Understanding pelvic floor anatomy helps occupational therapists connect physical structures to function, enabling them to assess functional occupational implications and limitations, such as toileting, posture, breathing, and intimacy.
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What is Pelvic health?
Pelvic health encompasses pain-free pelvic joint mobility and stability, ease of bladder and bowel control, and sexual function (Mason, 2023).
What is the Pelvic Floor?
The pelvic floor is formed by a network of muscles that enclose the pelvis and prevent body contents from hanging down through the pelvic cavity.
The pelvic floor is a funnel-shaped structure that separates the pelvic cavity from the perineum (area between the genitalia).
Male Pelvic Floor Anatomy
Muscles
Layer 1 (Most superficial layer; palpable externally)
Urogenital triangle:
Ischiocavernosus: Compresses corpus Cavernosum (University of Arkansas for Medical Sciences- UAMS)
Bulbocavernosus: Compresses the bulb of the penis, compresses the spongy urethra (UAMS)
Superficial transverse perineum: Stabilizes the perineal body (UAMS)
Anal Triangle:
External Anal Sphincter muscle: Constricts the anal canal (UAMS)
Levator Ani muscles: Elevates the pelvic floor (UAMS)
Layer 2:
Sphincter Urethra: Compresses urethra (UAMS)
Compressor Urethra:
Deep Transverse Perineal: Stabilizes the perineal body (UAMS)
Layer 3 (Deepest layer):
Pubococcygeus: Stability & support of abdominal and pelvic organs (Mnatzakanian, 2025)
Iliococcygeus: Elevates pelvic floor & anorectal canal (Mnatzakanian, 2025)
Puborectalis: Onic contraction bends the anal canal anteriorly, creating the anorectal angle, which contributes to faecal continence. Voluntarily inhibited during defecation (Mnatzakanian, 2025)
Nervous System
Nervous System
Peripheral Nervous System
Autonomic- regulator of organ function & muscle tone, with reflex regulation of the bladder & bowel storage, filling, & emptying, and digestive Peristalisis.
Vagus Nerve: Master regulator for digestive function, and facilitates relaxation & release of muscles for bowel & bowel emptying (Mason, 2023)
Somatic Nervous System- controls muscle function & can override aspects of the autonomic system, "such as decision making to delay bladder emptying despite strong sensation of bladder fullness" (Mason, 2023).
Pudendal Nerve (S2-S4):
provides sensory input to the skin around the genitalia, and motor input to the external sphincter, urogential triangle, & Urethral sphincter (Mason, 2023)
Autonomic fibers regulate blood flow & Sexual function (Mason, 2023)
Sacral Nerve Branch
System Structures
System Structures
Reproductive system:
Seminal vesicles, Ductus Deferens, Prostate, and Ejaculatory duct
Perineum:
Penis, scrotum, and anus
Gastrointestinal System:
Rectum, Anal canal, Anal Aperture
Urinary System:
Bladder & Urethra
Other Structures
Other Structures
Bones
Pubic Bone, sacrum, coccyx
United by 4 Joints:
2 sacro-iliac joints
Symphysis pubis & sacrococcygeal joint
Blood Supply
Internal Iliac artery; anterior and posterior trunk
Internal iliac vein - key to most of the venous drainage from pelvic organs.
Lymphatic Supply
Major Lymph nodes: inguinal, sacral, external, and common iliac lymph nodes.
Male Pelvic Floor Muscle Function
As the floor of the pelvic cavity, these previously mentioned muscles play important roles in the proper functioning of the pelvic & abdominal viscera.
Muscles Function by Layer:
Layer 1: Sexual Activity
Layer 2: Bladder Control/ Continence
Layer 3: Weigh bearing, functional breathing, pressure management
Pelvic Health Norms
If there are any deviations from the norms, the occupational therapist must perform an in-depth assessment & obtain pertinent information from patients to guide intervention and/or referral.
Daily Occupations & Pelvic floor Connection
An interconnectedness between the pelvic floor and daily occupational engagement is undeniable. Thus, an understanding of anatomy and function is crucial to clinical assessment & intervention as PFDs can impair an individual's ability to engage in activities of daily living (ADL), Instrumental Activities of Daily Living (IADL), work, social activities, sleep and rest, and leisure activities, which have been found to have negative effects on quality of life (QoL). An occupational therapist can assist with alleviating symptoms & the negative effects of pelvic floor dysfunction on an individual's QoL.
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