Anatomy of Urinary Incontinence and Prolapse

Question 1

what is the pelvic floor

Answer 1

layer separating the pelvic cavity from the perineum

Question 2

role of the pelvic floor

Answer 2

provides support to pelvic organs

maintained urinary and faecal continence

Question 3

what are the three areas of the pelvic floor

Answer 3

Pelvic diaphragm

Muscles of perineal pouches

Perineal membrane

Question 4

what is the pelvic diaphragm

Answer 4

deepest layer of the pelvic floor

two muscles groups:
elevator ani
+
coccygeus

Question 5

what is the urogenital hiatus

Answer 5

anterior gap between medial borders of the pelvic diaphragm

passage for urethra and vagina

Question 6

which muscle forms most of the pelvic diaphragm

Answer 6

elevator ani

Question 7

what are the 3 parts of the elevator ani

Answer 7

Puborectalis (from the pubic bone, comes down and forms a sling around the rectum)

Pubococcygeus (middle one, from the pubic bone and inserts in the midline of the coccyx and organs on the midline eg, vagina or prostate)

Iliococcygeus (comes from ilium to the coccyx)

Question 8

where is the perineal body

Answer 8

fibromuscular skeleton of the pelvic floor

located between urogenital hiatus and anus

all pelvic floor muscles attach

Question 9

what is the innervation of the elevator ani

Answer 9

pudenal nerve to levator ani

Question 10

how does the elevator ani prevent incontinenece

Answer 10

its usually tonically contracted

it relaxed to allow urination and deification

Question 11

what additional support is found in the pelvis

Answer 11

endo-pelvic fascia

pelvic ligaments

Question 12

what is the endo-pelvic fascia

Answer 12

connective tissue ‘packing’
some fibrous tissue
some loose areolar tissue

Question 13

what are the pelvic ligaments

Answer 13

transverse cervical ligament 
utero-sacral ligament 
transverse cervical 
lateral ligament of the bladder 
lateral rectal ligaments

Question 14

what is the tendinous arch of the levator ani

Answer 14

fascia lying above the obturator interns muscle where the levator ani attaches

Question 15

what is the deep perineal pouch

Answer 15

lies below the pelvic diaphragm

lies above the perineal membrane

contains part of the urethra, vagina, bulbourethral glands in male, neuromuscular bundle for penis/clitoris, extensions of sischioanal fat pad muscles

Question 16

what muscles are in the deep perineal pouch

Answer 16

external urethral spinchter
compressor urethrae
deep transverse perineal muscle

Question 17

difference between the deep transverse perineal muscle in males and females

Answer 17

in females its usually just unnamed smooth muscle

in males its skeletal muscle

Question 18

what is the perineal membrane

Answer 18

thin sheet of tough membrane below the deep perineal pouch

attaches laterally to the sides of the pubic arch closing the urogenital triangle

the last passive support og the pelvic organs

Question 19

what is the superficial perineal pouch

Answer 19

layer below the perineal membrane

Question 20

what does the superficial perineal membrane contain in males

Answer 20

root of penis
bulb-corpus spongiosum, Crura- corpus cavernous

associated muscles - bulbospongiosus and ischiocavernosus

superficial transverse perineal muscle

Question 21

where does 90% of the blood go through during an erection and why

Answer 21

90% goes through the corpus cavernous

this is so that the urethra is not compressed in the corpus spongiosum and sperm can get out

Question 22

where does the ischicavernosus lie

Answer 22

over the corpus cavernous

Question 23

where does bulbospongiosus lie

Answer 23

over the corpus spongiosum

Question 24

what is in the superficial perineal pouch in females

Answer 24

cliterus and crura (made from corpus cavernous)

Bulbs of vestibule (corpus spongiosum, split into two on females)

greater vestibular glands (bartholins glands)

muscles:
- bulbospongiosus
- ischiocavernosis

Question 25

when does the pelvic floor actively contract

Answer 25

coughing, sneezing, vomiting

to maintain continence

Question 26

how does the pelvic floor maintain urinary continence

Answer 26

external urethral spinchter
compressor urethrae
elevator ani

Question 27

how does the pelvic floor maintain faecal continence

Answer 27

tonic contraction of puborectalis (bends anorectic anteriorly so faeces doesn’t just come out)

active contraction maintains continence after rectal filling

Question 28

what causes injury to the pelvic floor

Answer 28

Pregnancy
Childbirth (stretching or tearing of muscle, damage to the pudenal nerve)

Chronic constipation
obesity 
heavy lifting 
chronic cough or sneeze
previous injury to pelvic/pelvic floor 
menopause

Question 29

what is prolapse

Answer 29

failure of pelvic organ support

can be uterus, vagina or both

also bladder or rectum

Question 30

what is vaginal prolapse

Answer 30

pelvic organs protrude into the vagina

cystocele - bladder protruding into wall of vagina

enerocyele - bowel in pouch of Douglas protruding into wall of vagina

rectocele- rectum protruding into the vagina

presents as lump in vaginal wall

Question 31

what is uterine prolapse (and degrees)

Answer 31

when uterus moves down and potentially out of the vagina

1st - cervix drops into upper vagina
2nd - cervix has descended into the vagina but above the opening
3rd -cervix completely exits the vagina
4th- cervix and uterus outside of the vagina

Question 32

presentation of uterine prolapse

Answer 32

feeling of ‘lump’
dragging sensation
urinary incontinence

Question 33

Surgical treatment for uterine prolapse

Answer 33

sacrospinous fixation

• sutures placed in sacrospinous ligament to attach it to vagina
• this holds the vagina and the cervix up

performed vaginally

risk to prudential nerve bundle - try to place suture medially to the pudenal nerve

Question 34

treatment of incontinence

Answer 34

Trans-obturator approach

mesh put through the obturator canal to put a slin around the urethra