QUESTION NO 01

PART a) Define Pelvis?

Pelvis, also called bony pelvis or pelvic girdle is a basin or bowel shaped complex of bones that
connects the trunk and the legs which act to support and balance the trunk, and also contain and
support the intestines, the urinary bladder, and the internal sex organs.
The two hip bones articulate with each other anteriorly at the symphysis pubis and posteriorly
with the sacrum at the sacroiliac joints and form a basin shaped structure called as pelvis.

B- What is the concept of true and false pelvis?

The false pelvis (or greater pelvis) is bounded on either side by the ilium. In front it is
incomplete, presenting a wide interval between the anterior borders of the ilia; behind is a deep
notch on either side between the ilium and the base of the sacrum.

It is considered as a part of the pelvic cavity by some while part of the abdominal cavity by some
others so due to this contradiction hence the name false pelvis.

The false pelvis supports the intestines (specifically, the ileum and sigmoid colon), and transmits
part of their weight to the anterior wall of the abdomen as well as during early stages of labor it
helps guiding the fetus into true pelvis

The true pelvis (or lesser pelvis) is bounded in front and below by the pubic symphysis and the
superior rami of the pubis; above and behind, by the sacrum and coccyx; and laterally, by a
broad, smooth, quadrangular area of bone forming a cavity which is short, curved canal, deeper
on its posterior than on its anterior wall, and contains the pelvic inlet, an outlet, and a cavity.

It is important because it forms the bony canal through which the fetus passes during birth.

C- Define pelvic inlet, pelvic outlet and pelvic cavity?

Pelvic inlet:-The upper opening of the true pelvis bounded anteriorly by the pubic symphysis
and the pubic crest on either side, laterally by the iliopectineal lines, and posteriorly by the
promontory of the sacrum.
Pelvic outlet:- It is the inferior opening of the pelvis that is bounded by coccyx posteriorly, the
ischial tuberosities laterally, and the pubic arch anteriorly

It is diamond shaped.

 It has three notches: one in front, the pubic arch, formed by the convergence of the inferior
rami of the ischium and pubis on either side. The other notches, one on either side, are formed by
the sacrum and coccyx behind, the ischium in front, and the ilium above; they are called
the sciatic notches.

Pubic cavity:-

It is the space between the pelvic inlet and pelvic outlet and is short, curved canal, with a shallow
anterior wall and a much deeper posterior wall

D- What is the difference between male pelvis and a female pelvis?

1. The false pelvis is shallow in the female and deep in male.

2. The pelvic inlet is transversely oval in the female but heart shaped in the male because of
indentation produced by the promontory of the sacrum in the male.

3. The pelvic cavity is roomier in the females than in the male, and the distance between the inlet
and the outlet is much shorter.

4. The pelvic outlet is larger in the female than in the male. The ischial spines are everted in the
female but inverted in the male.

5. The sacrum is shorter, wider, and flatter in the female than in the male.

6. The subpubic angle, or pubic arch, is more rounded and wider in the female than in the male.

7. The obturator foramen is round in males while oval in females.

8. The pubic arch is less than 90 degree in males while greater than 90 degree in females.

E- Briefly describe different types of pelvis according to Caldwell and moloy?

According to Caldwell and moloy the pelvis is divided into four types on the basis of shape of
inlet.

1. Gynecoid type 2.Android type 3.Anthropoid type 4.Platypelloid type

1. Gynecoid type :- This is the most common type of pelvis in females and is generally
considered to be the typical female pelvis. Its overall shape is round, shallow, and open.
 2. Android type :- This is type of pelvis bears more resemblance to the male pelvis. It’s
narrower than the gynecoid pelvis and is shaped more like a heart or a wedge.

3 .Anthropoid type :- An anthropoid pelvis is narrow and deep. Its shape is similar to an
upright egg or oval.

4. Platypelloid type :- The platypelloid pelvis is also called a flat pelvis. This is the least
common type. It’s wide but shallow, and it resembles an egg or oval lying on its side.

F- What is pelvic floor and pelvic diaphragm?

Pelvic floor separates the pelvic cavity above and perineum below. It consists of pelvic
diaphragm, perineal membrane and deep perineal pouch. The above mentioned structures and
their constitutes combine and form pelvic floor.

FUNCTION:-The muscles of the pelvic floor supports the abdominal viscera and does not let
them drop out through pelvic outlet by counteracting the diaphragm and anterior and lateral
abdominal wall muscles. The puborectalis also helps preventing the flow the fecal material into
anal canal by maintaining the anorectal angle.

The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with the
parietal pelvic fascia on their upper and lower aspects. It separates the pelvic cavity above from
the perineal region below. It is a dome shaped set of structure.

The pelvic diaphragm supports the weight of the pelvic viscera in erect position. The levator ani
which is described as an dilator as well as sphincter probably serves for the fixation and
prevention of prolapse of pelvic viscera passing through the levator hiatus.

G- What is perineal membrane and deep perineal pouch?

Perineal membrane :- The perineal membrane is a thin triangular horizontal layer of dense

tough fascia in the perineum which divides the urogenital triangle into superficial (inferior) and
deep (superior) perineal pouches. It attaches to the inferior margins of the ischiopubic rami,
enclosing the anterior portion of the pelvic outlet. Its posterior border is free.

It provides attachment for roots of eternal genitalia. It allows structures to pass from pelvic floor
into perineum. In females it has urethral orifice and vaginal orifice. In males it contains only
anterior urethral orifice.

Deep perineal pouch :- The deep perineal pouch lies between the perineal membrane and the
fascia over the inferior aspect of levator ani muscle. Its contents are different in both males and
females.

In Males
 membranous urethra
 deep transverse perineal muscles
 sphincter urethrae
 paired bulbourethral glands (Cowper's glands). Their ducts drain into the bulbous urethra
below the perineal membrane (i.e. in the superficial perineal pouch)
 internal pudendal vessels
 dorsal nerve of the penis

In Females
 proximal urethra
 deep transverse perineal muscles
 compressor urethrae muscle
 urethrovaginalis muscle
 sphincter urethrae
 internal pudendal vessels
 dorsal nerve of clitoris.

I-Write a note on pelvic floor exercises?

Pelvic floor exercises or Kegels involve contracting and relaxing the pelvic floor muscles in a
controlled manner.
These help improve the function of pelvic floor muscles and also help in recovering and
maintaining pelvic health and fitness. Scientific research proves that the pelvic floor exercises
provide evidence-based treatment for a range of pelvic floor problems including muscle
weakness and bladder leakage (stress incontinence).
Pelvic floor exercises can help in
 Strengthening pelvic floor muscles
 Decreasing bladder leakage
 Relieving prolapse symptoms
 Reducing back or pelvic pain

Procedure:-

Pelvic floor exercises involve contracting and then relaxing your pelvic floor muscles. The
correct action is to squeeze and lift using the muscles inside and around your three pelvic
openings (i.e. bladder entrance or urethra, vagina and anus).
Pelvic Floor Safe Exercises
These are exercises that reduce the load and potential strain on the pelvic floor during physical
activity. Eercises like Kegel,squats,cycling etc.It’s important that women are involved in
appropriate regular exercise for the many physical and emotional benefits it provides.
Some women with gynaecological problems stop exercising because of their symptoms or
through fear of making their problems worse when this isn’t necessary.
Pelvic floor safe exercises include:
 Strength training
 Fitness (aerobic) training
 Core muscle training
 Weight management activities
 Bone health exercise
 Group exercise (e.g. modified Yoga)

Reference:-
1.Snell's Clinical Anatomy by Regions Book by Lawrence E.Wineski.

2. https://www.healthline.com/health/types-of-pelvis
3.https://www.dartmouth.edu/~humananatomy/part_6/chapter_37.html#:~:text=The
%20pelvic%20diaphragm%20is%20a,from%20the%20perineal%20region%20below.
4. https://radiopaedia.org/articles/deep-perineal-pouch#:~:text=The%20deep%20perineal
%20pouch%20is,line%20between%20the%20ischial%20tuberosities.
5. https://www.pelvicexercises.com.au/kegel-exercise/