous lesions as of 2025.^[46]^[47] Atrophic changes increase the risk of intestinal metaplasia and subsequent gastric adenocarcinoma, classifying it as a precancerous condition.^[48] Vaginal rugae loss commonly occurs in postmenopausal atrophy, known as genitourinary syndrome of menopause, due to declining estrogen levels that diminish epithelial thickness and fold prominence, resulting in vaginal dryness and dyspareunia.^[49]^[50] This hypoestrogenic state reduces vaginal compliance and lubrication, heightening discomfort during intercourse.^[51] The 2025 AUA/SUFU/AUGS guideline emphasizes low-dose vaginal estrogen or ospemifene for treating GSM-related rugae loss.^[52] In contrast, infections such as vulvovaginal candidiasis can cause acute inflammation and edema of the vaginal mucosa, potentially altering rugae appearance through swelling, though chronic cases may lead to secondary atrophic changes if untreated.^[53] Palatine rugae alterations frequently arise from surgical scarring following cleft palate repair, where tissue trauma disrupts the normal transverse ridge pattern on the hard palate, potentially tethering the mucosa and impairing speech articulation.^[54] Such scarring can contribute to hypernasality or velopharyngeal insufficiency by affecting palatal mobility during phonation.^[55] Rare neoplastic involvement includes squamous papillomas on the hard palate, which may arise near or involve rugae and present as exophytic, verrucous lesions requiring excision to prevent malignant transformation.^[56] Bladder rugae, or mucosal folds, become involved in cystitis through inflammatory edema, where bacterial or interstitial processes cause urothelial swelling that obscures normal folding and exacerbates pain and urgency.^[27]^[57] In neurogenic bladder, chronic overdistension from detrusor areflexia leads to persistent bladder enlargement, stretching the mucosa and resulting in the disappearance or flattening of rugae, which impairs reservoir function and increases infection risk.^[58] Endoscopic evaluation of rugae changes, particularly atrophy or irregular folding in the stomach, serves as an early indicator of malignancy, with loss of folds signaling underlying metaplasia or dysplasia warranting biopsy.^[43]^[59] These alterations, visible during upper endoscopy, guide surveillance in high-risk patients to detect premalignant lesions before progression.^[60]

Diagnostic and Forensic Applications

In dentistry, palatine rugae serve as stable anatomical landmarks due to their relative resistance to change during orthodontic treatments, facilitating the evaluation of dental movements and treatment planning.^[61] They are particularly useful in prosthodontics for aligning restorations and in bite registration, where the incisive papilla and anterior rugae provide reliable reference points for superimposing maxillary digital scans.^[62]^[63] Forensic applications leverage the unique and individualistic patterns of palatine rugae, which remain intact even in cases of severe tissue damage, making them comparable to fingerprints for personal identification.^[64] In mass disasters, terrorist acts, or burnt remains, rugae impressions from bite marks or palate casts enable victim identification through rugoscopy, with automated 3D comparison methods enhancing accuracy in forensic odontology. Recent advances as of 2025 include the integration of artificial intelligence for pattern validation and rapid 3D superimposition techniques, enhancing identification accuracy.^[65]^[66]^[67] Endoscopic visualization of gastric rugae via gastroscopy aids in diagnosing conditions associated with Helicobacter pylori infection, such as atrophic gastritis, where flattening or loss of rugal folds indicates mucosal thinning and visible submucosal vessels.^[68] This assessment also detects intestinal metaplasia, a precancerous change, as the absence of rugae correlates with moderate to severe atrophy in the gastric corpus.^[69] In gynecology, colposcopy evaluates vaginal rugae to assess hormonal status, as postmenopausal estrogen deficiency leads to atrophy and progressive flattening of these mucosal folds, reducing vascularity and elasticity.^[70] It also identifies trauma, such as lacerations in the rugae or vaginal walls, during examinations for postcoital bleeding or injury.^[71] Cystoscopy reveals irregularities in bladder rugae—mucosal folds that form when the bladder is relaxed—for diagnosing urinary tract infections, where inflammation or lesions like cystitis cystica appear as protrusions or edema in the folds, often linked to recurrent infections.^[27]^[72] Research applications include genetic studies of palatine rugae symmetry, where asymmetries and pattern variations correlate with genetic variants in genes like WNT3A and WNT11, aiding population ancestry analysis across ethnic groups such as Fars, Turkmen, and Sistani.^[73]^[62] These differences in rugae morphology provide a non-invasive proxy for estimating genetic ancestry and ethnic affiliations.^[74]

Comparisons with Similar Structures

Rugae versus Plicae

Rugae and plicae represent distinct types of mucosal and submucosal folds in human anatomy, differing primarily in their permanence and adaptability to organ distension. Rugae consist of temporary, irregular folds that form in the relaxed state of hollow organs, allowing for expansion by flattening under tension; this is evident in the gastric rugae of the stomach, which are prominent when empty but smooth out as the organ fills with food.^[75] In comparison, plicae, such as the plicae circulares found in the duodenum and jejunum, are permanent, fixed submucosal structures that do not flatten with distension, maintaining their form to support consistent organ function.^[76] These structural differences highlight rugae's role in dynamic accommodation versus plicae's static reinforcement. Rugae occur in diverse locations across the body, including the stomach's inner lining for digestive storage, the vaginal walls as transverse epithelial ridges that enable stretching, and the hard palate as asymmetric connective tissue elevations behind the incisive papilla.^[77] Plicae, by contrast, are chiefly confined to the small intestine, where plicae circulares project into the lumen as circular or spiral elevations, optimizing the mucosal surface without the variability seen in rugae.^[18] Functionally, rugae facilitate volume adaptation in expandable organs; for instance, gastric rugae permit the stomach to distend significantly during meals, while vaginal rugae support elongation and dilation during sexual activity or childbirth.^[75] Plicae circulares, however, serve to permanently augment the absorptive capacity of the small intestine by increasing the effective surface area for nutrient uptake, independent of luminal contents.^[76] In terms of visibility, rugae are observable only when the associated organ is in a contracted or empty state, as distension erases their contours to prevent structural damage.^[18] Plicae circulares, with their enduring spiral or annular configuration, remain discernible at all times, contributing to the small intestine's unwavering histological architecture even under full distension.^[75]

Rugae versus Villi

Rugae and villi represent distinct levels of mucosal folding in the gastrointestinal tract, differing primarily in scale and structural composition. Rugae are macroscopic folds, typically measuring several millimeters to centimeters in height and length, formed by the folding of both the mucosa and submucosa layers.^[78] In contrast, villi are microscopic, finger-like projections confined to the mucosal layer, with heights ranging from 0.4 to 1 mm, and are further adorned with even smaller microvilli on their epithelial surface to enhance functionality.^[79]^[80] Regarding permanence, rugae exhibit greater dynamism, flattening substantially during organ distension to accommodate volume changes, as seen in the stomach or bladder.^[10] Villi, while capable of height variations influenced by factors such as diet and disease, generally maintain their structural form to support ongoing physiological processes.^[81] Rugae occur in various hollow organs, including the stomach, urinary bladder, vagina, and oral palate (as palatine rugae).^[10] Villi, however, are exclusive to the small intestine, specifically the duodenum, jejunum, and ileum, where they project from the mucosal surface.^[80] Functionally, rugae primarily facilitate gross expansion of organ capacity and provide a baseline increase in surface area for mixing or storage.^[10] Villi, on the other hand, specialize in maximizing nutrient uptake through their absorptive epithelium and associated vascular and lymphatic structures, often in conjunction with larger folds like plicae circulares.^[80]^[82] From an evolutionary perspective, both structures amplify mucosal surface area for efficient organ performance, but villi embody a finer, specialized adaptation in absorptive epithelia to optimize nutrient extraction in the small intestine.^[82]

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INTRODUCTION. Rugae are derived from the Greek word for a seam. It ... Rugae or plica palatine are the anatomical folds located on the anterior ...<|control11|><|separator|>
[60]
Palatal Rugae Patterns in Fars, Turkmen, and Sistani Ethnicities in ...
Jan 5, 2023 · Palatal rugae patterns can be used as a surrogate parameter in forensic medicine. This stems from the difficulty in falsifying these patterns, ...Missing: registration | Show results with:registration
[61]
Comparison and reproducibility of three methods for maxillary digital ...
Sep 30, 2021 · The use of structures located in the most anterior region of the palate (incisive papilla and first palate rugae) for registration of maxillary ...
[62]
Reliability of palatal rugae patterns in individual identification
The goal of this study was to see how stable the palatal rugae pattern was after orthodontic treatment, both with and without extractions and palatal expansion.Missing: prosthetics bite registration
[63]
The oral fingerprint: rapid 3D comparison of palatal rugae ... - Frontiers
For disaster victim identification using Forensic Odontology, an automated workflow for palatal rugae comparison in 3D could be beneficial (8–10, 17, 18, 23–27) ...
[64]
Palatal Rugae Patterns as a Bioindicator for Forensic Identification ...
3 Rugae pattern are specific to different racial groups making it convenient for their identification in a mass disaster situation. Rugae pattern is unique ...
[65]
Endoscopic diagnosis of Helicobacter pylori infection
Nov 13, 2024 · The endoscopic findings of atrophic gastritis include thinning of the mucosa, visible blood vessels, and flattening or loss of wrinkles on the ...
[66]
Medline ® Abstract for Reference 44 of 'Gastric intestinal metaplasia'
RESULTS The sensitivity and specificity of absence of rugae for moderate to severe atrophic gastritis in the gastric corpus were 67 % and 85 %, respectively.<|separator|>
[67]
Vaginal Atrophy NYC - Adaptive Gynecology
As the vagina undergoes atrophy, the anatomical wrinkles (rugae) of the vaginal walls progressively flatten as they lose collagen, fatty tissue, and their ...
[68]
Postcoital Bleeding: A Review on Etiology, Diagnosis, and ... - NIH
A bivalve speculum exam should be performed to evaluate the vaginal rugae and cervix. Attention should be focused to determine if there are any lacerations ...
[69]
Bladder Mucosal Cystitis Cystica Lesions Are Tertiary Lymphoid ...
Jan 30, 2023 · Cystitis cystica lesions were associated with postmenopausal status, pelvic floor myofascial pain, and number of urinary tract infections in the prior year.Missing: folds rugae
[70]
Left-right asymmetry in palatal rugae is associated with genetic ...
The present study evaluated the association between genetic variants in WNT3A and WNT11, and palatal rugae phenotypes.
[71]
A systematic review of the association of palatal shape with genetic ...
This study aims to review the literature regarding palatal shape variation, and its influence on estimating genetic ancestry, sex, and age.
[72]
Histology of the lower digestive tract - Kenhub
The lumen of the small intestines also has visceral folding of the mucosa that is analogous to the stomach's rugae. However, these circular folds (plicae ...
[73]
SG-ABDOMINAL VISCERA
### Comparison of Rugae and Plicae Circulares
[74]
Normal Vulvovaginal, Perineal, and Pelvic Anatomy with ...
The walls of the vagina are covered with rugae, which are epithelial ridges for stretching and expansion. Normally, the vaginal walls are collapsed and in ...
[75]
Rugal folds | Radiology Reference Article | Radiopaedia.org
May 20, 2021 · The rugal folds are the mucosal folds within the stomach that give the distinctive appearance on barium studies.Missing: hollow | Show results with:hollow
[76]
Intestinal villus structure contributes to even shedding of epithelial ...
Feb 16, 2021 · The villi are 400–1000 μm tall in humans (2) and 150–400 μm tall in mice (3) and contribute an absorptive surface area ∼6.5 times greater ...
[77]
Anatomy, Abdomen and Pelvis, Small Intestine - StatPearls - NCBI
Feb 18, 2025 · [8] Villi and crypts arise on the small intestine's lining. Cuboidal cells line the small intestine in the 9th week of gestation. Villi ...
[78]
Common factors and nutrients affecting intestinal villus height - NIH
Many factors influence the height of intestinal villi, including age, diet, disease, and environmental conditions. This review summarizes the common factors ...
[79]
Good fences make good neighbors: Gastrointestinal mucosal structure
The mucosa and submucosa of the contracted stomach are piled into folds called rugae. As the stomach expands with food content, the rugae flatten themselves to ...