Module 2: Muscles of Pelvis and Perineum
a) Pelvic Floor
Pelvic floor formed by multiple muscles collectively known as pelvic diaphragm
- Pelvic diaphragm separates the perineum from superior parts of the pelvic cavity
- Anterior urogenital part of pelvic diaphragm further covered by urogenital diaphragm (refer
to anatomy of perineum)
- Formed by levator ani (anterior) and coccygeus (posterior) muscles
- Levator ani muscle divided into three main parts:
o Puborectalis: originates from pubic symphysis and wraps around rectum →
Important for rectal continence
o Pubococcygeus: pubis → coccyx
o Iliococcygeus: ischial spine → coccyx
- Coccygeus muscle:
o Origin: ischial spine
o Insertion: coccyx (and sacrum)
*Some parts of levator ani originates from arcus tendinous instead of bony structures
**Levator ani also contain puboanalis (wrap around anal canal), pubovaginalis (wrap
around vagina) and iliosacralis (connecting ischial spine to sacrum)
Function:
1. Support and stabilize position of pelvic viscera
2. Acts as a sphincter for anorectal junction and vagina
Perineal body located between urogenital and pelvic diaphragms
Clinical significance: destruction of pelvic diaphragm or perineal body
→ prolapse of bladder, uterus, vagina and rectum
→ surgical repair under GA
Nerve supply: S4-5, branches of pudendal nerve
The pelvic diaphragm forms the floor of the pelvis and serves as a bed for the pelvic organs.
b) Pelvic Diaphragm
The pelvic diaphragm is formed by the union of the levator ani and the coccygeus muscles. A
layer of fascia lines the superior and inferior aspects of the pelvic diaphragm. The levator ani
muscle consists of three separate muscles: pubococcygeus, puborectalis, and iliococcygeus.
Structures piercing pelvic diaphragm
• The anus
• The urethra
• The vagina (in females)
There are two openings/gaps/hiatus in the pelvic diaphragm to allow the structures to pass from
pelvis to perineum.
Urogenital hiatus – An anteriorly situated gap, which allows passage of urethra (and vagina in
females).
Rectal hiatus – A centrally positioned gap, which allows passage of the anal canal.
Between the urogenital hiatus and the anal canal lies a fibrous node known as the perineal body
which joins the pelvic floor to the perineum ( for its clinical relevance in females refer to clinical
anatomy)
Functions of Pelvic Diaphragm
▪ Supports pelvic viscera - resisting inferior thrust during e.g. coughing, deep expiration etc.
▪ Raise the pelvic floor, assisting the anterior abdominal wall muscles in compressing the
viscera, e.g. in coughing, deep expiration, vomiting, urinating.
▪ Support of the prostate and the vagina providing sphincteric action of the latter, and urethra.
▪ The puborectalis holds the anorectal junction anteriorly, increasing the angle between the
rectum, and anal canal. This prevents passage of feces from the rectum, into the anal canal
when defecation is not desired, or is inconvenient.
▪ Coccygeus muscle support the coccyx, and pull it anteriorly, after it has been pressed
posteriorly during child-birth.
Superior (A) and inferior (B) views of the pelvic diaphragm muscles.
Lateral Wall of Pelvis
Lateral wall of pelvis
▪ Piriformis: lateral rotator of hip joint
- Origin: anterior sacrum
- Insertion: head of femur
- Forms posterolateral wall of pelvis
▪ Obturator internus: lateral rotator of hip joint
- Origin: ischiopubic ramus + obturator membrane
- Insertion: head of femur
- Forms anterolateral wall of pelvis
- Obturator canal: hole formed by obturator internus and obturator membrane in the
obturator foramen → allows obturator A/V/N to supply adductor muscles of the thigh
- Sacrospinous ligament: connects sacrum and ischial spine
- Separates greater sciatic foramen from lesser sciatic foramen
▪ Sacrotuberous ligament: connects sacrum and ischial tuberosity
- Composes the inferior boundary of the lesser sciatic foramen
*Obturator membrane covers the obturator foramen and is between obturator internus and
obturator externus
Pelvic Reflection in Pelvic Cavity
Abdominal viscera lined by visceral peritoneum.
Abdominal wall lined by parietal peritoneum.
Peritoneal cavity: space between visceral and parietal peritoneum.
Retroperitoneal space: space behind posterior parietal peritoneum.
▪ Contains kidneys, adrenals, ureters, spine, muscles, blood vessels and nerves.
At pelvic cavity, peritoneum reflects against pelvic organs to form pouches.
In male, space between rectum and bladder is known as rectovesical pouch.
In female,
Rectouterine pouch: space between rectum and uterus.
Rectovesical pouch: space between uterus and urinary bladder.
Pelvic reflection in the pelvic cavity
