PT 1016 ORGAN SYSTEM ANATOMY

PELVIC CAVITY

PELVIC CAVITY RECTUM

• Cavity of the true pelvis

• Area between pelvic inlet and outlet
• Divided by the pelvic diaphragm into main pelvic
cavity and perineum
o The structure that divides the two is the floor
of the pelvic cavity; which is the pelvic
diaphragm
GASTROINTESTINAL ORGANS
SIGMOID COLON
• About 5 inches
• Continuous with sigmoid at about the level of the 3rd
sacral vertebrae
• Continues to tip of coccyx
• Continuous with anal canal as this structure
penetrates pelvic floor and passes through the
perineum to end as anus
• Rectal ampulla is the lower part of the rectum that is
dilated

PUBORECTALIS MUSCLE

• 10 to 15 inches long
• S shape
• Mobile except at the beginning where it continues
from descending colon and end where it continues as
rectum
• Continuation of the descending colon in front of the • The puborectalis muscle forms a sling at the junction
pelvic brim of the rectum with the anal canal
• Is continuous with the rectum in front of the 3rd sacral o The rectum follows the concavity of the
vertebra sacrum and at the end of it is the
• Attaches to the posterior wall through the sigmoid puborectalis muscle
mesocolon o Is responsible for producing the anorectal
BLOOD AND NERVE SUPPLY angle

Anorectal angle
• Supplied by inferior mesenteric artery (sigmoid
branch) • Feces is stored in this area
• Vein: inferior mesenteric vein that joins portal vein • Once the area of the ampulla is stretched, the urge to
• Nerve supply: inferior hypogastric plexus defecate can be felt
(sympathetic and parasympathetic) o Puborectalis muscle and external sphincter
helps to hold in your feces (voluntary
RELATIONSHIPS
control)
Anterior
PERITONEUM
• Male: bladder
• Rectum is covered by peritoneum anteriorly and
• Female: posterior of urethra and upper vagina
laterally
o In between the sigmoid and the female
• The lower third is devoid of peritoneum
bladder is the uterus
RELATIONSHIPS
Posterior
• Most posterior element of the pelvic viscera
• Rectum and sacrum
• Is anterior to the sacrum and coccyx

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PT 1016 ORGAN SYSTEM ANATOMY
PELVIC CAVITY

GENITOURINARY TRACT

URETERS

Anterior

• Male: sigmoid, coils of ilium (rectovesical pouch),

bladder, termination of vas deferens and seminal
vesicle
• Female: sigmoid colon and coils of ileum at the
rectouterine pouch or pouch of Douglas, posterior
surface of vagina
o Pouch of Douglas: space between uterus and
rectum
MUSCLE LAYERS
• Muscular coat of the rectum is arranged with outer
longitudinal and inner circular layers of smooth
muscles
• The mucous membrane, with the circular muscle
layers form semicircular permanent folds called the
Houston valves or transverse folds of the rectum
BLOOD AND NERVE SUPPLY
• Muscle tube that extends from kidney to the
posterior surface of bladder
• Serves as passage of urine that is formed or
developed in the kidney
• Enters the pelvic cavity anterior to the bifurcation of
common iliac artery at SI joint
• Runs anterior of the internal iliac artery
• Has 3 constrictions
o Where renal pelvis joins the ureter
o Pelvic brim
o As it pierces the bladder
o Kidney stones may clog in either of these
constrictions
• In the pelvic, the ureter is crossed by:
o Ductus deferens (in men)
▪ In front of the ureter
o Uterine artery (in women)
▪ In front of the ureter
o Bridge under water
▪ Solid structure is always anterior

URINARY BLADDER

• Blood supply: superior rectal artery, middle rectal and

inferior rectal arteries
• Vein: superior rectal (drains to inferior mesenteric
vein), middle and inferior rectal (drains to internal
iliac and internal pudendal veins respectively)
• Lymphatics: pararectal nodes to inferior mesenteric
nodes • Receptacle for storage of urine
• Nerve supply: receives supply from inferior • Is pyramidal in shape when the bladder is not yet
hypogastric plexuses (sympathetic and filled up
parasympathetic) o Becomes rounded as it becomes filled with
o Sensitive to only stretch urine

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PT 1016 ORGAN SYSTEM ANATOMY
PELVIC CAVITY

PARTS OF URINARY BLADDER • The ureters pierce the bladder obliquely providing a
valve like action preventing reverse flow of urine
Apex
toward the kidney as it fills
• Part behind the symphysis pubis o There is no sphincter in between the ureters
• Is connected to the umbilicus by the median umbilical and the bladder
ligament (remains of urachus) o As the bladder gets filled, the position of the
ureter somehow inclines to become
Base horizontal to limit the filling of bladder
• The urethra exits at the lowest point of the triangle of
• Posterior surface
trigone
• Triangular
• Superolateral angle is joined by the ureter and MALE VS FEMALE BLADDER
inferior part by the urethra
MALE FEMALE
• Opening of the ureter is at the base of the bladder 2 vas deferentia lie side by side on Neck lies directly on the upper
the base of bladder separating the surface of the urogenital
Superior surface seminal vesicles diaphragm

• Covered by peritoneum Neck of bladder lies inferiorly and

• Related to coils of ileum or sigmoid rests on the upper surface of
prostate gland
Two inferolateral surfaces

• Related in front to the retropubic pad of fat and pubic
bone
• Posteriorly they lie in contact with obturator internus
muscles (above) and levator ani muscles (below)
Neck
• Rests on the upper surface of prostate; held in
position by puboprostatic ligaments in male
(pubovescial in female)
o Related to prostate in males
TRIGONE
DETRUSOR MUSCLE
• A layer of the urinary bladder wall made of smooth
muscle
• Innervated by the autonomic nervous system
• When the bladder is stretched, this signals the
parasympathetic nervous system to contract the
detrusor muscle
o The bladder is innervated by the autonomic
nervous system and is also has afferent or
sensory fibers around the bladder wall
o This encourages the bladder to expel urine
through the urethra

BLOOD AND NERVE SUPPLY

• The triangular shape area where the mucous

membrane covers the internal surface of the base of
bladder
o Smoother area as compared to its
surrounding structures Arteries
o Upper area is where the entrance of ureter
is found • Superior and inferior vesical arteries, branches of
o Inferior area has an opening going to the internal iliac artery
urethra
Nerve supply

• Inferior hypogastric plexus

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PELVIC CAVITY

o Sympathetic postganglionic fibers come o If the subject is distracted, the desire can
from L1-2 and descend via hypogastric fade and return with more urgency as the
plexus bladder continues to fill
▪ Inhibits contraction of detrusor o Normal bladder capacity: 300-500 cc
muscle of bladder wall and closure
Micturition reflex
of sphincter
▪ Bladder is relaxed; sphincter is
closed
o Parasympathetic preganglionic fiber come
from pelvic splanchnic nerve of S2-4 and
pass through the inferior hypogastric plexus
to the bladder wall
▪ Stimulates contraction of bladder
and opening of sphincter
▪ Empties the bladder
o Afferent fibers are through the pelvic
splanchnic and hypogastric plexus
▪ Sensory supply allows us to feel that
our bladder is filled up
• Initiated when volume of urine in bladder reaches 300
SPHINCTERS ml
Internal • Filling phase: sympathetic
o Relaxed bladder, closed sphincter
• Controlled by autonomics • Filled up phase: parasympathetic
o Contracted bladder, open sphincter
External
• Voluntary control can override the parasympathetic
• Can be voluntarily controlled 1. Stretch receptors are stimulated and transmit impulses to
CNS causing individual a conscious desire to micturate
MICTURITION 2. Afferent impulse pass pelvic splanchnic nerve and enter
• For the urine to exit the bladder, both the S2, 3, 4
autonomically controlled internal sphincter and the o Some via sympathetic nerve through hypogastric
voluntarily controlled external sphincter must be plexuses under L1, 2
opened 3. Efferent parasympathetic
o Problems with these muscles can lead to o Pelvic splanchnic nerve and inferior hypogastric
incontinence plexuses to the bladder wall where they synapse
▪ Weak external sphincter with post ganglionic neuron
o External sphincter is innervated by pudendal 4. Detrusor muscle is made to contract and sphincter vesicae
nerve (can be voluntarily controlled) is made to relax
▪ Babies cannot control their bladder; 5. Efferent impulse pass to urethral sphincter via pudendal
only sympathetic and (S2, 3, 4) and undergo relaxation
parasympathetic systems are acting 6. Micturition is assisted by raise in intra-abdominal pressure
(via abdominal muscle)
• The urinary bladder has a normal capacity of 500 ml
of urine, but it can hold twice this without rupturing
if, for example, the outflow is obstructed
o Holding urine for too long is harmful
▪ Can cause bacterial infection
• The desire to urinate usually starts when the bladder
reaches around 75% of its working volume

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PT 1016 ORGAN SYSTEM ANATOMY
PELVIC CAVITY

COMMON NEUROENIC BLADDER IN SPINAL CORD PATIENTS URETHRA

Atonic bladder • Begins at the base of the bladder and ends with
external opening in the perineum
• Occurs during spinal shock (or immediately after a
• Structure where urine from the bladder exits
spinal cord injury)
• Bladder muscle is relaxed and sphincter is tightly URETHRA IN FEMALE VS MALE
contracted
o Bladder becomes distended and finally
overflows (sympathetic function)
o Patient is not aware that the bladder is full
▪ Sensory supply is also affected

Automatic reflex bladder FEMALE MALE

Short, about 4 cm long Long, about 20 cm (enclosed or
• Women are more prone within the penis area)
to develop UTI
Bends twice along its course
Travels in a slightly curved course beginning at the base of bladder
and passing inferior to the prostate
Opening is anterior to the vaginal
opening Divided into: preprostatic,
• 3 openings: vaginal, prostatic, membranous part and
• Occurs after patient has recovered from spinal shock spongy part
urethral, anal
(lesion above S2-4)
o 24-48 hours Skene’s glands: two paraurethral
mucous gland at the lower end of
o Also observed in comatose or stroke patients the urethra and drains onto the
• Bladder fills and empties reflexly lateral margin of urethral orifice
• Stretch receptors in bladder wall are stimulated as it
is filled and afferent impulses pass to spinal cord
URETHRA IN MEN
segment while efferent impulse pass down the
bladder muscle which contracts
• Sphincter vesicae and urethral sphincter both relax
• Simple reflex occurs every 1-4 hours
• Type of bladder also found in infants

Autonomous bladder
Preprostatic urethra or intramural part of urethra
• Occurs in sacral segment
o Contains parasympathetic and pudendal • 1-1.5 cm long
supply • Extends vertically from bladder neck to the superior
• Bladder is without external reflex control aspect of prostate
• Bladder wall is flaccid and capacity of bladder is • Associated with internal urethral sphincter
greatly increased • Prevents retrograde movement of semen to the
• Fill to capacity and overflows resulting to continuous bladder
dribbling
• Bladder may be partially emptied by manual Prostatic urethra
compression • 4 cm long: widest and most dilatable part
• Infection and back pressure effect in ureter and • Descends through the anterior part of the prostate
kidneys are inevitable o Enclosed within the prostate
o In elderly male, urethra is impinged when
prostate becomes enlarged
• Forms a gentle curvature with anterior concavity
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PELVIC CAVITY

Membranous part SEMINAL VESICLE

• Shortest and narrowest part, 1-2 cm long

• Lies in the perineal region
• Begins at the apex of prostate and ends at the bulb of
the penis
• Traverses the deep perineal pouch and passes
through the external urethral sphincter and perineal
• Lobulated organ about 2 inches long at the posterior
membrane
surface of bladder
• Associated with the external urethral sphincter
• Has 4 lobes
• Posterolaterally related with Bulbourethral or
o 2 on each side
Cowper’s gland
• Each vesicle consists of much coiled tube embedded
Spongy urethra in connective tissue
• Functions to produce secretion that is added to the
• The longest part (15-16 cm and 5 mm in diameter) seminal fluid
• Passes through the bulb (Bulbar part of spongy o Secretion contains substances essential for
urethra) and corpus spongium of the penis (penile nourishment of spermatozoa
part of spongy urethra)
• Ends at the external urethral orifice BLOOD SUPPLY
o Expanded in the bulb of penis: intrabulbar
• Arteries: inferior vesicle and middle rectal arteries
fossa and
• Veins: internal iliac vein
o In the glans penis: navicular fossa
• Lymph drainage: internal iliac node
o Proximal part receives opening of ducts of
bulbourethral glands EJACULATORY DUCTS
o Also receives openings of urethral glands

MALE GENITAL ORGANS

VAS DEFERENS

• Less than 1 inch in length and are formed by union of

vas deferens and duct of seminal vesicle
o During ejaculation, sperm comes out from
testes, to the vas deferens, to the
• Thick wall tube; 18 inches in length
epididymis, joining the ejaculatory duct
• Conveys mature sperm from epididymis to the
• It pierces the posterior surface of prostate and opens
ejaculatory duct to the urethra
into prostatic part of urethra
• Ampulla of vas deferens is the dilated terminal part
• Function: drain seminal fluid into the prostatic
• Joins the duct of the seminal vesicle to form the
urethra
ejaculatory duct
o Sperm exits through the penis
o Seminal vesicle adds seminal fluid to further
nourish the sperm PROSTATE

• NOT part of reproductive system of males but

contains gland secretions
• Unpaired fibromuscular glandular organ
• Found surrounding the neck of bladder and urogenital
diaphragm inferior to the bladder (urethra)

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PELVIC CAVITY

o Enlarged prostate causes problems in the Prostate cancer

urine flow of men
• Has a base (lies superiorly against bladder neck) and • Posterior lobe is most commonly affected
apex (lies inferiorly against urogenital diaphragm) • Screening for prostate cancer
• Made of numerous glands (30-40) o Digital rectal exam: finger is inserted in
rectum to palpate for the posterior lobe
• Ejaculatory ducts pierce the upper part of posterior
o Firm posterior lobe = presence of tumor
surface of prostate and open into the prostatic
urethra RELATIONSHIPS
• Function: produces thin milky fluid containing citric
acid and acid phosphate that is added to seminal fluid
at the time of ejaculation
o Prostatic fluid

5 LOBES
Superior

• Base is continuous with neck of bladder

Inferior

• Apex lies on upper surface of urogenital diaphragm

Anterior Anterior
• Devoid of glandular tissue • Related to symphysis pubis separated by
• In front of urethra extraperitoneal space at the cave of Retzius
o Contains fats
Middle or median
Posteriorly
• Wedge
• Between urethra and ejaculatory ducts • Anterior surface of rectal ampulla separated by
• Upper surface is related to trigon rectovesical septum (fascia of Denonvilliers)
• Rich in glands
BLOOD AND NERVE SUPPLY
Posterior
• Blood supply: inferior vesical and middle rectal
• Behind urethra and below ejaculatory ducts arteries
• With gland tissue • Venous: prostatic venous plexus lies outside of
capsule and receive blood from deep dorsal vein of
Left and right lateral lobes
penis and vesical veins
• Separated by vertical groove • Lymphatic: internal iliac nodes
• Lateral lobes has many glands • Nerve: inferior hypogastric plexus

Benign prostatic hyperplasia (BPH) BULBOURETHRAL GLANDS

• When males get older, sometimes the lobes get

hypertrophied
• Commonly affected are medial and lateral lobes
o Urethral opening may narrow or constrict =
difficulty in peeing • One on each side
• Non-cancerous • Small, pea shape mucous glands found within the
deep perineal pouch lateral to the membranous part
of urethra
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• Opens into the bulb of the spongy urethra at root of
penis
FEMALE GENITAL ORGANS
OVARY
• Found on lateral wall of pelvis called ovarian fossa
o Boundaries: external iliac vessel above and
internal iliac vessel behind
o Found hanging down the rectouterine pouch
(of Douglas)
• Oval shaped measuring 1.5 x 0.75 in. and attached to
the back through the mesovarium ligament
• Suspensory ligament of ovary
o Part between mesovarium and lateral wall of
pelvis
• Tunical albuginea
o Thin fibrous capsule around ovary (covering
of ovary)
• Ovary contains the female eggs that would prepare
the female for a possible fertilization
o If contact with sperm cell does not happen,
fertilization does not occur and the mucosal
thickness is shredded = menstruation
Function
• Produces female sex hormones estrogen and
progesterone
o Hormones responsible for the secondary
sexual characteristics of female
▪ Developing menstruation
▪ Enlarged breasts
▪ Pubic hair
▪ Body shape changes
▪ Fat deposits
• Site of egg production (oogenesis); mature eggs are
ovulated into the peritoneal cavity and normally
directed into the adjacent opening of the uterine tube
by cilia
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BLOOD SUPPLY
• Ovarian artery from abdominal aorta at the level of L1
UTERINE TUBE (FALLOPIAN TUBE)
• About 4 inches
Function
• Receives the ovum and provides site where
fertilization of ovum takes place
• Provides temporary nourishment for the fertilized
ovum and transports it to the cavity of uterus
• Serves a conduit along which spermatozoa travel to
reach ovum
4 PARTS
Infundibulum
• Receives the released egg
• Funnel shape lateral projections beyond the broad
ligament
• Ends with fingerlike free edge called fimbriae
Ampulla
• Widest part of tube
• Where fertilization of ova and sperm takes place most
of the time
• Ectopic pregnancy
o Egg and sperm is stuck and does go to the
uterus
o Fetus cannot grow and live
Isthmus
• Narrowest part
• Just lateral to uterus
Intramural part
• Segment that pierces uterine wall
BLOOD AND NERVE SUPPLY
• Artery: uterine artery
• Nerve: sympathetic and parasympathetic nerve from
inferior hypogastric plexus
• Lymph drainage: internal iliac and para-aortic nodes
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PELVIC CAVITY

UTERUS Supravaginal cervix

• Anterior: superior surface of bladder

• Lateral: ureter

Vaginal cervix

• Anterior: anterior fornix of vagina

• Hallow, pear shape organ with thick muscular coat • Lateral fornix of vagina
Function STRUCTURE OF UTERUS

• Serves as site for the reception, retention and

nutrition of the fertilized ovum

PARTS

Fundus Muscle wall or myometrium

• Lies above the entrance of fallopian tube • Thick smooth muscle supported by connective tissue

Body Endometrium

• Lies below entrance of uterine tube; is continuous • Mucous membrane lining the body of uterus;
with cervix continuous with mucous membrane lining the uterine
• Where the fertilized egg is eventually implanted tube

Cervix Parametrium

• Lower part of the uterus • Supravaginal part of cervix surrounded by visceral

• Divided into supravaginal and vaginal parts pelvic fascia
o Supravaginal: upper portion • Where uterine artery crosses the ureter on each side
o Vaginal: lower portion
o Vagina is already in the part of perineum BLOOD AND NERVE SUPPLY

Cavity • Arterial: uterine artery

• Vein: uterine vein that drains to internal iliac vein
• Triangular and communicates with vagina through • Lymph drainage
external os o Fundus: accompany the ovarian artery and
• Internal os is the opening going to the vaginal part of drain into the para-aortic nodes at the level
the vervix of first lumbar vertebra
o Vessel from body to cervix drain to internal
RELATIONSHIPS
and external iliac lymph node
Anterior o Round ligament of uterus: inguinal canal and
drain to superficial inguinal lymph nodes
• Uterovesical pouch and superior surface of bladder • Nerve supply: sympathetic and parasympathetic
Posterior nerves from branches of inferior hypogastric plexus

• Rectouterine pouch (pouch of Douglas), ileum or

sigmoid

Laterally

• Related laterally to the broad ligament and uterine

artery and vein
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PELVIC CAVITY

SUPPORT OF UTERUS Function

• Serves as excretory duct for menstrual flow

• Forms part of birth canal where baby exits

RELATIONSHIPS

Anterior
• Supported by tone of muscle (levator ani) and the
condensation of pelvic fascia forming 3 ligaments • Related to the bladder (above) and urethra
o Injury to the floor can cause prolapse of
uterus Posterior

Transverse cervical (cardinal) ligament
• Transverse ligament that pass to cervix and upper end
of vagina from lateral wall of pelvis
Pubocervical ligament
• 2 firm bands of connective tissue that pass to the
cervix from posterior surface of pubis
• Found on each side of neck of bladder to which they
give some support (pubovesical ligament)
Sacrocervical ligaments
• Located at the back
• 2 firm fibromuscular bands of pelvic fascia that pass
to the cervix and upper end of vagina from lower end
of sacrum
• Forms 2 ridges, one on each side of retrouterine
pouch (pouch of Douglas)
VAGINA
• Upper third is related to the rectouterine pouch
• Middle third to ampulla of rectum
• Lower third perineal body (which separates it from
the anal canal
Lateral
• Upper part: ureter
• Middle: anterior fibers of perineal body
• Lower part: urogenital diaphragm
BLOOD AND NERVE SUPPLY
• Arteries: vaginal artery
• Vein: plexus of vaginal vein found around the vagina,
drains to internal iliac vein
• Lymphatics:
o Upper third of vagina drains to external and
internal iliac nodes
o Middle: drains to internal iliac nodes
o Lower third: drains to superficial inguinal
nodes
• Nerve supply: inferior hypogastric plexus (autonomic)

SUPPORT

• Upper part: levatores ani and transverse cervical,

pubocervical and sacrocervical ligaments
• Muscular tube that extends upward and backward
• Middle part: urogenital diaphragm
from vulva to the uterus
• Lower part: perineal body
• 3 inches
• Anterior wall is pierced by the cervix; upper part of VISCERAL PELVIC FASCIA
the vagina lies above pelvic floor and lower lies within
perineum • Layer of connective tissue that covers and supports
• Divisions of vagina (at the area surrounding the the pelvic viscera
cervix) called fornices • It is condensed to form the pubocervical, transverse
o Anterior cervical and sacrocervical ligaments of the uterus
o Posterior
o Lateral (right and left)
• Hymen: thin mucosal fold at vaginal orifice which is
perforated at the center
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PERITONEUM

• The pelvic cavity is a continuation of the abdominal

cavity therefore its covering also goes down as low as
the pelvic cavity
• Passes down from the anterior abdominal wall to the
upper surface of the bladder then at the level of
internal os
• It passes the anterior part of the body and fundus of
uterus to the posterior surface
• Continues to cover the upper part of the posterior
surface of vagina
• Passes anterior to the sigmoid and upper part of
rectum

BROAD LIGAMENT

• Two layered fold of peritoneum extending across

pelvic cavity from lateral margin of uterus to lateral
pelvic wall
• 3 parts
o Mesovarium: attach ovary
o Suspensory ligament of ovary
o Mesosalpinx: between uterine tube and
mesovarium
• Each broad ligament contains:
o Uterine tube
o Round ligament of the ovary and uterus
o Uterine and ovarian blood vessels, lymph
vessels, and nerves

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