Anatomy 5 - Urinary Incontinence and Prolapse Flashcards
What does the pelvic floor separate?
Pelvic cavity from perineum
What are the functions of the pelvic floor?
Support for pelvic organs
Urinary and faecal continence
What makes up the pelvic floor?
Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane (fibrous sheet)
What is the deepest layer of the pelvic floor?
Pelvic diaphragm
What 2 muscle groups make up the pelvic diaphragm?
Coccygeus
Levator ani
What is the urogenital hiatus?
Passage through pelvic diaphragm for urethra and vagina (anterior gap between medial borders)
What muscle group forms the majority of the pelvic diaphragm?
Levator ani
What are the 3 parts of the pelvic diaphragm?
Puborectalis
Pubococcygeus
Iliococcygeus
What state is the levator ani in for majority of time?
Tonically contracted
When does the levator ani relax?
To allow urination and defacation
What are the attachments and insertions of the levator ani?
Attach via pubic bone, ischial spines and tendonous arch of levator ani
To perineal body, occygeus and walls of organs in the midline
What muscle creates a sling around the rectum?
Puborectalis
What is the endopelvic fascia made up of?
Connective tissue
Loose areolar tissue
Fibrous tissue
What does the fibrous tissue of endopelvic fascia form?
The pelvic ligaments
What are the major ligaments of uterus ? 3
Utero-sacral ligament
Tansverse cervical (cardinal) ligament
pubocervical ligament
What is the function of the utero-sacral ligament?
Stops the uterus sinking down
Where does the deep perineal pouch lie?
Below the fascia
Above the perineal membrane (slide 7 says below - check this out)
What does the deep perineal pouch cover?
Inferior aspect of pelvic diaphragm
What does the deep perineal pouch contain?
Part of urethra (and vagina), bulbourethral glands (males), neurovascular bundle for penis/ clitoris, extensions of ischioanal fat pads and muscles
What is the perineal membrane?
Thin sheet of tough deep fascia
What is the urogenital triangle?
Opening for urethra and vagina
Where the perineal membrane attaches laterally to the pubic arch
Where does the superficial perineal pouch lie?
Below perineal membrane
What does the male superficial perineal pouch contain?
Root of penis i.e. bulb - corpus spongiosum and crura - corpus cavernosum
Proximal spongy penile urethra
Superficial transverse perineal muscle
Branches of internal pudendal vessels
Pudendal nerve
Bulbospongiosus and ischiocavernosus muscles
What muscles are involved in ejaculation and erection?
Bulbospongiosus
Ischiocavernosus
What does the female superficial perineal pouch contain?
Clitoris and crura - corpus cavernosum Paired bulbs of vestibule Bulbospongiosus and ischiocavernosus muscles Greater vestibule glands Superficial transverse perineal muscle Branches of internal pudendal vessels Pudendal nerve
What are the greater vestibular glands also called?
Bartholin’s glands
What are the functions of the pelvic floor?
Support to pelvic organs
Urinary continence
Faecal continence
How does the pelvic floor give support to pelvic organs?
Usually tonically contracted
Actively contracts when coughing, sneezing, vomiting
What parts of the pelvic floor help maintain urinary continence?
External urethral sphincter
Compressor urethrae
Levator ani
How is faecal continence maintained?
Tonic contraction of the pubo-rectalis bends anorectum anteriorly
Active contaction maintains continence after rectal filling
Acute angle when contracted
Relaxes to allow matter through
What can cause injury to pelvic floor?
Pregnancy/ Childbirth Chronic constipation Obesity Heavy lifting Chronic cough or sneeze Previous pelvic injury Menopause (degeneration of the fibrous ligaments)
What contributes towards urinary continence?
Urinary bladder neck support
External urethral sphincter
Smooth muscle in urethral wall
What organs can prolapse?
Uterus
Vagina
Bladder
Rectum
What happens in a pelvic organ prolapse?
Herniation through supporting fascia of: Urethra (urethrocele) Vagina Rectum (rectocele) Bladder (cystocele) Bowel (enterocele) Rectouterine pouch
Into the vagina
What happens in a uterine prolapse?
Pelvic floor muscles and ligaments stretch and weaken
Uterus slips down into or protrudes out of the vagina
What are the degrees of uterine prolapse?
1st
2nd
3rd
What are the treatment options for prolapse?
Sacrospinous fixation
Incontinence surgery
What is sacrospinous fixation?
Suture sacrospinous ligament (medial to ischial spine)
How is the sacrospinous fixation performed?
Vaginally
What structures are at risk during a sacrospinous fixation?
Pudendal NVB
Sciatic nerve
What is incontinence surgery?
Mesh through obturator canal (transobturator approach) to create a sling around the urethra
Where are the incisions made via for incontinence surgery?
Through vagina and groin
