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REPRO > Anatomy of Urinary Incontinence and Prolapse > Flashcards

Anatomy of Urinary Incontinence and Prolapse Flashcards

1
Q

What is the pelvic floor responsible for?

A
  • important to support pelvic organs
  • important to maintain urinary and FECAL continence
  • resistance to increase in intra-abdominal pressure and intra-pelvic pr.
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2
Q

What is the pelvic floor?

A

separates the pelvic cavity from the perineum

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3
Q

What is it made of?

A

3 layers

  • pelvic diaphragm
  • muscles of the perineal pouches
  • perineal membrane
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4
Q

What is the pelvic diaphagrm and what muscles does it consist of?

A
  • the DEEPEST layer of the pelvic floor

- 2 muscle groups: Levator ani + Coccygeus

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5
Q

Refer to slide 3 on the anatomy lecture. What are the first 2 hiatus found in the anterior gap, btw the medial borders of thepelvic diaphragm in a female…

How is it diff. in men?

A
  • first small= Urethra
  • second large opening (no distinct form)= Vagina
  • men have no vagina; therefore only ONE opening (urethra) found in the anterior gap
  • —-both sexes have a centrally positioned hiatus = Rectum
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6
Q

What does the pelvic diaphragm appear as?

A
  • a sling
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7
Q

Like how there is 3 parts to the pelvic floor. There is also 3 parts to the levator ani muscle- a constituent of the pelvic diaphgram….Name these 3 muscles.

A
  • Puborectalis
  • Pubococcygeus
  • Iliococcygeus
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8
Q

Describe the shape of the pelvic floor.

A
  • Funnel Shaped; attached to the walls of the lesser pelvis
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9
Q

What is the shape of the puborectalis m.?

A

-is a U-shaped muscle ext. from the bodies of the PUBIC bones, past the urogenital hiatus and AROUND the anal canal

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10
Q

What is the importance of the puborectalis muscle?

A
  • to maintain FECAL continence

- its TONIC contraction bends the canal ANTERIORLY= Anorectal angle (90*) at the anorectal jxn —-keeping shit in

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11
Q

Where does the pubococcygeus muscle extend to?

A
  • from the PUBIC bone and anterior aspect of the tendinous arch
    -around the urogenital hiatus
    > runs posteromedially> attaches at coccyx and anococcygeal ligament
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12
Q

The extent of the iliococcygeus muscle?

A

start anteriorly at the ischial spines and posterior aspect of the tendinous arch.
- attaches posteriorly to the coccyx and the anococcygeal ligament.

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13
Q

Which of the 3 muscles of the levator ani; is considered to be the LEVATOR of the pelvic floor?

A

the iliococcygeus muscle

- elevates the pelvic floor and the anorectal canal

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14
Q

The levator ani muscle is _______ most of the time…must be ______ to allow urination and defecation to occur.

A

TONICALLY CONTRACTED

RELAXED

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15
Q

What is the nerve supply of the levator ani muscle?

A
  • pudendal nerve (S2, S3, S4)
  • nerve to levator ani

(anterior ramus of S4)

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16
Q

Name 2 additional supports for the pelvic organs.

A
  • Endo-pelvic fascia

- pelvic ligaments

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17
Q

What is the endo-pelvic fascia?

A

-consists of some loose areolar tissue, -some fibrous tissue (collagen and elastic fibres)

18
Q

Name some pelvic ligaments.

A
  • –uterosacral lig.
  • –transverse cervical
  • lateral ligament of bladder
  • lateral rectal ligaments
19
Q

Where is the deep perineal pouch located?

A
  • below the fascia covering the INFERIOR aspect fo the PELVIC diaphragm
  • above the perineal membrane
20
Q

What does the DEEP Perineal pouch consist of?

A
  • part of the urethra
  • vagina
  • bulbourethral glands in MALES
  • neurovascular bundle of penis/clitoris
  • extensions of ischioanal fat pads
  • muscles
21
Q

Where is the perineal membrane located? What is it?

A
  • superficial to the deep perineal pouch —-attaches laterally to the sides of the pubic arch (closing the UROGENITAL triangle)
  • THIN sheet of TOUGH, DEEP fascia
22
Q

Does the perineal membrane have any openings?

A
  • yes

- for urethra and vagina

23
Q

What is the last passive support of the pelvic organs?

A
  • Perineal membrane along with the perineal body
24
Q

What are the boundaries of the anal triangle?

A

bounded by the coccyx, sacrotuberous ligaments, and a theoretical line between the ischial tuberosities.

25
Q

Where is the superficial perineal pouch located?

A
  • BELOW the perineal membrane
26
Q

What does the superf. perineal pouch contain?

A
  • root of penis
    (bulb- corpus spongiosum, crura, corpus cavernosum)
    (associated muscles- bulbospongiosum and ischiocavernosus)
  • also contains proximal spongy (penile) urethra, superficial transverse perineal muscle
    and branches of internal pudendal vessels and pudendal nerve
27
Q

If the bulbar urethra is to rupture, where might the urine be extravasated?

A
  • accumulates in the superficial perineal pouch (around the scrotum, penis and lower abdomen)
28
Q

Below the perineal membrane = superficial perineal pouch. What is located in the female’s perineal pouch?

A

Erectile tissue and associated m.

  • clitoris and crura (corpus carvernosum)
  • bulbs of vestibule
  • associated muscles (bulbospongiosus and ischiocavernosus)
29
Q

Name the non-erectile structures in the superficial perineal pouch.

A
  • also has : greater vestibular glands, superficial transverse perineal muscle and
    branches of internal pudendal vessels and pudendal nerve
30
Q

What parts of the pelvic floor provides support for urinary continence?

A
  • external urethral sphincter
  • levator ani
  • compressor urethrae
31
Q

How may the pelvic floor get injured?

A
  • pregnancy (childbirth- stretching and tearing of pudendal nerve)
  • chronic constipation
  • obesity
  • heavy lifting
  • chronic cough and sneeze
  • previous injury to pelvis/floor
  • menopause
32
Q

Urinary continence depends on?

A
  • urinary bladder NECK support
  • external urethral sphincter
  • smooth muscle in urethral WALL
33
Q

What is prolapse?

A
  • gynae problem; COMMON!
  • d.t FAILURE of support for pelvic organs; pelvic organs may herniate (could involve uterus, vagina or both); bladder and rectum too
34
Q

What herniates in a vaginal prolapse?

A
  • herniation of urethra, bladder, rectum or rectouterine pouch through the supporting fascia
  • presents as a lump through the vaginal WALL
35
Q

Name the diff. types of prolapse in the pelvis?

A
  • urethrocele, cystocele, rectocele, enterocele
36
Q

How does a uterine prolapse feel?

A
  • dragging sensation
  • feels like a lump
  • urinary incontinence
37
Q

What are the diff. types of uterine prolapse?

A

1st Degree: cervix drops in to vagina
2nd : cervix comes down to the OPENING of the vagina
3rd: cervix s OUTSIDE the vagina

38
Q

Can a uterine prolapse be treated? How?

A

Yes

  • —sacrospinous fixation (suture placed in the sacrospinous ligament)
  • medial to ISCHIAL spine
  • repairs the cervical descent
  • performed vaginally
39
Q

What is the risk of repairing a uterine prolapse?

A

risk of damaging the pudendal nerve and the sciatic nerve

40
Q

Can urinary incontinence be treated?

A
  • yes
  • —trans-obturator approach
  • mesh through the obturator canal (NVB space)
  • create a sling around the urethra
  • incisions through the vagina and groin

REPRO (55 decks)

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