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1. Welcome
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2. Dewan Institute Of Rehabilitation Sciences
Shaheed Benazir Bhutto
Dewan University
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3. THE
PELVIS
Presented By:
Saadiya Naeemi
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-DPT Batch-I

4. THE PELVIS:
It is the lower part of the trunk between the abdomen and the
lower limb.
THE BONES:
1. Innominate Bones ( Illium, Ischium & Pubis)
2. Sacrum.
3. Coccyx
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5. Fig. The Bones Of Pelvis.
1. Innominate
Bones:
Forms the Lateral
and Anterior wall.
2. Sacrum and
Coccyx:
Part of the vertebral
column and forms
the back wall.
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6. Articulation :
-Anteriorly: Symphysis Pubis.
-Posteriorly: Sacrum at Sacroiliac Joint.
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7. PELVIC BRIM :
- Posteriorly: Sacral Promontary.
- Anteriorly: Symphysis Pubis.
- Laterally: Ileopectineal Line.
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8. -Posterior: Lumbar Vertebra.
- Lateral: Illiac Fossa,
Illiacus muscle.
- Anterior: Lower part of Ant.
Abdominal wall.
False Pelvis :
(Greater Pelvis)
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9. Clinical Importance
After 3rd month of pregnancy, helps support Gravid Uterus.
False Pelvis :
(Greater Pelvis)
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10. True Pelvis :
i) Pelvic Inlet.
ii) Pelvic Outlet.
iii) Pelvic Cavity.
(Lesser Pelvis)
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11. i) Pelvic Inlet:
- Anterior: Symphysis Pubis.
- Posterior: Illeopectineal Line.
- Lateral: Sacral Promontory.
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12. Fig. Pelvic Inlet
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13. ii) Pelvic Outlet:
- Anterior: Pubic Arch.
- Posterior: Coccyx
- Lateral: Ischial Tuberosity.
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14. Fig. Pelvic Outlet
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15. ii) Pelvic Outlet:
Sub-Pubic Angle:
The angle beneath the pubic arch is known as the sub-
pubic angle and is of a greater size in women.
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Fig. Sub-Pubic Angle Female.
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Fig. Sub-Pubic Angle Female.
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18. ii) Pelvic Outlet:
Notches:
1. Three wide notches.
2. Anteriorly, the pubic arch is in between the ischiopubic rami
below the pubic symphysis.
3. Laterally, are the two sciatic notches which are divided by
Sacrotuberous Ligament & Sacrospinous Ligament.
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19. Fig. Pelvic Outlet
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20. iii)Pelvic Cavity:
- Lies between the inlet and outlet.
- Short, curved canal.
- Shallow anterior wall and a much
deeper posterior wall.
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21. Pelvic Walls:
1. Anterior wall.
2. Posterior wall.
3. Lateral wall.
4. Inferior wall (Pelvic Floor).
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22. 1.Anterior wall:
o Shallowest wall.
o Formed by posterior surface of:
 Pubic rami.
 Symphysis Pubis.
 Pubic Bones.
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25. 2.Posterior wall:
o Formed by :
 Sacrum.
 Coccyx.
 Piriformis Muscle.
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28. 3.Lateral wall:
o Formed by parts of hip bones.
o Pelvic Inlet.
o Obturator membrane.
o Sacrotuberous Ligament.
o Sacrospinous Ligament
o Obturator Internus Ligament.
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31. 4.Inferior wall:
o Supports Pelvic Viscera.
o Formed by Pelvic Diaphragm.
o In order to allow for urination and defecation, there are a
few gaps in the structure. There are two ‘holes’ that
have significance:
a) The urogeninital hiatus – An anteriorly situated gap, which
allows passage of the urethra (and the vagina in females).
b) The Ano-rectal hiatus – A centrally positioned gap, which
allows passage of the anal canal.
( Pelvic Floor)
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34. Pelvic Diaphragm:
o Funnel-shaped.
o There are three components:
1. Levator ani muscles (largest component).
2. Coccygeus muscle.
3. Fascia coverings of the muscles.
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35. 1.Levator Ani Muscles:
o It is a broad sheet of sub-muscles.
o It is composed of three separate paired muscles.
a. Pubo-coccygeus muscle.
b. Pubo-rectalis muscle.
c. Illio-coccygeus muscle.
o Acting together they raise the pelvic floor and assist
the abdominal muscles in forced expiration activities
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36. a. Pubo-coccygeus :
o The muscle fibres of the pubococcygeus arise from the body of
the pubic bone and the anterior aspect of the tendinous arch.
o The fibres travel around the margin of the urogenital hiatus and
run posteriomedially,attaching at
the coccyx and anococcygeal ligament.
o As the fibres run inferiorly and medially, some fibres divide and
loop around the prostate in males (levator prostatae) and
around the vagina in females (pubovaginalis).
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37. Fig. Pubococcygeus Muscle
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38. b. Pubo-rectalis :
o The puborectalis muscle is a U-shaped sling, extending from
the bodies of the pubic bones, past the urogenital hiatus,
around the anal canal.
o Its tonic contraction bends the canal anteriorly, creating the
anorectal angle (90degrees) at the anorectal junction (where
the rectum meets the anus).
o The main function of this thick muscle is to maintain faecal
continence – during defecation this muscle relaxes.
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39. Fig. Puborectalis Muscle
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40. Fig. Puborectalis Muscle
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41. Fig. Puborectalis Muscle
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42. c. Illeococcygeus :
o The iliococcygeus has thin muscle fibres.
o Starts anteriorly at the ischial spines and posterior aspect of
the tendinous arch.
o They attach posteriorly to the coccyx and the anococcygeal
ligament.
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43. Fig. Illeococcygeus Muscle
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44. 2. Coccygeus :
o The coccygeus is the smaller part.
o The levator ani muscles situated anteriorly.
o It originates from the ischial spines and travels to the lateral
aspect of the sacrum and coccyx, along the sacrospinous
ligament.
o Supports the Pelvic Viscera and flexes the coccyx.
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45. Fig. Coccygeus Muscle
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46. Types Of Pelvis:
Gynecoid
Pelvis.
Android
Pelvis.
Anthropoid
Pelvis.
Platypelloid
Pelvis.
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47. Nerve Supply
1. Superior Hypogastric Nerve.
2. Inferior Hypogastric Nerve.
3. Pelvic Splanchnic Nerve.
4. Lumbar Plexus:
 Lumbosacral trunk.
 Obturator Nerve.
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48. Nerve Supply
5. Sacral Plexus:
 Sciatic Nerve.
 Superior & Inferior Gluteal Nerve.
 Nerve to Quadratus Femoris & Obturator Internus.
 Posterior Cutaneous Nerve of Thigh.
 Pudendal Nerve.
 Nerve to Piriformis.
 Pelvic Splanchnic Nerve.
 Profratory Cutaneous Nerve.
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49. Arterial Supply:
Umbilical Artery.
Obturator Artery.
Superior & Inferior Vescial Arteries.
Middle & Superior Rectal Artery.
Internal Pudendal Artery.
Uterine Artery.
Illiolumbar Artery.
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50. Arterial Supply:
Ovarian Artery.
Median & Lateral sacral Arteries.
Superior Gluteal Artery.
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51. Fig. Arterial Supply. 51

52. Organs
•RENAL TRACT:
a. Ureters:
– Originate at Renal Pelvis
– Path initially medial to vertebrae
and at pelvic brim take infero-
posterior path
– Oblique entry into bladder avoids
urinary reflux
– Arterial supply via gonadal, renal,
vesical, vaginal and aortic
branches
– Autonomic innervation.
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53. Organs
b. Bladder:
• Trigonal structure.
• Wall has 3 layers of smooth
muscles: inner circular and
middle/outer longitudinal layers
• Arterial supply from superior and
inferior vesical nerves:
sympathetic closes bladder neck
whilst parasympathetic relaxes
detrusor muscle to allow for
miturition
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54. Organs
Bladder
Apex:
Behind
Symphysis
Pubis.
Base:
Lies
Posteriorly.
Neck:
Connects
Urethra & the
bladder.
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55. Organs
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56. Organs
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57. Organs
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c. Male Urethra:
15-
20cm
long
Four parts:
The male
urethra is
the conduit
for semen
during sexua
l intercourse
Pre-prostatic.
Prostatic.
Membranous.
Spongy.

58. Organs
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d. Female Urethra:
Short(Approx 4cm)
Between Clitoris And Vagina.

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Uterus:
Fallopian(Uterine)
Tube opens into it.
Uterine artery
Sympathetic and
parasympathetic
innervation from
pelvic plexus
Venous plexus
drain to rectal and
vesical veins
Ovaries:
Attached to
posterior aspect
of broad ligament
Ovarian artery
Sympathetics from
aortic plexus and
parasympathetics
from pelvic plexus.
Right ovarian
vein drains to
IVC whilst left to
left renal vein
Female
Viscera:

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Fallopian
tubes:
Run in free edge
of broad
ligament
Ovarian and
uterine
arteries
Vagina:
Opens into
vaginal
vestibule
Vaginal
artery
Sympathetic supply from
pelvic plexus and somatic
sensory innervation from
ilioinguinal and pudendal
nerves
Venous drainage
from pelvic floor
plexus to internal
iliac
Clitoris:
Female
equivalent of
penis
Nerve supply
via pudendal
Female
Viscera:

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Layers are :
• Skin.
• Dartos muscle.
• External spermatic fascia.
• Cremaster muscle.
• Internal spermatic fascia.
• Tunica vaginalis & tunica
albuginea
Scrotum:
Male
Viscera:

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- Testicular (gonadal artery)
- Pampiniform plexus drain to
testicular veins.
-Testicular vein drains to IVC on
right and left renal artery on left.
Testes:
Male
Viscera:

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Fig. Scrotum and Testes.
Male
Viscera:

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Prostate:
oMulti-lobar (5) with posterior groove.
oApex at the bottom and base at top .
oSmooth muscle.
oContains prostatic urethra
oArterial supply from inferior vesical,
middle rectal and occasionally pudendal
arteries.
oDrains to venous plexus and then to
internal iliac vein.
oSympathetic nerves promote ejaculation
and smooth muscle contraction whilst
parasympathetics promote erection.

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Prostate:

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• Receives ejaculatory
ducts, bulbourethral
and urethral glands.
• Arterial supply from
urethral artery, deep
artery to penis and
dorsal artery of penis.
• Drainage via
superficial and deep
dorsal veins of penis.
• Nerves are
sympathetic and
parasympathetics for
ejaculation and
erection.
• Sensory supply to skin
and glans of penis
from pudendal nerve.
Penis:

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68. QUESTIONS???
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