Anatomy 9 - Anatomy of urinary incontinence and prolapse

Question 1

What is the purpose of the pelvic floor? (3)

Answer 1

Separates the pelvic cavity from the perineum
Plays important role in providing support to pelvic organs
Plays an important role in maintaining continence (urinary and faecal)

Question 2

3 layers of the pelvic floor?

Answer 2

Pelvic diaphragm
Muscles of the perineal pouches
Perineal membrane

Question 3

Which is the deepest layer of the pelvic floor?

Answer 3

Pelvic dipahragm

Question 4

What 2 muscles make up the pelvic diaphragm?

Answer 4

Levator ani

Coccygeus

Question 5

What shape is the pelvic diaphragm?

Answer 5

Sling-shaped

Question 6

What is the name for the anterior gap between the medial borders of the pelvic diaphragm muscles?

Answer 6

Urogenital hiatus

Question 7

Purpose of the urogenital hiatus?

Answer 7

Passageway for urethra (males and females) and vagina

Question 8

Is levator ani or coccygeus more posterior?

Answer 8

Coccygeus

Question 9

What ligament does coccygeus lie on?

Answer 9

Sacrospinous ligament

Question 10

Attachments of levator ani?

Answer 10

Pubic bone, ischial spines and tendinous arch of levator ani

Perineal body, coccyx and walls of organs in midline

Question 11

3 parts of levator ani? (from medial to lateral)

Answer 11

Puborectalis
Pubococcygeus
Iliococcygeus

Question 12

What happens to the levator ani when you urinate/ defecate?

Answer 12

It must relax

Question 13

Nerve supply to levator ani?

Answer 13

Pudendal nerve

Nerve to levator ani

Question 14

Apart from the pelvic floor, what are 2 other groups of supportive tissues for the pelvic organs?

Answer 14

Endo-pelvic fascia

Pelvic ligaments

Question 15

What is endo-pelvic fascia?

Answer 15

Connective tissue “packing” -> what the bladder and rectum expand into

Question 16

What is the endo-pelvic fascia made of?

Answer 16

Loose areolar tissue (loose connective tissue)
Fibrous tissue (collagen and elastic fibres)

Question 17

Name 5 supporting pelvic ligaments?

Answer 17

Utero-sacral ligamnet
Transverse cervical ligament (cardinal ligament)
Tendinous arch of pelvic fascia
Tendinous arch of levator ani
Lateral ligament of bladder

Question 18

Where does the deep perineal pouch lie?

Answer 18

Below the fascia covering the inferior aspect of the pelvic diaphragm
Above the perineal membrane

Question 19

What does the deep perineal pouch contain? (6)

Answer 19

Part of the urethra
Part of the vagina in females
Bulbourethral glands in male
Neurovascular bundle of penis/ clitoris
Extensions of the ischioanal fat pads
Muscles

Question 20

Deep perineal pouch muscles in males and females?(3)

Answer 20

External urethral sphincter
Compressor urethrae
Deep transverse perineal muscles

Question 21

Is the deep transverse perineal muscle voluntary or involuntary in males?

Answer 21

Skeletal = voluntary

Question 22

Is the deep transverse perineal muscle voluntary or involuntary in females?

Answer 22

Smooth (involuntary)

Question 23

What does the perineal membrane separate?

Answer 23

Superficial and deep perineal pouch

Question 24

What is the perineal membrane?

Answer 24

Thin sheet of tough, deep fascia

Question 25

What does the perineal membrane attach to laterally?

Answer 25

Pubic arch

Question 26

What does the perineal membrane close?

Answer 26

Urogenital traingle

Question 27

Are there any holes in the perineal membrane?

Answer 27

Yes, for the urethra and the vagina in geamles

Question 28

Where does the superficial perineal pouch lie?

Answer 28

Below the perineal membrane

Question 29

What does the root of the penis consist of?

Answer 29

Bulb Crura Associated muscles (bulbospongiosus and ischiocarvernosus)

Question 30

What does the superficial perineal pouch consist of in the male? (4)

Answer 30

Root of the penis Proximal spongy urethra Superficial transverse perineal muscle Branches of internal pudendal vessels and pudendal nerve

Question 31

Is the superficial perineal pouch part of the pelvic floor?

Answer 31

No

Question 32

What does the female superficial perineal pouch contain?

Answer 32

Female erectile tissue Greater vestibular glands Superficial transverse perineal muscle Branches of internal pudendal vessels and nerve

Question 33

Name the erectile tissue in females? (3)

Answer 33

Crura and clitorris Bulbs of vestibule (paired) Associated muscles - bulbospongiosus and ischiocavernosus

Question 34

What is located at the bottom of the bulbs of vestibule in females?

Answer 34

Greater vestibular glands (bartholin's glands)

Question 35

What structure between the vagina and anus is important for pelvic floor support?

Answer 35

Perineal body

Question 36

How does the pelvic floor provide support to pelvic organs?

Answer 36

Normally tonically contracted and actively contracts during coughing, sneezing and vomiting

Question 37

What parts of the pelvic floor help maintain urinary continence? (3)

Answer 37

External urethral sphincter Compressor urethrae Levator ani

Question 38

How does the pelvic floor help to maintain faecal continence?

Answer 38

Tonic contraction of puborectalis bends the anorectum anteriorly Active contraction maintains continence after rectal filling

Question 39

How can childbirth lead to pelvic floor injury?

Answer 39

Stretching or tearing | Pudendal nerve damage

Question 40

Is the external urethral sphincter voluntary or involuntary in females?

Answer 40

Voluntary (same as in males)

Question 41

What does urinary continence depend on? (3)

Answer 41

Urinary bladder neck support External urethral sphincter Smooth muscle in urethral wall

Question 42

What structures can prolapse? (6)

Answer 42

``` Uterus Vagina Bladder Urethra Rectum Intestine ```

Question 43

Name for part of prolapsed bladder?

Answer 43

Cystocele

Question 44

Name for part of prolapsed intestine?

Answer 44

Enterocele

Question 45

Name for part of prolapsed rectum?

Answer 45

Rectocele

Question 46

Name for part of prolapsed urethra?

Answer 46

Urethrocele

Question 47

What is the name for the herniation of urethra, bladder, rectum or rectouterine pouch through the supporting fascia of the vagina?

Answer 47

Vaginal prolapse

Question 48

How does a vaginal prolapse present?

Answer 48

Lump in vaginal wall

Question 49

1st degree uterine prolapsed?

Answer 49

Slippage of the cervix slightly further down

Question 50

2nd degree uterine prolapsed?

Answer 50

Both the cervix and uterus sliding down

Question 51

3rd degree uterine prolapsed?

Answer 51

Whole uterus slides down, passing out of the body

Question 52

Treatment of a uterine prolapsed?

Answer 52

Sacrospinous fixation - sutures placed in sacrospinous ligament to repair cervical descent

Question 53

Describe incontinence surgery?

Answer 53

Mesh put through obturator canal to create a sling around the urethra (incisions made through vagina and groin)

Question 54

What can be injured during prolapse repair? (2)

Answer 54

Sciatic nerve | Pudendal NVB