Anatomy of Urinary Incontinence and Prolapse Flashcards
What is the role of the pelvic floor?
Separates pelvic cavity from perineum
Plays important role in providing support to pelvic organs
Plays an important role in maintaining continence
- Urinary
- Faecal
Name the 3 layers that make up pelvic flor
- Pelvic diaphragm
- Muscles of perineal pouches
- Perineal membrane
Which is the deepest/most internal layer of the pelvic floor?
Pelvic diaphragm
Which two muscle groups make up the pelvic diaphragm?
Levator ani: more anteromedial part
Coccygeus: Posterolateral
What is the significance of the anterior gap between medial borders of pelvic diaphragm?
Urogenital hiatus
Passage for urethra and vagina
Which muscle forms most of pelvic diaphragm?
Levator ani
Name the origin of puborectalis and pubococcygeus
Posterior aspect of coccygeus
What are the 3 parts of the levator ani?
Puborectalis
Pubococcygeus
Iliococcygeus - comes mainly from ischial spine, main attachment point is towards the coccyx
What is the function of levator ani?
Tonically contracted most of time
Must relax to allow urination and defecation
What is perineal body?
Fibro-muscular skeleton of pelvic floor
SUPER important for support to the pelvic floor (incontinence)
Name the innervations of levator ani
Pudendal nerve - S2 to S4
Nerve to levator ani
What are the additional layers of support apart from pelvic diaphragm?
Endo pelvic fascia
Pelvic ligaments
What is endopelvic fascia?
connective tissue ‘packing’
some loose areolar tissue
some fibrous
- collagen and elastic fibres
What are the pelvic ligaments?
Fibrous endo-pelvic fascia Provide support to pelvic organs Uterosacral Transverse cervical (cardinal) Lateral ligament of bladder Lateral rectal ligaments
What is the tendinous arch of pelvic fascia?
Thickened area of fascia that covers the obturator internus
Where is deep perineal pouch located?
Underneath pelvic diaphragm and above perineal membrane
What does deep perineal pouch contain?
Urethra
Vagina
Bulbourethral gland/Cowper’s glands (homologus for bartholin glands in females)
Neurovascular bundle for penis/clitoris
Extensions of the ischioanal fat pads and muscles
Which urethral muscles work together to maintain continence
External urethral sphincter
Compressor urethrae
What is the perineal membrane?
Thin sheath of tough membrane
Where does the perineal membrane attach?
Laterally to the side of the pubic arch, closing the urogenital triangle
What are the perineal membrane openings?
For urethra in males and vagina in females
Which is the last layer of passive support for pelvic organs?
Perineal body together with perineal membrane
Where is the superficial perineal pouch in males?
below perineal membrane
Contents of the superficial perineal pouch in males
Contains root of penis:
Bulb – corpus spongiosum, crura – corpus cavernosum
Associated muscles – bulbospongiosus and ischiocavernosus
Also contains proximal spongy (penile) urethra, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
Which erectile tissue contains 90% of blood flow in an erection?
Corpus cavernosum
Which muscle covers the bulb of penis?
Bulbospongiosus
Which muscle covers the crura of penis?
Ischiocavernosus
Ischiocavernosus muscles contributes to perineal body - T or F
F
Where is superficial perineal pouch located in females?
Below perineal membrane
What is the contents of the superficial perineal pouch in females?
Contains female erectile tissue and associated muscle:
Clitoris and crura – corpus cavernosum
Bulbs of vestibule – paired
Associated muscles – bulbospongiosus and ischiocavernosus
Also contains greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
Which structures of pelvic floor maintains urinary continence?
External urethral sphincter, Compressor urethrae,
Levator ani
Which features of pelvic floor maintains fecal continence?
Tonic contraction of puborectalis bends the anorectum anteriorly
Active contraction maintains continence after rectal filling
Which events cause injury to pelvic floor?
Pregnancy
Childbirth
- stretching or tearing
- pudendal nerve damage
Chronic constipation
Obesity
Heavy lifting
Chronic cough or sneeze
Previous injury to pelvis/pelvic floor
Menopause
