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The Pelvic Floor Per Brodal Institutt for medisinske basalfag Universitetet i Oslo 9th Semester 2008.

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Presentation on theme: "The Pelvic Floor Per Brodal Institutt for medisinske basalfag Universitetet i Oslo 9th Semester 2008."— Presentation transcript:

1 The Pelvic Floor Per Brodal Institutt for medisinske basalfag Universitetet i Oslo 9th Semester 2008

2 Abdominal Press (bukpressen) Pelvic floor muscles Thieme, Atlas of Anatomy P. Brodal 2008

3 The Pelvic Outlet –How is it best Closed? Conflicting needs: Firm closure, yet allow passage of large ” objects ” 3 P. Brodal 2008

4 Three Layers:  Diaphragma pelvis: Levator ani muscle and associated fascia  Diaphragma urogenitale: musculus transversus perinei (profundus) and fascia  Striated sphincter muscles 4 P. Brodal 2008

5 The Male Perineal Region 5 P. Brodal 2008

6 Levator Ani from the Inside Thieme, Atlas of Anatomy 2006 Iliococceygeus Pubococcygeus Iliococceygeus Puborectalis Levator hiatus Piriformis Tendineous arch of levator ani 6 P. Brodal 2008

7 Levator Ani from the Outside (Urogential Diaphragm Removed) Thieme, Atlas of Anatomy 2006 Iliococceygeus Pubococcygeus Puborectalis Coccyx Levator hiatus Coccygeus 7 P. Brodal 2008

8 Levator Ani cont’d Obturator internus muscle with fascia Tendineous arch Levator ani Muscles of the urogenital diaphragm 8 P. Brodal 2008

9 Levator Ani Muscle, The urogenital Muscles, and the Ischioanal Fossa Thieme, Atlas of Anatomy 2006 Levator ani Ischianal fossa Urogenital muscles Gluteus maximus Internal obturator muscle 9 P. Brodal 2008

10 Urogenital Diaphragm (female) Coccyx Thieme, Atlas of Anatomy 2006 Deep transverse perineal muscle External urethral sphincter Levator ani Perineal body (Centrum tendineum perinei) 10 P. Brodal 2008

11 Sphincters Thieme, Atlas of Anatomy 2006 Bulbospongiosus muscle External anal sphincter 11 P. Brodal 2008

12 Fascia of the Urogenital Diaphragm 12 Thieme, Atlas of Anatomy 2006 P. Brodal 2008 Ischioanal fossa (anterior recess) Superficial perineal fascia (Colles’) Inferior pelvic diaphragmatic fascia

13 The Pelvic Floor During Delivery 13 Thieme, Atlas of Anatomy 2006 P. Brodal 2008

14 Episiotomy 14 Thieme, Atlas of Anatomy 2006 P. Brodal 2008

15 Spaces Filled with Fat and Loose Connective Tissue Thieme, Atlas of Anatomy 2006 Subperitoneal space Peritoneal cavity Ischianal fossa 15 P. Brodal 2008

16 Spaces Filled with Fat and Loose Connective Tissue (Male) Thieme, Atlas of Anatomy P. Brodal 2008

17 Continence and Incontinence  Continence depends on The integrity of the pelvic floor muscles, their connective tissue layers and the sphincters The integrity of innervation of the muscles 17 P. Brodal 2008

18 Rupture of the Urethra  Urethral rupture may cause extravasation of urine in, below or above the urogenital diaphragm 18 Rupture in the bulbous part Perineal hematoma Blood trickling from the meatus Prostate loosened and displaced P. Brodal 2008


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