the pelvic floor per brodal institutt for medisinske basalfag universitetet i oslo 9th semester 2008
TRANSCRIPT
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
5P. Brodal 2008
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
15P. Brodal 2008
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