Urinary bladder, rectum and

anal canal
 Urinary bladder  The empty bladder is a
flattened three-sided
pyramid, with the sharp
apex pointing forwards to
Upper Surface
the top of the pubic
symphysis and a
Inferolateral surface Inferolateral surface
triangular base facing
backwards in front of the
rectum or vagina.
Apex

Neck  There are two

inferolateral surfaces held
 a neck where the urethra opens, and a in place by the anterior
superior surface on which the small intestine parts of levator ani,
and sigmoid colon or uterus lie.
• The apex has the remains of the urachus attached to it, the latter
forming the median umbilical ligament which runs up the midline of
the anterior abdominal wall in the median umbilical fold of
peritoneum.

• Most of the base, or posterior surface, lies below the level of the
rectovesical pouch and only the uppermost portion is covered by
peritoneum between the vas deferens on each side.

• In addition to the latter the seminal vesicles are applied to this

surface, and the ureters enter at the upper outer corner.

• In the female the base has a firm connective tissue union with the
anterior vaginal wall and upper part of the uterine cervix with no
peritoneum intervening.
MALE PELVIS FEMALE PELVIS
RETROPUBIC SPACE:

• It is a space filled with extraperitoneal fatty tissue

continuous with that of lower part of anterior
abdominal wall

• It accommodates distention of urinary bladder

• In case of rupture of urinary bladder, urine may

escape upward into the anterior abdominal wall
APEX of the urinary bladder
• Is directed forward

• Is related to upper border of symphysis pubis

• Is connected to umbilicus by the median umbilical ligament

(obliterated part of urachus)

The urachus is a fibrous remnant of the allantois, a canal that

drains the urinary bladder of the fetus that joins and runs
within the umbilical cord.
SUPERIOR SURFACE
Is covered by peritoneum in
both sexes

In male: it is related to

sigmoid colon & loops of
ileum

In female: it is related to

the uterus separating it
from sigmoid colon & loops
of ileum
• POSTERIOR SURFACE
• Is directed backward
• Its superolateral angles receive the ureters
• In male:
• Its upper part is covered by peritoneum

• It is related to vasa deferentia & seminal vesicles separating it from

rectum

• In female:
• It has no peritoneal covering

• It is related to vagina
SUPERIOR SURFACE INFEROLATERAL SURFACES
• Is covered by peritoneum in
• Are related to retropubic fat
both sexes
separating them from:

• In male: it is related to
sigmoid colon & loops of Body of pubis
ileum
Levator ani
• In female: it is related to the
uterus separating it from Obturator internus
sigmoid colon & loops of
ileum
oNECK:
oIs the lowest & most fixed part
oLies behind symphysis pubis
oIs continuous with urethra
oIn male:
oIt rests on upper surface of prostate
oAnteriorly: it is attached to puboprostatic ligament
oPosteriorly: it is related to beginning of ejaculatory ducts
oIn female:
oAnteriorly: it is attached to pubovesical ligament
oPosteriorly: it is related to anterior wall of vagina
• LIGAMENTS:
1. Median umbilical ligament
2. Puboprostatic (pubovesical) ligament:
• Forms the floor of retropubic space

• In male: is called “puboprostatic” & extends from

body of pubis to prostatic fascia & neck of bladder

• In female: is called “pubovesical” & extends from

body of pubis to neck of bladder
• The mucous membrane forms folds (rugae) that disappear when the
bladder is distended
• TRIGONE:
A triangular area in the base of bladder, bounded by the 2 ureteric orifices &
the internal urethral orifice

Its mucous membrane is elastic, more vascular & more sensitive

• UVULA VESICA: is an elevation immediately behind internal urethral

orifice produced by the underlying median lobe of prostate
URINARY BLADDER IN
CHILD
• It is an abdominal
organ even when
empty

• It begins to enter the

enlarging pelvis at six
years of age

• It is not entirely a pelvic

organ till after puberty Median sagittal section of a new-born female child
 Vascular supply Nerve supply
• ARTERIAL SUPPLY: • Parasympathetic fibers: from
S2,3,4 motor to detrusor
• Superior & inferior vesical muscle (muscle coat of bladder)
arteries & inhibitory to internal urethral
• VENOUS DRAINAGE: sphincter, produce micturition
• Veins from the vesical
venous plexus that drain • Sympathetic fibers: from first &
into the internal iliac vein second lumbar ganglia
• LYMPHATIC DRAINAGE:
• Into internal & external • Ascending sensory fibers: carry
iliac lymph nodes sensation of fullness
(distention) & pain sensation
RECTUM
Distal part of large gut

Present in lesser pelvis

Between sigmoid colon & anal canal

Curved anteroposteriorly and sideways

Sacculations, appendices epiploicae and

taenia coli absent
DIMENSIONS and LOCATION
• Approximate 12 cm long
• Upper part diameter equals sigmoid (4 cm)
• Lower part dilated – rectal ampulla
• Clinically – 15 cm above external anal margin

• it begins at the rectosigmoid junction, the end of the

sigmoid colon, at the level of the third sacral vertebra
or the sacral promontory depending upon what
definition is used.
• Three distinct submucosal folds, the valves of
Houston, extend into the rectal lumen.

• At S4, the rectosacral fascia (Waldeyer's fascia)

extends forward and downward and attaches to the
fascia propria at the anorectal junction.

• Anteriorly, Denonvilliers' fascia separates the rectum

from the prostate and seminal vesicles in male and
from the vagina in female.
COURSE
• Sacral flexure - Descends along sacrococcygeal curve – Downwards
and backwards, downwards and finally downwards and forwards

• Perineal flexure - posterior bend at Anorectal junction

• Both ends in median plane

• Three lateral curves
• Upper convex to right
• Middle convex to left (Most prominent)
• Lower convex to right
Anatomical Relations
• Upper 1/3 – peritoneum front and
sides
• Middle 1/3 – peritoneum
anteriorly
• Lower 1/3 – devoid of peritonium
• Distance between anus & floor of
rectovesical / recto uterine pouch
• Male – 7.5 cm
• Females – 5.5. cm
• Below the pouches, condensations of parietal pelvic fascia are found,
and the rectum is surrounded by visceral pelvic fascia from the superior
fascia of the pelvic diaphragm

• Anteriorly, the rectum is related in the male to coils of small intestine in

the rectovesical pouch above and to the back of the bladder, prostate,
seminal vesicles, and ductus deferentes below;

• in the female, it is related to coils of small intestine in the recto-uterine

pouch above and to the back of the vagina below. Laterally, the rectum is
related to the ileum or sigmoid colon.

• Posteriorly, the rectum is related to the sacrum, coccyx, and pelvic

diaphragm.
Arterial supply
• The superior rectal artery arises from the terminal branch of
the inferior mesenteric artery and supplies the upper rectum.

• The middle rectal artery arises from the internal iliac artery

• The inferior rectal artery arises from the internal pudendal

artery, which is a branch of the internal iliac artery.

• A rich network of collaterals connects the terminal arterioles of

each of these arteries, thus making the rectum relatively
resistant to ischemia
Venous drainage
• The superior rectal vein drains into the portal system via the inferior mesenteric
vein.

• The middle rectal vein drains into the internal iliac vein.

• The inferior rectal vein drains into the internal pudendal vein, and subsequently
into the internal iliac vein.

• A submucosal plexus deep to the columns of Morgagni forms the hemorrhoidal

plexus and drains into all three veins
Lymphatic drainage
• Parallels the vascular supply

• Lymphatic channels in the upper and middle rectum drain

superiorly into the inferior mesenteric lymph nodes

• Lymphatic channels in the lower rectum drain both

superiorly into the inferior mesenteric lymph nodes and
laterally into the internal iliac lymph nodes.
Anal canal
• Anal canal is the terminal part of alimentary tract

• Begins at ano-rectal junction (Rectal ampulla)

suddenly narrows at ano-rectal junction 2-3 cms
infront and slightly below Tip of coccyx, passes
downwards & backwards through Pelvic diaphragm .

• Opens at anal orifice situated in the cleft between

buttocks 4 cms below & in front of tip of coccyx.
 VISCERAL RELATIONS

• Males:
• -Upper 2/3 – RV pouch – coils
Females:
• of intestine and sigmoid colon
• -Lower 1/3 – Base bladder,
•Upper 2/3 – Recto
• seminal vesicles, Ductus
uterine pouch
• deferens, prostate •Lower 1/3 – lower part
vagina
Posteriorly INTERIOR
• Empty: Temporary longitudinal folds
• Commonly three folds permanent
• •Lower 3 pieces sacrum, coccyx semilunar or transverse folds
• Anococcygral ligament • Superior fold – beginning of rectum-
• Piriformis, Levator ani, Coccyges Occasionally encircles
• Median Sacral, superior
• Middle fold – largest, most constant
• rectal and lower lateral sacral immediately above rectal ampulla
vessels
• Sympathetic chain, ganglion impar • Inferior fold – 2.5 cm below middle fold
• Lymphatic, fat
• Fourth fold – sometimes, 2.5 cm above
middle fold
 SPHINCTER ANI INTERNUS SPHINCTER ANI EXTERNUS
• Involuntary sphincter Thickening of • Voluntary sphincter Surrounds entire
circular muscle of lower part of rectum length of anal canal
• Surrounds upper 3/4th of anal canal • Consists of 3 parts – Subcuatneous
• Lower end corresponds with Hilton’s Superficial & Deep Subcutaneous:
line • Flat band around anus separated from
• Middle corresponds with pectinate line perianal skin by external venous plexus
• Internally the sphin.is separated from • Superficial part: Ellipical in shape
mucous membrane by internal venous Arises from tip of coccyx &
plexus anococcygeal raphe, inseted into
• Externally separated from ext. sphin. perineal body
Muscle by Conjoint sheath derived from • Deep: annular in shape surrounds ano-
levator ani and longitudinal muscles of rectal junction No bony attachment –
rectum inserted into perineal body
• Nerve supply: Sup.Hypogastric & pelvic • Nerve supply: Inf. Rectal br. Of
splanchnic pudendal n. Perineal br. of 4th sacral n.
Vascular supply
Blood Supply. Veinous drainage

• The rectum and anal canal are supplied • The submucosal venous plexus above the
by the superior rectal artery (the pectinate line drains into the superior
continuation of the inferior mesenteric rectal veins (portal system), which may
artery), with assistance from the become varicose, resulting in internal
middle and inferior rectal arteries, and hemorrhoids or "piles." The submucosal
by the median sacral artery. plexus below the pectinate line drains
into the inferior rectal veins, which may
become varicose, resulting in external
• Upper 2/3 – superior rectal artery hemorrhoids or piles. The unions of the
• Middle 1/3 – Additionally middle rectal superior with the middle and inferior
rectal veins are important portal-systemic
• Distal 1/3 – inferior rectal artery anastomoses.
 Rectal Prolapse

 Rectocoele
Thank
you.