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Pelvic Diaphragm
 Levator Ani and coccygeus of both the
side combinely forms pelvic diaphram
 Diaphram seperates the pel...
Pubococcygeus part
 Having three parts of fibers
◦ Anterior fibers
◦ Middle fibers
◦ Posterior fibers
Anterior fibers
◦ Arise from medial part of the pelvic
surface of the body of the pubis
◦ In male
 Fibers closely surroun...
Middle fibers
 The middle fibres constitute the
puborectalis.
 These arise from the lateral part of the
pelvic surface o...
 The posterior fibres of the
pubococcygeus arise from the anterior
half of the white line on the obturator
fascia. These ...
Iliococcygeus Part
 The fibres of this part arise from:
◦ The posterior half of the white line on the
obturator fascia; a...
The Coccygeus
 This muscle represents
◦ the posterior or ischiococcygeus part of the
pelvic diaphragm.
 It is triangular...
Nerve Supply
 The levator ani is supplied by
◦ (1) a branch from the fourth sacral
nerve;
◦ (2) a branch either from the ...
Actions of Levators Ani and
Coccygeus
 The levatores ani and coccygeus close the
posterior part of the pelvic outlet.
 2...
 In micturition, defaecation and parturition,
a particular pelvic outlet is open,
 but contraction of fibres around othe...
 The coccygei pull forwards and
support the coccyx, after it has
been pressed backwards during
defaecation or parturition...
Relations of the Levator Ani
 The superior or pelvic surface is
covered with pelvic fascia which
separates it from the bl...
 3. The anterior borders of the two
muscles are separated by a triangular
space for the passage of the urethra
and the va...
 evolution, the muscles have been
modified to form the pelvic diaphragm
which supports the viscera
 . Such support becam...
CLINICAL ANATOMY
 The muscles of the pelvic floor may be
injured during parturition
 . When the perineal body is torn, a...
MCQ
1. Part of the pelvic diaphram are all
except
a) Pubococcygeus
b) Iliococcygeus
c) Ishiococcygeous
d) Piriformis
2. Le...
3. which of the following is not true about
the relations of levator ani
a) Posterior border is lies against coccygeus
b) ...
5.Branch of the posterior devision of the
internal iliac artery
a) Superior gluteal artery
b) Inferior gluteal artery
c) S...
Neurourol Urodyn. 2015 Sep 28. doi: 10.1002/nau.22891•Xicohténcatl-
Rugerio
I1, Corona-
Quintanilla
DL2, Nicolás
L2, Martí...
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
Pelvic diaphragm ppt
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Pelvic diaphragm ppt

  1. 1. Pelvic Diaphragm  Levator Ani and coccygeus of both the side combinely forms pelvic diaphram  Diaphram seperates the pelvis from perineum  These is devided into 3 parts ◦ Pubococcygeus ◦ Iliococcygeus ◦ Ischicoccygeus [coccygeus]
  2. 2. Pubococcygeus part  Having three parts of fibers ◦ Anterior fibers ◦ Middle fibers ◦ Posterior fibers
  3. 3. Anterior fibers ◦ Arise from medial part of the pelvic surface of the body of the pubis ◦ In male  Fibers closely surround the prostate known as levator prostate ◦ In female  these fibers are arround the vagina and forms the sphincter vagina  In both cases anterior fibers inserted into perineal body
  4. 4. Middle fibers  The middle fibres constitute the puborectalis.  These arise from the lateral part of the pelvic surface of the body of the pubis.  They form a loop arround the anorectal junction  In female anterior portion of puborectalis is shorter
  5. 5.  The posterior fibres of the pubococcygeus arise from the anterior half of the white line on the obturator fascia. These get attached to anococcygeal ligament and tip of coccyx
  6. 6. Iliococcygeus Part  The fibres of this part arise from: ◦ The posterior half of the white line on the obturator fascia; and ◦ The pelvic surface of the ischial spine.  They are inserted into the ◦ anococcygeal ligament and into the side of the last two pieces of coccyx.
  7. 7. The Coccygeus  This muscle represents ◦ the posterior or ischiococcygeus part of the pelvic diaphragm.  It is triangular in shape.  It is partly muscular and partly tendinous.  Its fibres arise from ◦ (a) The pelvic surface of the ischial spine, and ◦ (b) the sacrospinous ligament.  It is inserted into the side of the coccyx, and into the fifth sacral vertebra
  8. 8. Nerve Supply  The levator ani is supplied by ◦ (1) a branch from the fourth sacral nerve; ◦ (2) a branch either from the inferior rectal nerve, or from the perineal division of the pudendal nerve.  The coccygeus is supplied by a branch derived from the fourth and fifth sacral nerves.
  9. 9. Actions of Levators Ani and Coccygeus  The levatores ani and coccygeus close the posterior part of the pelvic outlet.  2. The levators ani fix the perineal body and support the pelvic viscera.  3. During coughing, sneezing, lifting and other muscular efforts, the levators ani and coccygei counteract or resist increased intra- abdominal pressure and help to maintain continence of the bladder and the rectum.
  10. 10.  In micturition, defaecation and parturition, a particular pelvic outlet is open,  but contraction of fibres around other openings resists increased intra-abdominal pressure and prevents any prolapse through the pelvic floor.  The increase in the intra-abdominal pressure is momentary in coughing and sneezing and is more prolonged in yawning, micturition, defaecation and lifting heavy weights.  It is most prolonged and intense in second stage of labour.
  11. 11.  The coccygei pull forwards and support the coccyx, after it has been pressed backwards during defaecation or parturition or child- birth
  12. 12. Relations of the Levator Ani  The superior or pelvic surface is covered with pelvic fascia which separates it from the bladder, the prostate, the rectum and the peritoneum.  2. The inferior or perineal surface is covered with anal fascia and forms the medial boundary of the ischiorectal fossa.
  13. 13.  3. The anterior borders of the two muscles are separated by a triangular space for the passage of the urethra and the vagina.  4. The posterior border is free and lies against the anterior margin of the coccygeus
  14. 14.  evolution, the muscles have been modified to form the pelvic diaphragm which supports the viscera  . Such support became necessary with the adoption of the erect posture by man.
  15. 15. CLINICAL ANATOMY  The muscles of the pelvic floor may be injured during parturition  . When the perineal body is torn, and has not been repaired satisfactorily, the contraction of anterior fibres of the levator ani increases the normal gap in the pelvic floor, instead of decreasing it.  This results in abnormalities like cystocoele, or prolapse of the uterus.
  16. 16. MCQ 1. Part of the pelvic diaphram are all except a) Pubococcygeus b) Iliococcygeus c) Ishiococcygeous d) Piriformis 2. Levator ani is supplied by a) Branch from forth sacral nerve b) Branch from the inferior rectal nerve c) Both of them d) None of them
  17. 17. 3. which of the following is not true about the relations of levator ani a) Posterior border is lies against coccygeus b) Anterior borders are joined with each other c) Inferiorly covered with anal fascia d) Superior is covered with pelvic fascia 4. Pelvic diaphram helps in all the actions except a. Prolapse of uterus b. Micturation, Defecation c. Parturation d. Lifting heavy wight
  18. 18. 5.Branch of the posterior devision of the internal iliac artery a) Superior gluteal artery b) Inferior gluteal artery c) Superior vesical artery d) Middle rectal artery
  19. 19. Neurourol Urodyn. 2015 Sep 28. doi: 10.1002/nau.22891•Xicohténcatl- Rugerio I1, Corona- Quintanilla DL2, Nicolás L2, Martínez- Gómez M2,3, Cuevas E2, Castelán F2, Rodríguez -Antolín J2. The role of the pubococcyg eus muscle in the urethrogenit al reflex of male rats. To determine the response of the pubococcyge us muscle (Pcm) during the urethrogenital reflex (UGR). The Pcm is innervated by the caudal branch of the somatomotor branch of the pelvic ner ve. The electrically induced contraction of the Pcm increased the UP. The mechanical stimulation of the urethra during the induced micturition caused the reflex activity of the Pcm. Our results suggest that the activation of the Pcm is relevant for the UGR in male rats. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

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