Pelvic Diaphragm & Pelvic

Fascia
(The Pelvic Wall)
 Pelvic Diaphragm

• The pelvic diaphragm is formed by;

- the levatores ani muscles

- the small coccygeus muscles and their covering fasciae.

• It is incomplete anteriorly to allow passage of the urethra in males

and the urethra and the vagina in females.
 Levator Ani Muscle
Origin of Levator Ani
• The levator ani muscle is a wide thin sheet that has a linear origin from;

- the back of the body of the pubis,

- a tendinous arch formed by a thickening of the fascia covering the obturator

internus,

- the spine of the ischium.

 Insertion of Levator Ani
• From this extensive origin, groups of fibers sweep downward and medially
to their insertion as follows:

1. Anterior fibers: The levator prostatae or sphincter vaginae form a sling

around the prostate or vagina and are inserted into a mass of fibrous
tissue, called the perineal body, in front of the anal canal.

• The levator prostatae support the prostate and stabilize the perineal body.

• The sphincter vaginae constrict the vagina and stabilize the perineal body.
2. Intermediate fibers:

• The puborectalis forms a sling around the junction of the rectum and
anal canal.

• The pubococcygeus passes posteriorly to be inserted into a small

fibrous mass, called the anococcygeal body, between the tip of the
coccyx and the anal canal.

3. Posterior fibers: The iliococcygeus is inserted into the anococcygeal

body and the coccyx.
Action of Levator Ani:
1. The levatores ani muscles of the two sides form an efficient muscular
sling that supports and maintains the pelvic viscera in position.

2. They resist the rise in intrapelvic pressure during the straining and
expulsive efforts of the abdominal muscles (as occurs in coughing).

3. They also have an important sphincter action on the anorectal

junction, and in the female they serve also as a sphincter of the
vagina.
Nerve supply:

• The perineal branch of the fourth sacral nerve.

• The perineal branch of the pudendal nerve.

 Coccygeus Muscle
• Origin: This small triangular muscle arises from the spine of the
ischium.

• Insertion: It is inserted into the lower end of the sacrum and into the
coccyx.

• Action: The two muscles assist the levatores ani in supporting the
pelvic viscera.

• Nerve supply: A branch of the 4th and 5th sacral nerves

 Pelvic Fascia

• The pelvic fascia is formed of connective tissue and is continuous

above with the fascia lining the abdominal walls.

• Below, the fascia is continuous with the fascia of the perineum.

• The pelvic fascia can be divided into;

- parietal and visceral layers.

Parietal Pelvic Fascia
• The parietal pelvic fascia lines the walls of the pelvis and is named
according to the muscle it overlies.

• Where the pelvic diaphragm is deficient anteriorly, the parietal pelvic

fascia becomes continuous through the opening with the fascia
covering the inferior surface of the pelvic diaphragm, in the
perineum.

• It covers the sphincter urethrae muscle and the perineal membrane

and forms the superior fascial layer of the urogenital diaphragm.
Visceral Layer of Pelvic Fascia
• The visceral layer of pelvic fascia covers and supports all the pelvic
viscera.

• In certain locations, the fascia thickens and extends from the viscus to
the pelvic walls and provides support.

• These fascial ligaments are named according to their attachments, for

example, the pubovesical and the sacrocervical ligaments
Pelvic Peritoneum
• The parietal peritoneum lines the pelvic walls and is reflected onto
the pelvic viscera and becomes continuous with the visceral
peritoneum .
 Muscles of Pelvic Wall and Floor

1. Piriformis
• Origin: Front of sacrum

• Insertion: Greater trochanter

of femur

• Action: Lateral rotator of femur

at hip joint.

• Nerve Supply: Sacral plexus.

2. Obturator internus

• Origin: Obturator membrane

and adjoining part of hip bone.

• Insertion: Greater trochanter of

femur.

• Action: Lateral rotator of femur

at hip joint.

• Nerve Supply: Nerve to

obturator internus from sacral
3. Levator ani

• Origin: Body of pubis, fascia of

obturator internus, spine of
ischium.
• Insertion: Perineal body;
anococcygeal body; walls of
prostate, vagina, rectum, and
anal canal.
• Action: Supports pelvic
viscera; sphincter to anorectal
junction and vagina.
• Nerve Supply: Fourth sacral
nerve, pudendal nerve.
4. Coccygeus

• Origin: Spine of ischium.

• Insertion: Lower end of sacrum;

coccyx.

• Action: Assists levator ani to

support pelvic viscera; flexes
coccyx.

• Nerve Supply: Fourth and fifth

sacral nerve.