This 37 slide presentation provides an overview of the pelvis and pelvic floor anatomy. It discusses the bones that make up the pelvis, the true and false pelvis cavities, and the pelvic viscera in males and females. The muscles of the pelvic floor are described in detail, including the levator ani muscle and its components. Other structures covered include the pelvic fasciae, vasculature, nerves, pudendal canal, and related clinical terms. The presentation provides a comprehensive review of key anatomical structures and relationships in the pelvis region.

1. Dr. Komal Parmar
22.12.16
Total number of Slides: 37
1
Pelvic Diaphragm
and Pudendal Canal

2. Abdominopelvic Cavity
2

3. 3

4. 4

5. Pelvis
• The term pelvis
(‘basin’) is applied
variously to the skeletal
ring formed by the hip
bones and the sacrum,
the cavity therein, and
even the entire region
where the trunk and
lower limbs meet.
• The term Pelvic Cavity
refers to a body
cavity that is bounded by
the bones of the pelvis.
5

6. False Pelvis
• Bounded on either side by the
ilium; in front it is incomplete,
presenting a wide interval
between the anterior borders
of the ilia; behind is a deep
notch on either side between
the ilium and the base of the
sacrum.
• The false pelvis supports the
intestines (specifically, the
ileum and sigmoid colon), and
transmits part of their weight
to the anterior wall of the
abdomen.
• Aka Greater Pelvis
True Pelvis
• Bounded in front and below by the
pubic symphysis and the superior rami
of the pubis; above and behind, by the
sacrum and coccyx; and laterally, by a
broad, smooth, quadrangular area of
bone, corresponding to the inner
surfaces of the body and superior
ramus of the ischium, and the part of
the ilium below the arcuate line.
• The true pelvis contains the pelvic
colon, rectum, bladder, and some of
the reproductive organs. The rectum is
at the back, in the curve of the sacrum
and coccyx; the bladder is in front,
behind the pubic symphysis.
• In the female,
the uterus and vagina occupy the
interval between these viscera. The
pelvic splanchnic nerves arising at S2–
S4 are in the lesser pelvis.
• Aka Lesser Pelvis
6

7. True Pelvis and Pelvic Floor
7
• The true pelvis is a bowl-shaped
structure formed from the sacrum,
pubis, ilium, ischium, the ligaments
which interconnect these bones and
the muscles which line their inner
surfaces.
• Begins at the level of Pelvic Inlet
• The floor or ‘outlet’ of the true pelvis
is formed by the muscles of Levator
Ani.
• Below the Levator Ani, lies the region
known as Perineum.
• The deep limit of the perineum is the
• inferior surface of the pelvic
diaphragm and its superficial limit is
them skin which is continuous with
that over the medial aspect of the
thighs and the lower abdominal wall.

8. 8

9. Pelvic
Viscera
in
Males
9

10. 10

11. Muscles and Fasciae of Pelvis
Muscles
Wall
Piriformis
Obturator
Internus
Diaphragm
Levator Ani
Ischiococcygeus 11
Fascia:
• Superiorly continuous
with Visceral Pelvic
Fascia
• Inferiorly continuous
with Perineal Fascia
• Laterally Obturator
Fascia

12. 12

13. MUSCLES OF PELVIS 13

14. 14

15. 15
Its fascia gives attachment to some of the fibres of
levator ani and thus only the upper portion of the
muscle lies lateral to the contents of the true
pelvis, whilst the lower portion forms part of the
boundaries of the ischio-anal fossa.

16. Levator Ani
• Broad muscular sheet of
variable thickness which is
attached to the internal
surface of the true pelvis
and forms a large portion
of the pelvic floor.
• The muscle is subdivided
into named portions
according to their
attachments and the pelvic
viscera to which they are
related. These parts are
often referred to as
separate muscles, but the
boundaries between each
part cannot be easily
distinguished and they
perform many similar
physiological functions.
16

17. 17

18. • Levator Ani is subdivided into named portions
according to their attachment to the pelvic viscera
that they are related to
1. Pubococcygeus (Puboperinealis,
Puboprostaticus/pubovaginalis, Puboanalis,
Puborectalis),
2. Iliococcygeus,
3. Puborectalis
18
Ischiococcygeus
(aka Coccygeus)
is referred to as a
separate muscle
lying
posterosupiriorly
to Levator Ani.

19. Perineal Body
• The perineal body is an
irregular
and fibromuscular mass. It
is located at the junction
of the urogenital and anal
triangles – the central
point of the perineum.
• Anatomically, the perineal
body lies just deep to the
skin. It functions as a
point of attachment for
muscle fibres from the
pelvic floor and the
perineum itself
Anococcygeal
Raphae
• The anococcygeal
body (anococcygeal
ligament, or anococcygeal
raphe) is a fibrous
median raphe in the floor
of the pelvis, which
extends between
the coccyx and the margin
of the anus. It is composed
of fibers of the levator ani
muscle which unite with
the muscle of the opposite
side, muscle fibres
from external anal
sphincter and fibrous
connective tissue.
19

20. 20

21. 21

22. Components of Levator Ani:
Pubococcygeus
22

23. Components of Levator Ani:
Iliococcygeus
• The iliococcygeal part is
attached to the inner
surface of the ischial spine
below and anterior to the
attachment of
ischiococcygeus and to
the tendinous arch as far
forward as the obturator
canal.
• The most posterior fibres
are attached to the tip of
the sacrum and coccyx
but most join with fibres
from the opposite side to
form Anal raphe. 23

24. Puborectalis Ischiococcygeus
• It lies as the most
posterosuperior portion of
levator ani and arises as a
triangular musculotendinous
sheet with its apex attached
to the pelvic surface and tip
of the ischial spine.
• The base of the muscle is
attached to the lateral
margins of the coccyx and the
fifth sacral segment.
24

25. • Relations The superior, pelvic
surface of levator ani is separated
only by fascia (superior pelvic
diaphragmatic, visceral and
extraperitoneal) from the urinary
bladder, prostate or uterus and
vagina, rectum and peritoneum.
• Its inferior, perineal, surface forms
the medial wall of the ischio-anal
fossa and the superior wall of the
anterior recess of the fossa, both
being covered by inferior pelvic
diaphragmatic fascia.
• The posterior border is separated
from the coccyx by areolar tissue.
• The medial borders of the two levator
muscles are separated by the visceral
outlet, through which pass the
urethra, vagina, and anorectum.
25

26. Vascular Supply
• Inferior Gluteal A
• Inferior Vesical A
• Inferior Pudendal A
Innervation
• Nerves to Levator Ani
(S3-S4)
26

27. Pelvic Fasciae
• Parietal Pelvic Fascia:
• Obturator F
• F over Piriformis
• F over Levator Ani. Pelvic Diaphragm= Fascia + Levator Ani
• Presacral F
• Visceral Pelvic Fascia
• Derived from mesenteries
• Cardinal and Uterosacral Ligaments
• White Line of Pelvic Fascia
27

28. Vasculature of Pelvis
28

29. 29

30. Nerves
30

31. 31

32. Pudendal Canal
324 cm above the lower limit of Ischial
Tuberosity

33. 33

34. 34

35. 35

36. 36

37. 37