1: Continence Flashcards
What are 5 common pelvic health disorders?
- Incontinence
- Supportive dysfunction
- Pelvic pain
- Colorectal dysfunction
- Sexual dysfunction
What plane of motion is the best to load the pelvic floor?
Transverse
How much fluid is filtered by the kidneys?
200 quarts
Why is there an increased risk of cancer based on kidney function?
Exposed to carcinogens for for prolonged periods of time
What happens to kidneys with age?
Decreased blood flow and efficiency leads to increased urine volume. Alters fluid/electrolyte balance
What is the daytime storage for the bladder?
2 cups (16 oz)
What is the nighttime storage for the bladder?
4 cups (32 oz)
What happens to bladder capacity with age?
Decreased, nocturia increases after 60 yrs
What are the three primary functions of the pelvic floor muscles (PFM)?
- Sphincteric
- Supportive
- Sexual
What are the functions of the deep PFM?
Sphincteric and supportive
What is the function of the urogenital diaphragm?
Sphincteric
What are the functions of the superficial PFM?
Sexual and sphincteric
What are the three categories of PFM?
- Deep
- Urogenital diaphragm
- Superficial
What muscles make up the outside wall of the pelvic floor?
Piriformis and obturator internus
What category of muscles make up the floor of the pelvic floor?
Levator ani
What are the 5 levator ani muscles?
- Pubococcygeus
- Puborectalis
- Pubovaginalis
- Iliococcygeus
- Ischiococcygeus
What levator ani muscles control defecation?
Pubococcygeus and ruborectalis
What levator ani muscles support the pelvic viscera?
Illiococcygeus and ischiococcygeus
What are the three muscles that make up the superficial pelvic floor?
Bulbospongiousus, ischiocavernosus, superficial transverse perineal
What is the function of the bulbospongiosus?
Empties urethra by acting as a sphincter, assists with sexual function
What is the function of the ischiocavernosus?
Assist with sexual function
What is the function of the superficial transverse perineal?
Stabilizes perineal body
What three muscles make up the urogenital diaphragm?
Sphincter urethrae, compressor urethrae, sphincter urethral vaginalis (female only)
What is the function of the sphincter urethrae?
Control flow of urine
What is the function of the compressor urethrae?
Compresses ventral wall of urethra
What is the function of the sphincter urethral vaginalis?
Compress ventral wall of urethra
What is the innervation for the external urethral sphincter?
S2-S3
What is the innervation of the external anal sphincter?
S2-S3
What is the innervation of the levator ani?
S3-S5
What is the innervation of the PFM?
Pudendal nerve (S2-S4)
What is the innervation of the bladder - detrusor?
S2-S4
What is the innervation of the bladder - neck and fundus?
T10-L2
What are the three requirements for continence?
- Competent sphincters
- Adequate PFM strength
- Adequate bladder storage
What controls micturition and by what means?
Pons micturition center (PMC), frontal cortex, and hypothalamus
Organizes the lower urinary tract and controls relaxation of urethral sphincter and PFM
Describe the PFM muscles?
Type I muscle fibers, tonic and phasic motor unit activity, guarding reflex
Describe the four components of anorectal function
- Colon transports feces through rectosigmoid sphincter
- Rectum stores feces
- Distension of rectum triggers void
- Puborectalis maintains optimal angle of rectum
How much feces can be stored in the rectum?
300 mL
Describe sexual response
Rhythmic contractions contribute, PFM activation decreased venous outflow
How does the body respond to changes in abdominal pressure to maintain continence?
Urethral constriction by the urethral wall and stabilization of the pelvic floor
What determines continence?
Maximum urethral closure pressure at rest and during increases in pressure
What bladder volume will induce conscious awareness?
8-12 oz
When is continence maintained?
Urethral pressure is more than bladder pressure
What are four age related changes of bladder capacity?
- Diminished capacity
- Increased residual urine
- Uninhibited bladder contractions
- Delayed sensation to urinate
What is a normal bowel schedule?
1-3x per day up to once every three days. Variable in teenage females
What are the most common or normal types of stool according to the Bristol Stool Chart?
Type 3 and 4
When should you refer out based on bowel schedule?
Unexplained change in bowel habits in patients over 40 years, need a colonoscopy
What does Type 1 stool indicate?
Severe constipation
What does Type 7 stool indicate?
Severe diarrhea
Describe fecal continence
Pressure based system. External anal sphincter and ruborectalis muscles relax to cause opening
What does anal continence depend on?
Sphincter, pelvic function, rectal distensibility, anorectal sensation, anorectal reflexed, intact nervous system, mental function, stool volume, stool consistency, colonic transit
