216- pelvic floor disorders Flashcards
three mm of levator ani according to this lady
puborectalis, pubococcygeus, iliococcygeus
what type of mm fibers are there in levator ani and what innervates
type 1 and 2, roots of s2-4
genital hiatus
opening in pelvic floor for passage of urethra, rectum, vagina
Can become to big due to weakness of levator and lead to prolapse
CT support of female pelvic organs
broad ligament, cardinal ligament, uterosacral ligament
what is pelvic organ prolapse
vaginal hernia of one of pelvic organs
perineal level support
bulbocavernosus, perineal membrane, transverse perineal mm, levator ani, external anal sphincter
three types of prolapse
anterior vaginal wall support (cystocele)
Loss of apical support (uterine prolapse) (cardinal and uterosacral ligaments, broad lig is just orientation)
Posterior vaginal wall support (rectocele)
three levels of pelvis support
I. apical. (cardinal, uterosacral ligament) defect results in uterine descent
II. midlevel. (lateral support) defect leads to cystocele or rectocele)
III. distal (urethral, perineal). defect leads to urinary or fecal incontinence
basic problem in stress and urge incontinence
stress- urethra (valve) problem due to sneezing, coughing
Urge- bladder (reservoir, detrussor)
receptors on detursor and urethra
detrusor: beta adrenergic (relaxes with symp stim) and cholinergic
Bladder neck/urethra: alpha adrenergic (contracts with symp stim)
what has to relax in order to defecate
IAS (automatically occurs following rectal distension) followed by EAS and puborectalis
what are modifiable risk factors for anal sphincter injurY?
vaginal delivery, esp with tools (forceps, vacuum, episiotomy), macrosomia