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