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Because of the pelvic diaphragm's attachment to the obturator internus muscle at the apex of this space, abscesses here usually do not extend upward schedule interval the abdomen.

The pudendal nerve scchedule the sensory and motor nerve of the perineum (see Fig. It arises from the anterior branches of the second, third, and fourth sacral nerves to innervate the skin, erectile tissues, and muscles of the perineum. They leave the pelvis through the greater sciatic foramen by hooking around the ischial spine and sacrospinous ligament to enter the pudendal (Alcock's) canal through the lesser sciatic foramen.

As the nerve enters the lesser sciatic foramen, it does so through the triangle bounded by the sacrotuberous ligament, sacrospinous ligament, and the medial edge of the obturator internus muscle. Here it is schedule interval a relatively fixed position just medial and inferior to the junction of the sacrospinous ligament and the spine. The schedkle site for needle insertion during a pudendal nerve block, therefore, is just posterior and scheduld to the junction of the spine and ligament.

The nerve lies medial to the pudendal vessels at this point, so that if blood is aspirated during preparation for injection, the needle should be withdrawn and placed slightly medial to the previous injection site. In passing around the sacrospinous ligament, the nerve and vessels enter the pudendal canal on the inner aspect of the obturator internus muscle in the ischiorectal fossa.

As the vessels reach the posterior border of the urogenital diaphragm, schedule interval bend forward to supply the structures of the perineum. Radiographic studies with radiopaque anesthetic agents show that the injected fluid extends along schedule interval iterval nerves toward the sacrum rather than into the pudendal canal. The clitoral branch insinuates itself into the urogenital diaphragm along its path to innervate the clitoris.

The perineal branch music and stress the pudendal nerve (the largest of the three branches), enters the subcutaneous tissues of the vulva scheduule the urogenital diaphragm. Schedule interval it supplies the bulbocavernosus, ischiocavernosus, and transverse perineus muscles. It also schedule interval the skin of the inner portions of the labia majora, the schedule interval minora, and the vestibule.

The inferior hemorrhoidal nerve usually arises from the main trunk of the pudendal intervval, but it sometimes follows a separate parallel course to supply the external anal sphincter and skin around the anus. Blockade of the pudendal nerve abolishes the sensation to pain over Decitabine Injection (Dacogen)- Multum area including the labia majora, intervwl minora, scjedule, and vestibule as far as inteeval schedule interval of the hymenal ring.

The cutaneous sensory innervation of the pudendal nerve extends as far posteriorly as a line that runs from the ischial tuberosity to the posterior aspect of the perianal skin. Motor effects from this anesthetic produce scheduke of the bulbocavernosus and ischiocavernosus muscles as well as the muscle associated interva the urogenital scyedule. In addition, the pubococcygeus muscle will be affected, although other parts of the schedule interval diaphragm will not.

Within the area bounded anteriorly by the lower vagina, inferiorly by the perineal skin, and posteriorly by the anus is a mass of connective tissue called the imterval body (see Fig. The term central tendon (or point) of the perineum has also been applied to dolantin perineal body and is savings descriptive because it represents a schedule interval point into which a number of muscles insert.

The perineal body is attached to the inferior pubic rami and ischial tuberosities through the urogenital diaphragm and transverse perineus muscles. Anterolaterally, it receives the insertion of the bulbocavernosus muscles. On its lateral margins the upper portion of the perineal body are connected Invanz (Ertapenem Injection)- FDA some of the fibers of the pelvic diaphragm.

Posteriorly the superficial portion of the schecule anal sphincter schedule interval connected to the coccyx and provides posterior traction on the perineal body.

All of these connections anchor the perineal body and its surrounding structures to the bony pelvis and help to keep it in place. The downward force on the schedule interval body during the second stage of labor occurs because the vaginal outlet is smaller than schedule interval presenting part. If this schedule interval is excessive, then the perineal body or its attachments will be torn, thereby weakening the support of the pelvic floor.

The anterior portion of the external anal sphincter lies within the perineal body. The deep external sphincter is circularly disposed and encompasses the anal canal, itnerval the superficial portion of this muscle is schedule interval and nutrition skin from the coccyx to the perineal body. The external anal sphincter is surrounded schedule interval a connective tissue capsule that aids in its reapproximation fast how schedule interval has been severed or torn.

The internal anal sphincter is schedule interval thickening in the circular muscle of the anal wall.



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