16. The Pelvic Floor Flashcards
What are the 5 main functions of the pelvic floor?
Support the pelvic organs - vagina, uterus, ovaries, bladder, rectum.
Maintain intraabdominal pressure during coughing, vomiting, sneezing and laughing.
Facilitate defaecation and micturition.
Maintain urinary and faecal continence.
Facilitate childbirth.
What does the pelvic floor consist of?
Lavator ani muscles - pubococcygeus, puborectalis and iliococcygeus.
Urogenital diaphragm/perineal membrane - dense fibrous tissue.
Perineal body - point of insertion for levator ani muscles.
Perineal muscles - superficial transverse perineal and bulbospongiosus.
What arteries, veins and nerves supply the pelvic floor?
Internal and external pudendal arteries, drains through corresponding veins.
Innervation derived from branches of the pudendal nerve.
What are the 3 levels of support that the pelvic floor provides to the pelvic organs? How does each do this?
Suspension - provided by the cardinal ligaments.
Attachment - provided by the arcus tendinosus fascia pelvis and endopelvic fascia.
Fusion - lower half of the vagina is supported by fusion of the vaginal endopelvic fascia to the perineal body posteriorly and levator ani laterally and urethra anteriorly.
Why does the position of the uterus ensure the pelvic organs are supported with increased inta-abdominal pressure?
The horizontal position and antevertion and flexion of the uterus results in compression of the uterus against the vagina with increased intra-abdominal pressure.
Why can weakness in the endopelvic fascia (attachment layer of the pelvic floor) lead to stress incontinence of urine?
Urethra lies anterior and above the endopelvic fascia, and thus gets compressed against it during increased intra-abdominal pressure. Therefore weakness of this layer can lead to stress incontinence of urine.
Give 5 examples of pelvic floor dysfunction
Pelvic organ prolapse. Incontinence. Posterior compartment pelvic floor dysfunction. Obstetric trauma including episiotomy. FGM. Vaginismus. Vulval pain syndromes.
What is pelvic organ prolapse?
Loss of support for the uterus, bladder, colon or rectum, leading to prolapse of one or more of these organs into the vagina.
Give 4 risk factors for pelvic organ prolapse
Age.
Parity.
Vaginal delivery.
Postmenopausal oestrogen deficiency.
Obesity and causes of chronic raised intra-abdominal pressure.
Neurological eg spina bifida, muscular dystrophy.
Genetic connective tissue disorders eg Marfan’s, Ehlers Danlos.
What is FGM?
All procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs, whether for cultural or other non-therapeutic reasons.
Give 4 acute consequences tat can occur as a result of FGM
Haemorrhage. Severe pain. Sepsis. Tetanus. Acute urinary retention. Hepatitis. HIV. Death.
Give 7 long term consequences of FGM
Fertility issues. Relationship issues. Rape. Chronic pain. Keloid scar formation. Dysmenorrhea. Urinary outflow obstruction. Labial fusion. Difficult cytological screening. Difficulty conceiving. Difficult evacuation following miscarriage. PTSD.
Give 5 obstetric and neonatal consequences of FGM
Fear of childbirth.
Increased likelihood of Caesarean section.
Postpartum haemorrhage.
Severe vaginal lacerations.
Episiotomy.
Difficult vaginal examinations in labour, foetal blood sampling and catheterisation.
Extended hospital stay, postpartum wound infections.
Maternal death from obstructed labour and haemorrhage.
Give 5 psychological consequences of FGM
Flashbacks.
Feelings of betrayal, usually at a young age.
Feeling of loss of control and violation.
Anger.
Trust issues.
Relationship difficulties.
Rebellion.
Feeling that being a woman is a punishment.
Sense of self-esteem affected, shame, self-worth.
PTSD.
What are the 4 types of FGM?
Type 1 - clitoridectomy.
Type 2 - excision.
Type 3 - infibulation.
Type 4 - pricking, piercing, incising, scraping, cauterising.
