Pelvic floor and perineum

Pelvic diaphragm

  1. Levator ani
    • Largest and most important muscle of pelvic floor
    • Arises posterior aspect of body of pubic bone, fascia of side wall of pelvis (covering obturator internus) and spine of ischium
  2. Coccygeus
  3. Superifical muscles of anterior and posterior perineum

Anterior (Urogenital perineum)

  1. Line joining ischial tuberosities passes just in front of anus
  2. Attached to sides of triangle is tough fascial sheet - perineal membrane (pierced by urethra), deep to membrane is external uretheric sphincter
  3. Enclosing deep aspect of external sphincter is second fascial sheath
  4. Superficial to perineal membrane is superficial perineal pouch, contains:
    • Bulbospongiosus (covers corpus spongiosum surrounding urethra)
    • Ischiocavernosus (on each side) arising from ischial ramus and covering corpus cavernosum
    • Superficial transverse perineal muscle - runs transversely from perineal body to ischial ramus (of no functional importance)

 

Posterior (anal) perineum

  1. Triangle lying between ischial tuberosities and the coccyx
  2. Contents:
    • Anus
    • Superficial sphincters
    • Levator ani
    • Ishiorectal fossa (lined with lobulated fat); communicate with each other behind the anus - infection on one side readily passess to other