ANATOMY OF THE PELVIS

DR. ABDUL RASHAD

SENIOR LECTURER
DPT,MPHILL(OPT) ,MPPTA, MMTC (NZ), MSTC(AUS),
IASTM(GREECE)
UNITED COLLEGE OF PHYSICAL THERAPY
 OBJECTIVES
• By the end of the lecture, students should be able to:
• Describe the anatomy of the pelvic wall, bones, joints &
muscles.
• Describe the boundaries and subdivisions of the pelvis.
• Differentiate the different types of the female pelvis.
• Describe the pelvic floor.
• Describe the components & function of the pelvic
diaphragm.
• List the blood supply & nerve supply of the pelvis.
• List the lymph drainage 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 canal &
urinary tracts & internal organs of reproduction. 3
 FOUR
JOINTS

1- Anteriorly:
Symphysis pubis (cartilaginous joint).
2- Posterolateral:
Two Sacroiliac joints. (Synovial joins)
3- Posteriorly:
Sacrococcygeal joint (cartilaginous), 4
The pelvis is divided into two
parts by the pelvic brim.
Above the brim is the False
or greater pelvis, which is
part of the abdominal cavity. Pelvic
Below the brim is the True or brim
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
contents. 5
True pelvis has:
 An Inlet.
 An Outlet.
 A Cavity

The cavity is a
short, curved
canal, with a
shallow anterior
wall and deeper
posterior wall.
The cavity lies
between the
inlet and the
outlet.
6
 PELVIC INLET PELVIC OUTLET

Anteriorly: Symphysis pubis.

Anteriorly: Symphysis pubis.
Posteriorly: Promontory of
Posteriorly : Coccyx,
sacrum, ala of sacrum.
Anterolaterally: ischiopubic ramus
Laterally: Ileopectineal (arcuate) Posterolaterally: Sacrotuberous
lines. ligament,
7
 FEMALE MALE

In female the Sacrum is wider and shorter.

Also, the Angle of the pubic arch is wider.
The promontory and the ischial spines are less projecting in
female. 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.
There are 4
types of
female bony
pelvis. 9
The Gynaecoid or genuine female pelvis
It has an almost round brim and will permit the passage of
an average-sized baby with the least amount of trauma to
the mother and baby in normal circumstances. The pelvic
cavity (the inside of the pelvis) is usually shallow, with
straight side walls and with the ischial spines not so
prominent as to cause a problem as the baby moves
through

The Anthropoid pelvis

It has an oval brim and a slightly narrow pelvic cavity.
The outlet is large, although some of the other diameters
may be reduced. If the baby engages in the pelvis in an
anterior position, labour would be expected to
be straightforward in most cases. 

10
The Android pelvis

It has a heart-shaped brim and is quite narrow in front.

This type of pelvis is likely to occur in tall women with
narrow hips and is also found in African women. The
pelvic cavity and outlet is often narrow, straight and
long. The ischial spines are prominent.

Women with this shape pelvis may have babies that lie
with their backs against their mothers’ backs and may
experience longer labours. It is important that these
women take an active role during their labour and need
to squat and move around as much as possible.

11
The Platypelloid pelvis
It has a kidney-shaped brim and the pelvic cavity is usually
shallow and may be narrow in the antero-posterior (front to
back) diameter. The outlet is usually roomy. During labour
the baby may have difficulty entering the pelvis, but once
in, there should be no further difficulty.

Many women are concerned that their pelvic capacity may

be limited and that they will therefore have difficulty
in giving birth. The true capacity of the pelvis will only be
realised during labour. Only the forces created by mother
and baby during birth will allow the pelvis to open to its full
potential. This may take some time, but it is the only true
way of exploring the “fit” between the mother and baby
during birth

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 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.
13
 POSTERIOR PELVIC WALL

It is large and formed by sacrum, coccyx , piriformis

muscles and their covering of parietal pelvic fascia. 14
 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. 15
 LATERAL PELVIC WALL

It is formed by:
1- Upper 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. 16
 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.
17
 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:
• True (main) pelvic cavity above, which contains the pelvic viscera, &
• Perineum below which carries the external genital organs.
18
 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.

19
 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- Puborectalis.
LEVATORES ANI MUSCLES - ANTERIOR FIBERS

• 1- Pubococcygeus.
• originates from
the posterior
surface of the
levator prostatae body of the pubis
• inserts into the
perineal body
(and coccyx.
• supports the
prostate (or
constricts the
vagina)
sphincter vaginae
• stabilizes the
perineal body
• forms a sling
around the
prostate or the
vagina
 1- Pubococcygeus.

The anterior fibers sweep

downward and
medially to their
levator
prostate
Insertion, as follows:
1. Anterior fibers
• (The levator prostate
or sphincter vaginae)
form a sling around
the prostate or vagina.
The levator prostate
supports the prostate
sphincter
and stabilizes the
vaginae perineal body.
The sphincter vaginae
constricts the vagina
and stabilizes the
perineal body.
22
2. Intermediate
fibers:
The puborectalis
forms a sling around
the recto-anal
Junction.
It has a very
important role in
maintaining fecal
continence.

23
LEVATORES ANI MUSCLES - POSTERIOR FIBERS

 iliococcygeus
 inserted into
the
anococcygeal
body and the
coccyx
Nerve supply to
levator ani:
1. perineal branch
of the fourth
sacral nerve
2. perineal branch
of the pudendal
nerve.

Actions 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.
25
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
sacral nerves
Arteries of the
(I) Internal iliac artery(IIA):
Pelvis
• 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.
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.
4. Medial (adductor) region of thigh
5.The fetus (through the umbilical
IIA arteries).
 Iliolumbar Parietal Branches

Obturator • From posterior

division:

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

• From anterior
division:

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

Vaginal artery:
Replaces the inferior
vesical artery.
Uterine artery:
Crosses the ureter
superiorly and
supplies the uterus
& uterine tubes, and
anastomose with the
ovarian artery.

(II) Ovarian artery:

Arises from the
abdominal aorta.
IN BRIEF…

31
 Venous
Drainage

INTERNAL
INTERNALILIACILIACVEINS
VEINS
•• ItItcollect
collecttributaries
tributaries
corresponding
correspondingto tothe
the
branches
branchesof ofthe
the
internal
internaliliac
iliacartery.
artery.
•• joins
joinsthe
theexternal
externaliliac
iliac
vein
veinininfront
frontofofthe
the
sacroiliac
sacroiliacjoint
jointto
to
form
formthethecommon
commoniliaciliac
vein
vein
Ovarian vein:
Right vein drains
into IVC
Left vein drains into
left renal Vein.
32
 LYMPHATICS OF THE PELVIS

•• The
Thelymph
lymphnodes
nodesand andvessels
vessels
are
arearranged
arrangedininaachain
chainalong
along
the
themain
mainblood
bloodvessels.
vessels.
•• Thus,
Thus,there
thereare
areexternal
externaliliac
iliac
nodes,
nodes,internal
internaliliac
iliacnodes,
nodes,
and
andcommon
commoniliaciliacnodes.
nodes.

lymph from Common iliac

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

33
 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)