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Reproductive System > 11) The Pelvic Floor > Flashcards

11) The Pelvic Floor Flashcards

1
Q

What is the pelvic floor?

A

Muscular and fibrous tissue diaphragm which fills lower part of pelvic canal

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2
Q

What are the functions of the pelvic floor?

A

Support pelvic organs (bladder and uterus)
Resistance to increase in intra-pelvic/abdominal pressure
Urinary and fecal continence (sphincters)

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3
Q

What pierces the pelvic floor?

A 
Urogenital hiatus (urethra and vagina)
Rectal hiatus (anal canal)
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4
Q

What joins the pelvic floor and perineum?

A

Perineal body

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5
Q

What are the 3 components to the pelvic floor?

A

Levator ani muscles, coccygeus muscles and fascia coverings of muscles

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6
Q

Where do the levator ani muscles attach to the pelvis (3)?

A

Anteriorly: pubic bodies
Laterally: thickened fascia of obturator internus
Posteriorly: ischial spines

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7
Q

What are the 3 muscles of levator ani and what are they innverated by?

A

Puborectalis
Pubococcygeus
Iliococcygeus
Pudendal nerve

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8
Q

What are the functions of puborectalis?

A

U shaped sling around anal canal, maintains fecal continence, relaxes in defecation
Creates anorectal angle (80-90)

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9
Q

Describe the pubococcygeus muscle:

A

From pubic bones and anterior tendinous arch to coccyx

Some fibres loop around prostate and vagina

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10
Q

Describe the iliococcygeus muscle:

A

Ischial spines and posterior tendinous arch to coccyx

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11
Q

Describe the coccygeus muscle and its innervation:

A

Ischial spines to sacrum and coccyx

Innervated by anterior rami of S4-5

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12
Q

What blood vessels supply the pelvic floor?

A

Pudendal, vaginal and inferior rectal from internal iliac artery

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13
Q

What damage can be caused by childbirth?

A

Pudendal nerve stretched - neuropraxia and muscle weakness
Stretch and damage to pelvic floor and perineal muscles
Stretch or rupture of ligaments supporting muscles

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14
Q

What are the consequences of pelvic floor dysfunction?

A

Prolapse of pelvic viscera or vagina (if perineal body damaged)
Incontinence

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15
Q

What procedure can be used to avoid damage to pelvic floor in childbirth?

A

Episiotomy - surgical cut in perineum, in mediolateral direction

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16
Q

What factors increase risk of prolapse?

A 
Age
Menopause (atrophy)
Obesity 
Chronic cough 
Family history
17
Q

What is the treatment for pelvic floor dysfunction?

A

Pelvic floor muscle exercise

Surgery

18
Q

What is the treatment for correcting continence due to pelvic floor dysfunction?

A

Increase support to sphincter and prevent descent of bladder neck
Colosuspension, tension free vaginal tape

19
Q

What are the side effects of treating continence surgically?

A

Voiding difficulty, overactive bladder

20
Q

What is the treatment for decreasing risk of prolapse due to pelvic floor dysfunction?

A

Remove prolapsed organs, restore CT supports

21
Q

What are the side effects of procedures reducing risk of prolapse?

A

Recurrence, incontinence, dyspareunia (painful sex)

22
Q

What is the perineum?

A

Fibromuscular sheet which closes pelvic outlet

23
Q

What are the anatomical borders of the perineum?

A 
Ant: Pubic symphysis 
Pos: Tip of coccyx
Lat: Inferior pubic and ischial rami and sacrotuberous ligament 
Roof: Pelvic floor
Base: Skin and fascia
24
Q

What is the perineal body?

A

Fibromuscular node at junction of anterior and posterior perineum. Point of attachment for muscles and sphincters

25
Q

What is contained in the posterior anal triangle?

A

Anus, levator ani and ischiorectal fossa (pudendal nerve along lateral wall)

26
Q

What is contained in the anterior urogenital triangle?

A

Bulbourethral glands, urethra and vagina

27
Q

What are the layers of the urogenital triangle?

A

Superior fascia, sphincter urethrae and perineal membrane

28
Q

In males, what is below the perineal membrane?

A

Superficial transverse perineal membrane, bulbospongiosus and ischiocavernosus

29
Q

In both sexes, what is below the perineal membrane?

A

Superficial perineal pouch

Reproductive System (24 decks)

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