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ESA 3- Reproductive system > 9. The pelvic floor > Flashcards

9. The pelvic floor Flashcards

1
Q

name the 2 muscular layers forming the pelvic floor, and their constituents

A
  1. pelvic diaphragm (supportive ‘cup’ attaching to lesser pelvis and separating pelvic cavity from perineum)
    - levator ani: pubococcygeus, puborectalis and iliococcygeus
    - coccygeus
  2. perineum (fibromuscular ‘saucer’ centred around perineal body)

Deep layer:

  • compressor urethrae and external urethral sphincter
  • deep transverse perineal

Superficial layer:

  • bulbospongiosus and ischiocavernosus (superficial perineal pouch)
  • external anal sphincter
  • superficial transverse perineal
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2
Q

which nerve supplies most of the pelvic floor musculature to maintain tone

A

pudendal n. (S2-4)

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3
Q

name 3 pelvic floor muscles important in maintaining faecal continence

A

Voluntary:

  1. Puborectalis - maintains 80° anorectal flexure at anorectal junction
  2. External anal sphincter - constricts anal canal during peristalsis, resisting defecation; supports and fixes perineal body/pelvic floor

Involuntary:

  1. Internal anal sphincter - smooth muscle (sup. 2/3 anal canal) maintaining continuous muscle tone (sympathetic) to prevent fluid/flatus leakage
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4
Q

name and label this muscular layer

A

pelvic diaphragm

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5
Q

name and label this muscular layer

A

perineum

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6
Q

which nerve and spinal cord segment is responsible for external anal sphincter contraction

A

inferior anal n.

S4

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7
Q

describe the osseofibrous boundaries of the perineum

A
  • anterior: pubic symphysis
  • anterolateral: inferior pubic and ischial rami
  • lateral: ischial tuberosities
  • posterolateral: sacrotuberous ligaments
  • posterior: inferior-most sacrum and coccyx
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8
Q

describe the 2 triangles of the perineum

A

transverse line between 2 ischial tuberositis separates:

  1. anal triangle
    - contains anal canal and anus
  2. urogenital triangle
    - contains root of scrotum and penis or vulva
    - has additional layer of tough deep fascia: perineal membrane, perforated bu urethra and vagina
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9
Q

what is the function of ther perineal body in women

A

tear-resistant body between vagina and external anal sphincter - supports posterior part of vaginal wall against prolapse

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10
Q

dysfunction of pelvic floor results in which type of urimary problem

A

stress incontinence

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11
Q

describe 4 different types of pelvic organ prolapse

A
  1. CYSTOCOELE: anterior wall prolapse - bladder bulges into anterior vaginal wall
  2. UTERINE PROLAPSE: prolapse of uterus and cervix, or top of vagina
  3. VAGINAL VAULT PROLAPSE: prolapse of vagina apex after hysterectomy
  4. Posterior wall prolapse: RECTOCOELE - rectum bulges into posterior vaginal wall; or ENTEROCOELE - loops of bowel prolapse into rectovaginal space/Pouch of Douglas
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12
Q

name 6 risk factors for pelvic organ prolapse

A
  1. increasing age
  2. vaginal delivery (4x increased after 1 delivery, 11x increased after 4 deliveries)
  3. post-menopausal oestrogen deficiency
  4. obesity and causes of chronic raised intra-abdominal pressure
  5. neurological, e.g. spina bifida, muscular dystrophy
  6. genetic CT disorders, e.g. Marfan’s, Ehlers Danlos
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13
Q

describe the management options for pelvic floor prolapse

A
  1. pelvic floor exercises
  2. pessaries (ring, shelf or gelhorn)
  3. surgical management (risk of recurrence and possible complications)
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14
Q

name these types of prolapse

A
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15
Q

which levator ani muscles and nerves of pelvic floor are at particular risk of damage during childbirth

A
  • pubococcygeus and puborectalis
  • pudendal n.
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16
Q

describe the 4 degrees of perineal trauma

A
  • 1st degree tear: laceration of vaginal epithelium or perineal skin only
  • 2nd degree tear: involvement of perineal muscles, but not anal sphincter
  • 3rd degree tear: involvement of anal spincter but not anal mucosa
  • 4th degree tear: involvement of anal sphincter and anal mucosa
17
Q

which procedure can be used to try and prevent OASIS (obstetric anal sphincter injuries) and in which cases is it recommended

A
  • mediolateral episiotomy: 45-60 degree angle from midline to prevent tearing of perineal body
  • intstrumental deliver, large baby, shoulder dystocia
18
Q

describe the 4 different types of FGM

A
  1. CLITORIDECTOMY: partial or total removal of clitoris or prepuce
  2. EXCISION: partial or total removal of clitoris and labia minora, +/- excision of labia majora
  3. INFIBULATION: narrowing of the vaginal orifice with creation of a covering seal by cutting and apposition of labia minora and/or labia majora, +/- clitoridectomy
  4. All other harmful procedures to the female genitalia for non-medical purposes, eg pricking, piercing…

ESA 3- Reproductive system (22 decks)

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