216b pelvic floor dysfxn

Question 1

major structures of female bony pelvis

Answer 1

scaffold for soft tissues

• ilium
• schium
• sacrum
• pubis

Question 2

important landmarks

Answer 2

sacral promontory -
Ischial spine - nerve block for pudendal nerve during birth
Anterior long ligament - strong ligament inside of spin
sacrospinous ligament - ischial spine and sacram
iliopectineal/cooper’s ligament

Question 3

pelvic floor musculature

Answer 3

primary support for pelvic viscera

sling around recutrm, vainga, urethra –> levator ani muscles

Question 4

levator ani muscles

Answer 4

puborectalis - slings around 3 lumen to other side of pubis
pubococcygeus - pubis to coccyx
iliococcygeus -

Question 5

levator ani muscle types

Answer 5

type I - slow twitch, baseline tone

type II - fast twitch, volunatary contrations

Question 6

nerve to levator ani

Answer 6

anterior roots of S2-4

Question 7

genital hiatus

Answer 7

opening in pelvic floor for passage of urethra, rectum, vagina

problems arise when it’s too big due to weakness of levator plate –> prolapse

Question 8

perineal level support

Answer 8

last level of support of pelvic floor

bulbocavernous muscles around vagina
perineal membrane
superficial transverse perineal muscle - seperates vagina and anus
external anal sphinchter msucle

Question 9

connective tissue support for pelvic floor

Answer 9

broad ligament - peritonium over repor organs; stablizes uterus in position

cardinal ligament -
uterosacral ligament-
*combined hold utuerus in place; from utuerus to sacrum

Question 10

manifestations of PFD

Answer 10

pelvic organ prolapse
urinary incontinence
bowel control problems

Question 11

pelvic organ prolapse

Answer 11

bulging through vagina due to dysfunctional in pelvic muscles, ligaments, ct support –> urinary problems, bower problems, sexual discomfort

Question 12

prolapse risk factors

Answer 12

genetics, obesity, age, pelvic floor injury –> childbirth that requires vacuum or forceps

Question 13

types of prolapse

Answer 13

anterior vaginal wall support –> cystocele; dropped bladder

loss of apical support –> uterine prolapse; loss of cardinal and uterosacral ligaments which support uterus

posterior vaginal wall support –> rectocele

Question 14

levels of support to vagina

Answer 14

I - apical (cardinal-uterosacral ligament complex) –> uterine descent, vaginal vault prolapse

II - midlevel (lateral) –> cystocele or rectocele

III - distal

Question 15

stress vs urge incontinence

Answer 15

stress - urethra (valve) problem

urge - bladder problem (detrusor) problem; detrustor constricts and causes leakage

Question 16

blader inversation

Answer 16

detrusor - B-adrenergic and cholinergic receptors (stimulation leads to bladder wall contraction, antagonism leads to bladder wall relaxation)

bladder nexk - urethra - a-adrenergic receptors – stimulation causes contraction, antagonism causes relation

Question 17

fecal incontinence - anal sphincter complex

Answer 17

internal anal sphincter - smooth, involuntary control, 75% of continence mechanism

external anal sphincter - striated muscle, voluntary and involuntary, can contract more if necessary, 25% of continence

Question 18

puborectalis and defecation

Answer 18

slings around rectum –> creates 90 degree angle to block anal contents from passing into anal canal

Question 19

anorectal physiology

Answer 19

contact and sampling from rectal distension
determines what it is

if not convenient to contract then EAS and puborecatlis contract

if convenient - EAS and puborecalis relax

Question 20

fecal incontinence risk factors

Answer 20

female, childbirth, operative deliver, old, poor health