Block 5 Seminar 1:

Pelvic Floor and Perineal Pouches

MBChB Year 1, Medical School, University of Warwick

5th May 2016

Mike Gilder
M.Gilder@warwick.ac.uk
This seminar provides an overview of clinical anatomy learning
objectives for:

STC Seminar 1: Pelvic Floor and Perineal Pouches

These slides may not be used in the seminar, but you may find them
helpful as a resource.

Any questions outside of sessions?

Very welcome to e-mail me:

M.Gilder@warwick.ac.uk
Overview: Boundaries of Perineum
and Pelvic Floor
Ligaments of the Uterus (Superior view)

UTEROSACRAL
LIGAMENT
RECTUM

TENDINOUS
TRANSVERSE
ARCH RUNS
(CARDINAL)
FROM PUBIS
UTERUS CERVICAL
TO SACRUM
LIGAMENT

BLADDER

Ligaments formed
from condensations
PUBOCERVICAL
of endopelvic fascia
LIGAMENT
Schematic Section of Female Pelvic Floor and Perineum
Transverse (cardinal) ligaments

Cervix ANTERIOR
RECESS OF
Obturator internus ISCHIOANAL
FOSSA
Levator ani
Obturator DEEP
membrane PERINEAL
Vagina POUCH
PERINEAL
CU EUS MEMBRANE
(Deep fascia)
IC BSG
SUPERFICIAL
PERINEAL
POUCH
SUPERFICIAL
FASCIA
CU = compressor urethrae; EUS = external urethral sphincter SKIN
IC = ischiocavernosus; BSG = bulbospongiosus muscles
Schematic Section of Male Pelvic Floor and Perineum

ANTERIOR
Bladder RECESS OF
ISCHIOANAL
Obturator internus FOSSA

Levator ani DEEP

Obturator Pros tate PERINEAL
membrane POUCH
Urethra

PERINEAL
CU EUS MEMBRANE
(Deep fascia)
IC SUPERFICIAL
Bulb
PERINEAL
BSG POUCH
COLLES’ SUPERFICIAL
FASCIA Penis & FASCIA
Scrotum
SKIN
DARTOS FASCIA
Boundaries of Perineum
Rectum
Arcuate
ligament PUBIC Internal
Pubic symphysis
SYMPHYSIS Genitalia
Bladder
COCCYX

Urethra
Urethra Anus
PERINEAL BODY PERINEAL MEMBRANE
UROGENITAL ANAL TRIANGLE
TRIANGLE
ISCHIAL
TUBEROSITY
UROGENITAL TRIANGLE: ‘Closed’ by perineal membrane
ANAL TRIANGLE: ‘Open’: Anal canal / fat in ischioanal fossa

PERINEAL BODY: Mass of connective tissue –

attachment point for perineal & pelvic floor muscles
Modified from :Clinically Oriented Anatomy, Moore et al., 7th Ed. Page: 403
Ischioanal Fossa
Ischioanal Fossa

Lesser Pelvis
Iliacus
Obturator internus Rectum
(pelvic & perineal
parts) Obturator internus
Pudendal nerve Superior and
and vessels in Inferior fascia of
pudendal canal pelvic floor
Levator ani Branches of
pudendal nerve
External anal traversing fat of
sphincter ischioanal fossa

Modified from :Clinically Oriented Anatomy, Moore et al., 7th Ed. Page: 342
Ischioanal Fossa

Fascia covering the inferior aspect of the pelvic diaphragm forms the roof of the
ischioanal fossa.

Abcesses of the right or left ishioanal fossa may extend to the contralateral
fossa via the deep postanal space.
Perianal / Ischioanal Abcess
Perineal Membrane and Fascial
Compartments
Superficial Fascia of Abdomen and Perineum

Scarpa’s fascia

Cut edge of Dartos

fascia of penis
Cut edge of Dartos
fascia of scrotum Inguinal
ligament
Colle’s fascia
of perineum
Extent and Attachment of the Membranous Layer of the
Superficial Fascia

Attached to inferior border

of perineal membrane
‘Type of Accident Resulting in Ruptured Bulbar Urethra’
Straddle Injury: Extravasation into Superficial Perineal Pouch

Bladder

Obturator internus
Levator ani RUPTURE OF
Obturator Pros tate SPONGY
membrane URETHRA
Urethra

PERINEAL
CU EUS MEMBRANE
(Deep fascia)
Bulb
IC SUPERFICIAL
FASCIA
SKIN
COLLES’
FASCIA Penis &
Scrotum
DARTOS FASCIA
Superficial Perineal Pouch: Extravasation of Urine and Blood

Membranous
layer of superficial Perineal
abdominal fascia: membrane and
Scarpas Fascia perineal body

Dartos Fascia

Membranous layer of
superficial perineal
Dartos Muscle & Fascia fascia: Colles fascia
Pelvic Trauma: Extravasation into Deep Perineal Pouch

SEPARATION OF
Bladder
PUBIC SYMPHYSIS
Obturator internus / PUBOPROSTATIC
LIGAMENTS:
Levator ani RUPTURE OF
Obturator Pro state MEMBRANOUS
membrane URETHRA
Urethra

PERINEAL
CU EUS MEMBRANE
(Deep fascia)
Bulb
IC
SUPERFICIAL
FASCIA
COLLES’ SKIN
FASCIA Penis &
Scrotum
DARTOS FASCIA
Deep Perineal Pouch: Extravasation of Urine and Blood

Torn and
separated
Perineal
intermediate
membrane and
part of urethra
perineal body
Innervation of Perineum
Nerves of Female Perineum: Cutaneous Zones

PUDENDAL NERVE
Pudendal Nerve
Block