The Pelvic Floor
Per Brodal
Institutt for medisinske basalfag
Universitetet i Oslo
9th Semester 2008
Abdominal Press (bukpressen)
Pelvic
floor
muscles
Thieme, Atlas of Anatomy 2006
P. Brodal 2008
Pelvic
floor
muscles
2
The Pelvic Outlet –How is it best Closed?
Conflicting needs:
Firm closure, yet allow passage of
large ”objects ”
P. Brodal 2008
3
Three Layers:
 Diaphragma pelvis: Levator ani muscle and
associated fascia
 Diaphragma urogenitale: musculus transversus
perinei (profundus) and fascia
 Striated sphincter muscles
P. Brodal 2008
4
The Male Perineal Region
P. Brodal 2008
5
Levator Ani from the Inside
Tendineous arch of
levator ani
Iliococceygeus
Piriformis
Levator hiatus
P. Brodal
2008of Anatomy 2006
Thieme,
Atlas
Puborectalis
Pubococcygeus
Iliococceygeus
6
Levator Ani from the Outside
(Urogential Diaphragm Removed)
Puborectalis
Levator hiatus
Pubococcygeus
Iliococceygeus
Coccygeus
Coccyx
P. Brodal
2008of Anatomy 2006
Thieme,
Atlas
7
Levator Ani cont’d
Obturator internus
muscle with fascia
Tendineous arch
Levator ani
Muscles of the
urogenital diaphragm
P. Brodal 2008
8
Levator Ani Muscle, The urogenital
Muscles, and the Ischioanal Fossa
Internal
obturator
muscle
Gluteus
maximus
Levator ani
Ischianal fossa
Thieme, Atlas of Anatomy 2006
P. Brodal 2008
Urogenital muscles
9
Urogenital Diaphragm (female)
External urethral
sphincter
Perineal body
Deep transverse
perineal muscle
(Centrum
tendineum
perinei)
Levator ani
Coccyx
P. Brodal
2008of Anatomy 2006
Thieme,
Atlas
10
Sphincters
Bulbospongiosus muscle
External anal
sphincter
P. Brodal
2008of Anatomy 2006
Thieme,
Atlas
11
Fascia of the Urogenital Diaphragm
Superficial perineal fascia
(Colles’)
Inferior pelvic
diaphragmatic
fascia
Ischioanal fossa
(anterior recess)
Thieme, Atlas of Anatomy 2006
P. Brodal 2008
12
The Pelvic Floor During Delivery
Thieme, Atlas of Anatomy 2006
P. Brodal 2008
13
Episiotomy
Thieme, Atlas of Anatomy 2006
P. Brodal 2008
14
Spaces Filled with Fat and Loose Connective
Tissue
Peritoneal cavity
Subperitoneal
space
Ischianal fossa
P. Brodal
2008of Anatomy 2006
Thieme,
Atlas
15
Spaces Filled with Fat and Loose
Connective Tissue (Male)
Thieme, Atlas of Anatomy 2006
P. Brodal 2008
16
Continence and Incontinence
 Continence depends on
•
•
P. Brodal 2008
The integrity of the pelvic floor muscles, their
connective tissue layers and the sphincters
The integrity of innervation of the muscles
17
Rupture of the Urethra
Rupture in
the bulbous
part
Prostate
loosened and
displaced
 Urethral rupture may
cause extravasation of
urine in, below or above
the urogenital diaphragm
P. Brodal 2008
Blood trickling
from the
meatus
Perineal hematoma
18