Human Anatomy
Pelvic Wall and Viscera
Pelvic wall and viscera for MBBS: levator ani, bladder, prostate, uterus and rectum, ureter and pelvic vessels, mapped to NMC codes AN48.1 to AN48.8.
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Pelvic Wall and Viscera
Pelvic wall and viscera for MBBS: levator ani, bladder, prostate, uterus and rectum, ureter and pelvic vessels, mapped to NMC codes AN48.1 to AN48.8.
The pelvic wall and viscera chapter covers the pelvic floor, the bladder, prostate, uterus and rectum, and the vessels and nerves of the pelvis. It underpins the anatomy of prostate enlargement, ureteric injury in surgery and the support of the uterus.
High-yield: Pelvic Wall and Viscera
- The pelvic floor is formed mainly by the levator ani muscle, which supports the pelvic organs.
- The levator ani is supplied by the pudendal nerve and by direct branches from the sacral plexus.
- The urinary bladder is a retroperitoneal organ that lies behind the pubic symphysis when empty.
- The trigone of the bladder is the smooth triangular area between the two ureteric openings and the urethral opening.
- In the male the prostate lies below the bladder and surrounds the first part of the urethra.
- The prostate is divided into lobes, and its median lobe enlargement obstructs urine flow in benign hyperplasia.
- The ureter crosses the pelvic brim in front of the bifurcation of the common iliac artery.
- In the female the ureter passes below the uterine artery, remembered as water under the bridge.
- The uterus is normally anteverted and anteflexed and is supported by the uterosacral and transverse cervical ligaments.
- The transverse cervical or cardinal ligament is the main support of the uterus and carries the uterine artery.
- The rectum begins at the third sacral vertebra and follows the curve of the sacrum.
- The internal iliac artery is the main blood supply of the pelvic viscera.
- The pouch of Douglas is the lowest part of the peritoneal cavity in the female, between the rectum and uterus.
- The sacral plexus lies on the posterior pelvic wall and gives rise to the sciatic and pudendal nerves.
Key pelvic relations
- **Ureter in the female:** Passes below the uterine artery, remembered as water under the bridge; at risk in hysterectomy.
- **Prostate:** Surrounds the first part of the urethra; median lobe enlargement obstructs urine.
- **Uterine support:** Transverse cervical (cardinal) and uterosacral ligaments are the main supports.
- **Blood supply:** Internal iliac artery is the chief supply of the pelvic viscera.
NMC competencies in this chapter
- **AN48.1:** Pelvic wall, floor and the levator ani muscle
- **AN48.2:** Urinary bladder: structure, relations and the trigone
- **AN48.3:** Prostate and male internal genital organs
- **AN48.4:** Uterus, uterine tubes and ovaries and their supports
- **AN48.5:** Rectum and anal canal in the pelvis
- **AN48.6:** Ureter in the pelvis and its relations
- **AN48.7:** Vessels and nerves of the pelvis including the sacral plexus
- **AN48.8:** Applied anatomy of the pelvic viscera
Frequently Asked Questions
Why is the ureter at risk during hysterectomy?
The ureter passes just below the uterine artery near the cervix, the water under the bridge relation, so it can be caught when the uterine artery is clamped.
How does prostate enlargement obstruct urine?
The prostate surrounds the first part of the urethra, so enlargement of its median lobe presses on the urethra and obstructs the flow of urine from the bladder.
What supports the uterus?
The transverse cervical or cardinal ligaments and the uterosacral ligaments are the main supports, along with the pelvic floor formed by the levator ani.
How does this chapter help in NEET-PG?
Pelvic organ relations, ureteric course and uterine support are examined in surgery, urology and obstetrics, so the pelvis is directly high-yield for PG.
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