What is pelvic floor?

Pelvic floor is the area underneath the pelvis and it comprises muscles and connective tissue such as ligaments and fascia. It separates the pelvic cavity above from the perineal region below. It provides support to the bladder, intestines and uterus (in females). It assists with continence through control of the urinary and anal sphincters. It facilitates birth. it helps to maintain optimal intra-abdominal pressure.

Ligaments of the Pelvis

Iliolumbar ligament - from tip of transverse process of L5 to posterior aspect of inner lip of iliac crest; strengthens the lumbo-sacral joint.

Lateral lumbosacral ligament

Sacrotuberous ligament- from sacrum to tuberosity of the ischium

Sacrospinous ligament - from ischial spine to lateral margins of the sacrum

Sacroiliac Ligaments

Ventral/Anterior sacroiliac ligament- from antero-lateral aspect of sacrum to auricular surface of the ilium

Dorsal/Posterior sacroiliac ligament

Upper portion (short posterior sacroiliac ligament) - from 1st and 2nd transverse tubercles of sacrum to tuberosity of ilium

Lower portion (long posterior sacroiliac ligament) - from 3rd transverse tubercle of sacrum to posterior superior iliac spine (PSIS)

Interosseous sacroiliac ligament- lies deep to posterior SI ligament and runs between the tuberosities of the sacrum and ilium

Sacrococcygeal Ligaments

Ventral/Anterio sacrococcygeal ligament -from anterior surface of sacrum to the front of the coccyx; continuation of the anterior longitudinal ligament of the spine

Dorsal sacrococcygeal ligament

Deep portion - from inside sacral canal at the 5th sacral segment to the dorsal surface of the coccyx; continuation of the psoterior longitudinal ligament of the spine

Superficial portion - from free margin of sacral hiatus to dorsal surface of the coccyx; corresponds with the ligamentum flavum of the spine

Lateral sacrococcygeal ligament - from inferior lateral angle of the sacrum to the transverse process of the 1st coccygeal vertebra

Pubic Symphysis Ligaments

Superior pubic ligament - runs between pubic tubercles

Inferior pubic ligament (aka arcuate public ligament) - runs between inferior pubic rami and blends with fibrocartilagnous disc of pubic symphysis

Anterior pubic ligament

Posterior pubic ligament - membranous structure which blends with periosteum

Endopelvic Fascia - Ligaments

Female: Pubovesical ligaments - attach bladder to pubic symphysis

Male: Puboprostatic ligaments - attach bladder to pubic symphysis

Sacrogenital - these are thickenings of the fascia, not specific ligaments

Uterosacral ligaments - attach upper vagina, upper portion of cervix and uterus to the 3rd sacral vertebra

Cardinal ligaments (aka Mackenrodt's) - attach upper vagina, cervix and uterus to the side walls of the pelvis

Round ligaments - attach uterus to mons pubis

Broad ligaments - attach uterus to medial aspect of the ilium

Uracus ligament - attaches bladder to umbilicus (formed from the remnants of the umbilican vein)

Penile Suspensory Ligaments

Penile Suspensory ligament - attaches to anterior aspect of interpubic disc and divides in two to sling around the penis

Fundiform ligament - extends from inferior linea alba and divides to wrap around the penis

Parietal pelvic fascia - lines the internal surface of the muscles of the pelvic floor and walls

Visceral pelvic fascia - invests each pelvic organ

The parietal and visceral fascia are continuous where organs penetrate the pelvic floor. They thicken to form the arcus tendineus, arches of fascia running adjacent to the viscera from the pubis to the sacrum.

Endopelvic fascia* - meshwork of smooth muscle, ligaments, blood vessels and connective tissue lying between the parietal and visceral fascia, sometimes condensing to form fibrous fascial septa which separate and suspend the organs.

Anatomists use the name subserous fascia whereas surgeons refer to this layer of retroperitoneal fascia as endopelvic fascia.

Hypogastric sheath - separates retropubic space from presacral space; conduit for vessels and nerves

Transverse cerical (cardinal) ligaments - part of hypogastric sheath; runs from lateral pelvic wall to uterine cervix and vagina; transmits uterine artery and provides passive support for the uterus

Vesicovaginal septum

Rectovesical septum

Rectovaginal septum

References

https://www.physio-pedia.com/Pelvic_Floor_Anatomy