4 Pelvic Floor Anatomy Flashcards
What are the functions of the pelvic floor? (4)
- Support (main function)
- Continence
-
Intra-abdominal pressure
- maintenence of high intra-abdominal pressure
- Childbirth
How does the pelvic floor support the pelvic organs? (Vagina, bladder, uterus, ovaries, bladder, rectum) (3)
- Suspension
- Strong vertical support
- Cardinal ligaments
- hold cervix and upper vagina in place
- Uterosacral ligaments
- holding back of cervix and upper vagina in place
- Round ligament
- Maintain anteverted position of uterus
- Cardinal ligaments
- Strong vertical support
- Attachment
- eg Vagina attached to: endopelvic fascia, levatator ani muscles, perineal body
- Fusion
- eg fusion of urogenital diaphragm and perineal body
- Lower half of vagina- supported by fusion of endopelvic fascia to perineal body, levatator ani and urethra
Name the deep muscles of the pelvic form and the collective term for them.
Levatator ani muscles:
- Pubococcygeus
- Puborectalis
- Iliococcygeus
Fill in the missing labels in the diagram:
Name the 3 superficial muscles found in the pelvic floor (these are found in men and women) and identify them on the following diagram:
- Ischiocavernous
- Bulbospongiosus
- Superficial transverse perineal
Why would a medio-lateral episiotomy be carried out during childbirth and which muscles may be damaged as a result?
- Avoid damage to perineal body (eg 2nd and 3rd degree tears)
- If baby large
- Difficult delivery
- Using forceps during delivery
Muscles: transverse perineal muscle, bulbocavernosus muscle
What complications can an episiotomy cause?
Infection, haemorrhage, dyspareunia (difficult/painful intercourse), damage to anal sphincter
Describe the 4 degrees of perineal tears:
Where is the perineal body on the following image and what is its function?
Main function: site of attachment for pelvic floor muscles and other structures providing support
What is the urogenital diaphragm?
Sheet- dense fibrous tissue- spans anterior half of pelvic floor
Attaches urethra, vagina, perineal body
Arises from inferior ischiopubic ramus
What nerve supplies the pelvic floor muscles?
S2,3 and 4
Pudendal nerve
What complications can a pelvic organ prolapse cause?
Disturb anorectal, urinary and sexual function
Depressive symtoms
Pain
Infection
How do we classify pelvic organ prolapses?
Compartment and organ which has prolapsed
ANTERIOR
Bladder/urethra
MIDDLE
Uterus into vagina
POSTERIOR
Rectum
Loops of bowel entering pouch of douglase
What is a ‘vault’ prolapse?
After hysterectomy
Supportive ligaments cut to remove uterus
Apex of vagina can prolapse
What causes/risk factors are there for pelvic organ prolapses?
Age- post menopause- less oestrogen
Parity
Pregnancy (esp vaginal delivery)
(Pregnancy still risk factor even if caesarian)
Oestrogen deficiency
Chronic increased abdominal pressure eg obesity
CT/ Neurological disorder
eg muscular dystrophy
eg marfans, ehlers danlos
How should a prolapse be managed? Give examples of non-surgical and surgical ways to manage it.
Depends on:
- Nature of symptoms, degree of bother
- Nature and extent of prolapse
- Future pregnacy plans
- Sexual activity
- Fitness for surgery
- Non-surgical
- Pessaries
- Surgical
- Hysterectomy
- Mesh (vault prolapse)
What is ‘stress incontinence’?
Increased abdominal pressure causes leaks of urine as support of urethral sphincter= inadequate
(risk factors same as developing prolapse)
How might a patient with stress incontinence present?
Passing urine whilst: coughing, laughing etc
How should stress incontinence be managed?
Pelvic floor muscle training
Surgical intervention eg slings to support urethral sphincter
What are the potential long term consequences of FGM?
- Psychological effects
- Sexual dysfunction
- Difficulty conceiving
- Chronic pain
- Menstrual disorders
(FGM is illegal in UK- must be reported. Safeguarding issue for under 18s)
What arteries does the pelvic floor receive its blood supply from and where is its lymphatic drainage?
Pudendal arteries (venous drainage is corresponding veins to pudendal arteries)
Inguinal lymph nodes
What is vaginismus?
Vaginal opening closed- pelvic floor muscles so tight
Describe a cystocele prolapse
Supportive tissue between a woman’s bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina
Will be symptomatic
What does OASIS stand for? How can this be prevented?
Obstetric Anal Sphincter Injuries
Prevention:
Episiotomy
Perineal protection at crowning
Encouraging mother NOT to push when head= crowning
What does vestibulodynia mean?
Painful vulva
hypersensitive nerve endings or an overgrowth of nerve fibers in the vestibule area of the vulva
What are the different types of FGM?
How might a posterior pelvic floor dysfunction present?
Vaginal/rectal bulge/lumConstipation
Incomplete evacuation
Anal incontinence
Name some causes of posterior compartment pelvic floor dysfunction:
