ANATOMY OF THE PELVIS

The bony pelvis is composed of four bones:

• Two hip bones, which form the anterior and lateral walls.
• Sacrum and coccyx, which form the posterior wall.
• These 4 bones are connected by 4 joints and lined by 4 muscles.
• The bony pelvis with its joints and muscles form a strong basin-shaped structure (with
multiple foramina),
• The pelvis contains and protects the lower parts of the alimentary & urinary tracts & 3
internal organs of reproduction.
 FOUR
JOINTS

1- Anteriorly:
Symphysis pubis (cartilaginous
joint).
2- Posteriolateraly:
Two Sacroiliac joints. (Synovial
joins) 4
The pelvis is divided into
two parts by the pelvic
brim.
Above the brim is the
False or greater pelvis, Pelvi
which is part of the c
abdominal cavity. brim
Below the brim is the True
or lesser pelvis.
The False pelvis is bounded
by:
Posteriorly:
Lumbar vertebrae.
Laterally:
Iliac fossae and the iliacus
muscle.
Anteriorly:
Lower part of the anterior
abdominal wall.
It supports the abdominal 5
contents.
The True pelvis has:
 An Inlet.
 An Outlet.
 A Cavity:

The cavity is a short,

curved canal, with
a shallow anterior
wall and a deeper
posterior wall.
It lies between the
inlet and the
outlet.

6
 PELVIC INLET PELVIC OUTLET

Anteriorly: Symphysis pubis. Anteriorly: Symphysis pubis.

Posteriorly: Promontory of sacrum, Posteriorly : Coccyx,
ala of sacrum. Anterolaterally: ischiopubic ramus
Posterolaterally: Sacrotuberous
Laterally: Ileopectineal (arcuate) lines.
ligament,

7
 FEMAL MALE
E

In female the Sacrum is usually wider and shorter.

Also, the Angle of the pubic arch is wider.
The promontory and the ischial spines are less projecting. 8
Types of Female Bony Pelvis

Information
of the shape
and
dimensions
of the female
pelvis is of
great
importance
for
obstetrics,
because it is
the bony
canal
through
which the
child passes
during birth. 9
 Pelvic walls
• The pelvis has 4 walls:
• Anterior.
• Posterior.
• Lateral.
• Inferior or floor.
• The walls are formed by bones
and ligaments that are lined
with muscles covered with
fascia and parietal peritoneum.

ANTERIOR PELVIC WALL

It is the shallowest wall and is formed
by the posterior surfaces of the bodies
of the pubic bones, the pubic rami, and
the symphysis pubis.
10
 POSTERIOR PELVIC WALL

It is large and formed by sacrum, coccyx , piriformis

muscles and their covering of parietal pelvic fascia. 11
 Piriformis

• Origin: Pelvic surface of the middle 3 sacral vertebrae.

• It leaves the pelvis through the greater sciatic foramen.
• Insertion: Greater trochanter of the femur.
• Action: Lateral rotator of the femur at the hip joint.
• Nerve supply: Sacral plexus. 12
 LATERAL PELVIC WALL

It is formed by:
1- Part of the hip bone below the pelvic inlet,
2- Obturator internus and its covering fascia & the obturator fascia.
3- Sacrotuberous ligament.
4- Sacrospinous ligament. 13
 Obturator Internus

• Origin: Inner surface of the obturator membrane and the hip bone.
• Insertion: It leaves the pelvis through the lesser sciatic foramen to be inserted
into the greater trochanter of the femur.
• Action: Lateral rotator of the femur at the hip joint.
• Nerve supply: Nerve to obturator internus.
14
 INFERIOR PELVIC WALL, OR PELVIC FLOOR

• Basin-like structure which supports the pelvic viscera and is formed by the
pelvic diaphragm.
• It stretches across the true pelvis and divides it into:
• Main (true) pelvic cavity above, which contains the pelvic viscera, &
• Perineum below which carries the external genital organs. 15
PELVIC DIAPHRAGM

It is formed by the
levator ani and
the coccygeus
muscles and their
covering fasciae.

It is incomplete
anteriorly to allow
passage of the urethra
in males and urethra
and vagina in females.

16
 LEVATORES ANI MUSCLES
It is a wide thin sheet-like muscle . ORIGIN:
1. Back of the
body of the
pubis
2. Tendinous arch
of the obturator
fascia
3. Spine of the
ischium.

Its fibers are divided

into 3 parts:
1- Pubococcygeus.
2- Iliococcygeus.
3-ischiococcygeus.
LEVATORES ANI MUSCLES - ANTERIOR FIBERS

• 1- Pubococcygeus.
• originates from the
posterior surface of
the body of the
levator prostatae pubis
• inserted into the
perineal body (and
coccyx.
• supports the
prostate (or
constricts the
vagina)
• stabilizes the
sphincter vaginae
perineal body
• forms a sling around
the prostate or the
vagina
The puborectalis forms a
sling around the recto-
anal Junction.
It has a very important
role in maintaining
fecal continence.

19
LEVATORES ANI MUSCLES Intermediate Part
 Iliococcygeu
s
 inserted into
the
anococcygeal
body and the
coccyx
 Ischiococcygeus
Posterior part
Arises from the ischial
spine and inserted
into the
anococcygealbody &
coccyx

21
Nerve supply
to levator
ani:
1. perineal
branch of the
fourth sacral
nerve
2. perineal
branch of the
pudendal
Actions
nerve.
of levator ani:
1. The 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 intra pelvic pressure during the straining and expulsive
efforts of the abdominal muscles (as in coughing).
3. They have a very important role in maintaining fecal continence.
4. They serve as a vaginal sphincter in the female.
22
COCCYGEUS MUSCLE
 small
triangular
muscle.
 Origin:
 Ischial spine.
 Insertion:
Lower end of
sacrum and
coccyx
 Action:
 Assist the
levator ani in
supporting
the pelvic
viscera
 Nerve
supply:
branches of
the 4th and 5th
Arteries of the
Pelvis (I) Internal iliac artery(IIA):

• One of the 2 terminal branch of the Common iliac

artery.
• Arises in front of the sacroiliac joint
• It descends downward & backwards over the pelvic
inlet.
• It divides at the upper border of the greater sciatic
foramen into:
• Anterior & Posterior divisions.
Posterior division Supplies:
1. Posterior abdominal wall.
2. Posterior pelvic wall.
3. Gluteal region.
Anterior division supplies:
1. Gluteal region.
2. Perineum.
3. Pelvic viscera.
IIA 4. Medial (adductor) region of thigh
5.The fetus (through the umbilical arteries).
 Iliolumba
Parietal Branches
r
Obturator • From posterior
division:

1. Iliolumbar artery.
2. Lateral sacral arteries
(2 branches.)
3. Superior gluteal artery.

• From anterior
division:

1. Obturator artery.
Lateral Superior 2. Inferior Gluteal artery.
sacral Inferior gluteal
Gluteal
 Visceral Branches
(all from anterior division)
Umbilical artery :
Umbilical Gives the superior vesical artery: The
distal part of this artery fibrosed
and forms the Medial Umbilical
Ligament.
Inferior Vesical artery in male or
vaginal in femal:
• In the male it supplies, the Prostate
and the Seminal Vesicles.
• It also gives the artery of the Vas
Deferens.
• Middle rectal artery
• Internal pudendal artery
• It is the main arterial supply to the
Internal superio perineum.
pudendal r
vesical
 Visceral Branches (in Female)

Vaginal artery:
Replaces the inferior
vesical artery.
Uterine artery:.
Crosses the Ureter
superiorly and supplies
the uterus & uterine
tubes.

(II) Ovarian artery:

Arises from the
abdominal aorta.
IN BRIEF…

28
 Venous
Drainage

INTERNAL
INTERNALILIACILIACVEINS
VEINS
•• ItItcollect
collecttributaries
tributaries
corresponding
correspondingto tothe
the
branches
branchesof ofthe
theinternal
internal
iliac
iliacartery.
artery.
•• joins
joinsthe
theexternal
externaliliaciliac
vein
veinininfront
frontofofthe
the
sacroiliac
sacroiliacjoint
jointtotoform
form
the
thecommon
commoniliaciliacvein
vein

Ovarian vein:
Right vein drains into
IVC
Left vein drains into left
renal Vein.
29
 LYMPHATICS OF THE PELVIS

•• The
Thelymph
lymphnodes
nodesand andvessels
vesselsare
are
arranged in a chain along the
arranged in a chain along the mainmain
blood
bloodvessels.
vessels.
•• Thus,
Thus,there
thereare
areexternal
externaliliac
iliac
nodes,
nodes, internal iliac nodes,and
internal iliac nodes, and
common iliac nodes.
common iliac nodes.

lymph from Common iliac nodes

& the (Ovaries, uterine tubes &
fundus of uterus) passes to Lateral
aortic (paraortic) nodes.

30
 Nerve Supply
• Somatic:
• Sacral plexus
• Autonomic:
• Sympathetic:
• Pelvic part of sympathetic
trunk:The 2 sympathetic trunks
unite inferiorly in front of the
coccyx and form a single
ganglion (Ganglion Impar).
• II- Superior & Inferior
• Hypogastric plexuses
• Parasympathetic:
Pelvic splanchnic nerves (From
S 2 , 3 & 4)