Pelvic floor and perineal body

Gyne Anatomy

1. Pelvic floor and Perineal body Themba Hospital FCOG(SA) Part 1 Tutorials By Dr N.E Manana

2. Pelvic floor The pelvic floor is formed by : The pelvic diaphragm and The perineal membrane and muscle of the deep perineal pouch Pelvic diaphragm Is the muscular part of the pelvic floor , it is bowl shaped , attached superiorly to the pelvic wall It consists of the levator ani and the coccygeus muscles Its circular line of attachment passes between the sciatic foramen , greater sciatic above and lesser sciatic below

3. 5.34

4. Pelvic diaphragm Levator ani The muscles originating from the pelvic wall , course medially and inferiorly and join together in the midline Attachment to the pelvic wall follows a contour which include ; posterior pubic body, tendinous arch over the obturator internus muscle and ischial spine In females the muscle blend together posterior to the vagina and around the anus in anal aperture in both sexes ( Anococcygeal ligament ) Anteriorly they form a U-shaped defect ( Urogenital hiatus ) Levator ani has 3 collections of fibers : 1. Pubococcygeus , 2. Puborectalis and 3. Iliococygeus muscles

5. Pelvic diaphragm Coccygeus The are 2 muscles , one on each side, triangular in shape , overlying the SSL The base is attached to the lateral margins of the coccyx and sacrum , and the apex is attached to the tips of the ischial spines They are innervated by the branches of the anterior rami of S4-S5 Participate in supporting the posterior aspect of the pelvic floor

6. Table 5.2

7. Perineal membrane and deep perineal pouch The perineal membrane is a thick fascia , triangular shaped , attached to the pubic arch Orientated in a horizontal plain , with a free posterior margin Anterior the a small gap between the membrane and the inferior pubic ligament The is a thin space above it termed the deep perineal pouch , which contains skeletal muscles and neurovascular elements The pouch is open above , only enclosed by the urogenital hiatus, therefor contributing to the pelvic floor It provides attachment for roots of the external genitalia and assoc muscles

8. Perineal membrane and deep perineal pouch 5.36

9. Perineal membrane and deep perineal pouch Anterior a group of muscle fibers surround the urethra ( External urethral sphincter) Two additional groups are assoc with the urethra and the vagina; sphincter urethrovaginalis and compressor urethrae Together they facilitate closure of the urethra Deep transverse perineal muscle parallels the free margin of the perineal membrane and joins with its partner in the midline They stabilise the perineal body

10. Perineal body Is an ill defined but important connective tissue structure into which muscles of the pelvic floor and perineum attach It is in the midline along the posterior border of the perineal membrane which it is attached to It is also attached to the posterior end of the urogenital hiatus Muscle attached: 1. Deep transvers perineal muscle , 2. Sphincter urethrovaginalis , 3. External anal sphincter , 4. Superficial transverse perineal muscle and 5. the Bulbospongiosus muscles

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