Download Pelvic floor

PELVIC FLOOR
LEARNING OBJECTIVE
At the end of the lecture the student should :
• Describe the anatomy of the pelvic walls.
 Discuss the muscles of pelvic floor
 Develop an understanding of blood supply, nerve supply, lymphatic drainage
of muscles.
 Know the actions of pelvic diaphragm.
 Understand the applied anatomy
PELVIC CAVITY
It is a funnel-shaped space bounded by bones, ligaments, muscular walls
and floor.
Pelvic Walls and Floors
• Anterior pelvic wall – is formed primarily by the bodies and rami of the
pubic bones and the pubic symphysis
• Lateral pelvic walls – formed by the hip bones and the obturator internus
muscles (O: proximal surface of the ilium and ischium; obturator membrane
I: greater trochanter of the femur)
Posterior Pelvic Wall –
• Formed by the sacrum and coccyx, adjacent parts of the ilia, and the S-I
joints; piriformis muscle covers the area (O: pelvic surface of 2nd and 4th
sacral segments, superior margin of the greater sciatic notch and
sacrotuberous ligament, I: greator trochanter of femur).
PELVIC FLOOR
The pelvic floor is formed by pelvic diaphragm:
Coccygeus
Levator ani muscles
Fascia covering the superior and inferior aspects of these muscles
STRUCTURES PASSING THROUGH THE PELVIC FLOOR
IN MALE
Urethra
Rectum
IN FEMALE
Urethra
Vagina
Rectum
LEVATOR ANI
Broad, muscular sheet
Attached to:
Aneriorly - Pubic bones
Posteriorly - Ischial spines
Laterally - Thickening in the obturator fascia (tendinous arch of levator ani)
PARTS OF LEVATOR ANI MUSCLE
PUBOCOCCYGEUS
Pubovaginalis
Pubourethralis
Puborectalis
Forms levator plate posteriorly
ILIOCOCCYGEUS
Most lateral and posterior
ANOCOCCYGEAL LIGAMENT
Between anal canal and vertebral column
CONSISTS OF:
Presacral fascia
Tendinous plate of pubococcygeus
Muscular raphe of iliococcygeus
Posterior part of puborectalis
External anal sphincter
COCCYGEUS MUSCLE
ATTACHMENT
Apex to Ischial spine
Base to Inferior end of sacrum and coccyx
Could be completely tendinous.
Lie lateral to piriformis
.
NERVE SUPPLY OF THE MUSCLES
LEVATOR ANI
S -S through pudendal nerve
Nerve to levator ani(S )
2
3
4
COCCYGEUS MUSCLE
Branches of S3 and S4.
BLOOD SUPPLY OF PELVIC DIAPHRAGM
Inferior vesical artery
Inferior gluteal artery
Pudendal artery
PELVIC FASCIA
TWO PARTS:
Membranous pelvic fascia
Parietal
Visceral
Endopelvic fascia
VISCERAL FASCIA
Membranous fascia directly ensheaths the pelvic organs
Membranous parietal and visceral are continuous where organs penetrate pelvic floor
PARIETAL FASCIA
Membranous layer lines inner aspect of muscles forming the wall and floor of pelvis
ENDOPELVIC FASCIA
Superior fascia of pelvic diaphragm
In front to body of pubis
ischial spine at the back
Laterally blends with obturator fascia forming tendinous arch
Inferior fascia of pelvic diaphragm
Laterally blends with obturator fascia
Medially external anal and urethral fascia
PELVIC SPACES
The loose areolar part forms the potential spaces.
Namely:
Retropubic
Presacral
Retrovesical
RELATIONS OF PELVIC DIAPHRAGM
Superior (pelvic surface)
Separated by fascia from:
Bladder
Prostate or uterus and vagina
Rectum
Inferior (perineal surface)
Forms medial wall of ishioanal fossa
APPLIED ANATOMY
Uterovaginal prolapse
Rectocele
Cystocele
Due to weakening of the pelvic diaphragm
INJURY TO PELVIC FLOOR
Injury to levator ani can occur during child birth.
Urinary stress incontinence
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