The Pelvic FloorThe Pelvic Floor

Per BrodalPer BrodalInstitutt for medisinske basalfagInstitutt for medisinske basalfag

Universitetet i OsloUniversitetet i Oslo

9th Semester 20089th Semester 2008

Abdominal Press (bukpressen)

Pelvic floor muscles

Pelvic floor muscles

Thieme, Atlas of Anatomy 20062

P. Brodal 2008

The Pelvic Outlet –How is it best Closed?

Conflicting needs:

Firm closure, yet allow passage of large ”objects ”

3P. Brodal 2008

Three Layers:

Diaphragma pelvis: Levator ani muscle and associated fascia

Diaphragma urogenitale: musculus transversus perinei (profundus) and fascia

Striated sphincter muscles

4P. Brodal 2008

The Male Perineal Region

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Levator Ani from the Inside

Thieme, Atlas of Anatomy 2006

IliococceygeusPubococcygeus

Iliococceygeus

PuborectalisLevator hiatus

Piriformis

Tendineous arch of levator ani

6P. Brodal 2008

Levator Ani from the Outside (Urogential Diaphragm Removed)

Thieme, Atlas of Anatomy 2006

Iliococceygeus

Pubococcygeus

Puborectalis

Coccyx

Levator hiatus

Coccygeus

7P. Brodal 2008

Levator Ani cont’d

Obturator internus muscle with fascia

Tendineous arch

Levator ani

Muscles of the urogenital diaphragm 8P. Brodal 2008

Levator Ani Muscle, The urogenital Muscles, and the Ischioanal Fossa

Thieme, Atlas of Anatomy 2006

Levator aniIschianal fossa

Urogenital muscles

Gluteus maximus

Internal obturator muscle

9P. Brodal 2008

Urogenital Diaphragm (female)

Coccyx

Thieme, Atlas of Anatomy 2006

Deep transverse perineal muscle

External urethral sphincter

Levator ani

Perineal body (Centrum tendineum perinei)

10P. Brodal 2008

Sphincters

Thieme, Atlas of Anatomy 2006

Bulbospongiosus muscle

External anal sphincter

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Fascia of the Urogenital Diaphragm

12Thieme, Atlas of Anatomy 2006P. Brodal 2008

Ischioanal fossa (anterior recess)

Superficial perineal fascia (Colles’)

Inferior pelvic diaphragmatic fascia

The Pelvic Floor During Delivery

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Thieme, Atlas of Anatomy 2006

P. Brodal 2008

Episiotomy

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Thieme, Atlas of Anatomy 2006

P. Brodal 2008

Spaces Filled with Fat and Loose Connective Tissue

Thieme, Atlas of Anatomy 2006

Subperitoneal space

Peritoneal cavity

Ischianal fossa

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Spaces Filled with Fat and Loose Connective Tissue (Male)

Thieme, Atlas of Anatomy 2006

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Continence and Incontinence

Continence depends on• The integrity of the pelvic floor muscles, their

connective tissue layers and the sphincters• The integrity of innervation of the muscles

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Rupture of the Urethra

Urethral rupture may cause extravasation of urine in, below or above the urogenital diaphragm

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Rupture in the bulbous part

Perineal hematoma

Blood trickling from the meatus

Prostate loosened and displaced

P. Brodal 2008