11) The Pelvic Floor Flashcards
What is the pelvic floor?
Muscular and fibrous tissue diaphragm which fills lower part of pelvic canal
What are the functions of the pelvic floor?
Support pelvic organs (bladder and uterus)
Resistance to increase in intra-pelvic/abdominal pressure
Urinary and fecal continence (sphincters)
What pierces the pelvic floor?
Urogenital hiatus (urethra and vagina) Rectal hiatus (anal canal)
What joins the pelvic floor and perineum?
Perineal body
What are the 3 components to the pelvic floor?
Levator ani muscles, coccygeus muscles and fascia coverings of muscles
Where do the levator ani muscles attach to the pelvis (3)?
Anteriorly: pubic bodies
Laterally: thickened fascia of obturator internus
Posteriorly: ischial spines
What are the 3 muscles of levator ani and what are they innverated by?
Puborectalis
Pubococcygeus
Iliococcygeus
Pudendal nerve
What are the functions of puborectalis?
U shaped sling around anal canal, maintains fecal continence, relaxes in defecation
Creates anorectal angle (80-90)
Describe the pubococcygeus muscle:
From pubic bones and anterior tendinous arch to coccyx
Some fibres loop around prostate and vagina
Describe the iliococcygeus muscle:
Ischial spines and posterior tendinous arch to coccyx
Describe the coccygeus muscle and its innervation:
Ischial spines to sacrum and coccyx
Innervated by anterior rami of S4-5
What blood vessels supply the pelvic floor?
Pudendal, vaginal and inferior rectal from internal iliac artery
What damage can be caused by childbirth?
Pudendal nerve stretched - neuropraxia and muscle weakness
Stretch and damage to pelvic floor and perineal muscles
Stretch or rupture of ligaments supporting muscles
What are the consequences of pelvic floor dysfunction?
Prolapse of pelvic viscera or vagina (if perineal body damaged)
Incontinence
What procedure can be used to avoid damage to pelvic floor in childbirth?
Episiotomy - surgical cut in perineum, in mediolateral direction
What factors increase risk of prolapse?
Age Menopause (atrophy) Obesity Chronic cough Family history
What is the treatment for pelvic floor dysfunction?
Pelvic floor muscle exercise
Surgery
What is the treatment for correcting continence due to pelvic floor dysfunction?
Increase support to sphincter and prevent descent of bladder neck
Colosuspension, tension free vaginal tape
What are the side effects of treating continence surgically?
Voiding difficulty, overactive bladder
What is the treatment for decreasing risk of prolapse due to pelvic floor dysfunction?
Remove prolapsed organs, restore CT supports
What are the side effects of procedures reducing risk of prolapse?
Recurrence, incontinence, dyspareunia (painful sex)
What is the perineum?
Fibromuscular sheet which closes pelvic outlet
What are the anatomical borders of the perineum?
Ant: Pubic symphysis Pos: Tip of coccyx Lat: Inferior pubic and ischial rami and sacrotuberous ligament Roof: Pelvic floor Base: Skin and fascia
What is the perineal body?
Fibromuscular node at junction of anterior and posterior perineum. Point of attachment for muscles and sphincters
