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PERINEAL
REGION
Dr Sana Yaseen
Anatomy dept.
• Is lowest part of trunk.
• Has 2 openings in males:
Gastrointestinal system
Urinary system
• In females 3 openings:
Gastrointestinal
Genital
Urinary system
INTRODUCTION
BOUNDARIES
• Superficial boundaries
• Deep boundaries
SUPERFICIAL BOUNDARIES
ANTERIORLY
– External part of genitalia
POSTERIORLY
– Superior end intergluteal cleft
ON EACH SIDE:
– Upper part of medial side of thigh
DEEP BOUNDARIES
ANTERIORLY
– Pubic arch-upper part
– Arcuate/ inferior pubic ligament
POSTERIORLY:
– Tip of coccyx
EACH SIDE:
– Combine ischipubic rami
– Ischial tuberosity
– Sacrotuberous ligament
Perineal region
Perineal region
DIVISION OF PERINEUM
• Perineum is divided into two triangular
areas:
By transverse line joining anterior part of
ischial tuberosities, passing anterior to
anus.
 Anal region: posterior
 Urogenital region: anterior
contents
Anal region:
• Termination of anal canal(anus) in
median plan
• External, internal anal sphincters
• Ischio anal fossa on each side
Urogenital region: anterior
• Contains external urogenital organs
• Males: urethra enclosing roof of penis,
scrotum
• Females: genital organs
ANAL REGION
CUTANEOUS INNERVATION:
– Inferior rectal nerve S2-S4
– Perineal branch of 4th sacral nerve
SUPERFICIAL FASCIA:
– Ischioanal fossa containing fats and
connective tissue .
– Pudendal nerve
DEEP FASCIA:
Formed by inferior fascia of pelvic diaphragm &
fascia covering obturator internus
PERINEAL BODY:
• Is central part of perineum
• Is fibromuscular node situated in
median plane about 1.25cm in front
of anal margin.
• Ten muscles of perineum converge
here.
ISCHIOANAL FOSSA
• Is wedge shaped potential space
• Situation: each side of anal canal below
pelvic diaphragm
• Ischianal fossa formely known as
ischiorectal fossa
• Base is directed downward towards
surface, apex pointing upward
Perineal region
DIMENSIONS:
• Length (anteroposterior) : 5cm
• Width (side to side): 2.5cm
• Vertical depth: 5-6.2cm
BOUNDARIES:
Base: perianal skin
Apex: line where Obturator fascia meets
fascia of pelvic diaphragm / anal fascia
Anteriorly:
posterior border of perineal membrane
Posteriorly:
• Lower border of gluteus maximus
• Sacrotuberous ligament
Lateral wall (vertical)
• obturator internus
• Ischial tuberosity medial surface
Medial wall (upward & laterally)
• External anal sphincter ani externus
• Levator ani
• Anal fascia
Superiorly:
• Levator ani
Contents of ischioanal fossa
1. ISCHIORECTAL FAT
2. INFERIOR RECTAL NERVE &
VESSELS
3. PUDENDAL CANAL AND ITS
CONTENTS
4. POST. SCROTAL/ POST. LABIAL
NERVES & VESSELS
5. PERINEAL BRANCH OF S4 NERVE
6. CUTANEOUS BRANCHES OF S2, S3
NERVES.
RECESSES: extensions of fascia
• Anterior recesses
• Posterior recesses
• ANTERIOR RECESSES:
Formed by reflection of the fossa,
anteriorly with the urogenital diaphragm
• This recess is between pelvic diaphragm
(superior border) UG diaphragm (inferior
border)
Perineal region
POSTERIOR RECESS
• Is superior to the sacrotuberous
ligament, where it reflects on the
posterior part of the pelvic diaphragm
• It is inferior to the pelvic diaphragm
Perineal region
SPACES AND CANALS
Fascia in this regions forms spaces and
canal
• Perineal space:
• Ischioanal space:
• Pudendal canal:
Perianal space:
• Extends from white line of Hilton to
pudendal canal.
• Separates perianal space from
deep ischioanal space.
• Infection in this region is very
painful due to tension caused by
tight arangement of fat in this
region.
Ischioanal space:
• Is large and deep
• Fat is loosely arrange.
• Lunate fascia arches over
ischioanal fat.dividing it into two
parts
Suprategmental space above fascia
Tegmental space below fascia
Perineal region
Perineal region
Urogenital region
• CUTANEOUS INNERVATION:
• Dorsal nerve of penis or of clitoris
• Ilioinguinal nerve & genital branch
of genitofemoral nerve
• Perineal branch of post. Cutaneous
nerve of thigh
• Post. Scrotal / labial nerves
• Perineal branch of pudendal nerve
• PUDENDAL CANAL
Fascial canal in lateral wall of ischioanal
fossa enclosing pudendal nerve &
internal pudendal vessels.
The fascia of canal fuses with
Above: lunate fascia
Laterally: lower part of obturator fascia
Medially: perineal fascia
Below: falciform process of
sacrotuberous ligament.
Perineal region
SUPERFICIAL FASCIA:
• Made of two layers
• Superficial fatty layer, continuous with
superficial fascia of surrounding regions
• Deep membranous layer colles’ fascia
DEEP FASCIA
• Also known as perineal membrane
• Is thick
Urogenital region is divided into two
parts via perineal membrane
Above it: deep perineal space
Below it: superficial perineal space
Perineal region

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Perineal region

  • 2. • Is lowest part of trunk. • Has 2 openings in males: Gastrointestinal system Urinary system • In females 3 openings: Gastrointestinal Genital Urinary system INTRODUCTION
  • 4. SUPERFICIAL BOUNDARIES ANTERIORLY – External part of genitalia POSTERIORLY – Superior end intergluteal cleft ON EACH SIDE: – Upper part of medial side of thigh
  • 5. DEEP BOUNDARIES ANTERIORLY – Pubic arch-upper part – Arcuate/ inferior pubic ligament POSTERIORLY: – Tip of coccyx EACH SIDE: – Combine ischipubic rami – Ischial tuberosity – Sacrotuberous ligament
  • 8. DIVISION OF PERINEUM • Perineum is divided into two triangular areas: By transverse line joining anterior part of ischial tuberosities, passing anterior to anus.  Anal region: posterior  Urogenital region: anterior
  • 9. contents Anal region: • Termination of anal canal(anus) in median plan • External, internal anal sphincters • Ischio anal fossa on each side Urogenital region: anterior • Contains external urogenital organs • Males: urethra enclosing roof of penis, scrotum • Females: genital organs
  • 10. ANAL REGION CUTANEOUS INNERVATION: – Inferior rectal nerve S2-S4 – Perineal branch of 4th sacral nerve SUPERFICIAL FASCIA: – Ischioanal fossa containing fats and connective tissue . – Pudendal nerve DEEP FASCIA: Formed by inferior fascia of pelvic diaphragm & fascia covering obturator internus
  • 11. PERINEAL BODY: • Is central part of perineum • Is fibromuscular node situated in median plane about 1.25cm in front of anal margin. • Ten muscles of perineum converge here.
  • 12. ISCHIOANAL FOSSA • Is wedge shaped potential space • Situation: each side of anal canal below pelvic diaphragm • Ischianal fossa formely known as ischiorectal fossa • Base is directed downward towards surface, apex pointing upward
  • 14. DIMENSIONS: • Length (anteroposterior) : 5cm • Width (side to side): 2.5cm • Vertical depth: 5-6.2cm
  • 15. BOUNDARIES: Base: perianal skin Apex: line where Obturator fascia meets fascia of pelvic diaphragm / anal fascia Anteriorly: posterior border of perineal membrane Posteriorly: • Lower border of gluteus maximus • Sacrotuberous ligament
  • 16. Lateral wall (vertical) • obturator internus • Ischial tuberosity medial surface Medial wall (upward & laterally) • External anal sphincter ani externus • Levator ani • Anal fascia Superiorly: • Levator ani
  • 17. Contents of ischioanal fossa 1. ISCHIORECTAL FAT 2. INFERIOR RECTAL NERVE & VESSELS 3. PUDENDAL CANAL AND ITS CONTENTS 4. POST. SCROTAL/ POST. LABIAL NERVES & VESSELS 5. PERINEAL BRANCH OF S4 NERVE 6. CUTANEOUS BRANCHES OF S2, S3 NERVES.
  • 18. RECESSES: extensions of fascia • Anterior recesses • Posterior recesses
  • 19. • ANTERIOR RECESSES: Formed by reflection of the fossa, anteriorly with the urogenital diaphragm • This recess is between pelvic diaphragm (superior border) UG diaphragm (inferior border)
  • 21. POSTERIOR RECESS • Is superior to the sacrotuberous ligament, where it reflects on the posterior part of the pelvic diaphragm • It is inferior to the pelvic diaphragm
  • 23. SPACES AND CANALS Fascia in this regions forms spaces and canal • Perineal space: • Ischioanal space: • Pudendal canal:
  • 24. Perianal space: • Extends from white line of Hilton to pudendal canal. • Separates perianal space from deep ischioanal space. • Infection in this region is very painful due to tension caused by tight arangement of fat in this region.
  • 25. Ischioanal space: • Is large and deep • Fat is loosely arrange. • Lunate fascia arches over ischioanal fat.dividing it into two parts Suprategmental space above fascia Tegmental space below fascia
  • 28. Urogenital region • CUTANEOUS INNERVATION: • Dorsal nerve of penis or of clitoris • Ilioinguinal nerve & genital branch of genitofemoral nerve • Perineal branch of post. Cutaneous nerve of thigh • Post. Scrotal / labial nerves • Perineal branch of pudendal nerve
  • 29. • PUDENDAL CANAL Fascial canal in lateral wall of ischioanal fossa enclosing pudendal nerve & internal pudendal vessels. The fascia of canal fuses with Above: lunate fascia Laterally: lower part of obturator fascia Medially: perineal fascia Below: falciform process of sacrotuberous ligament.
  • 31. SUPERFICIAL FASCIA: • Made of two layers • Superficial fatty layer, continuous with superficial fascia of surrounding regions • Deep membranous layer colles’ fascia
  • 32. DEEP FASCIA • Also known as perineal membrane • Is thick Urogenital region is divided into two parts via perineal membrane Above it: deep perineal space Below it: superficial perineal space