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Reproductive & Sexual Health > Anatomy of Urinary Incontinence and Prolapse > Flashcards

Anatomy of Urinary Incontinence and Prolapse Flashcards

1
Q

What does ghe pelvic floor separate?

A

separates pelvic cavity from perineum

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2
Q

What is the role of the pelvic floor?

A
  • provides support to organs
  • maintains continence
    • urinary
    • faecal
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3
Q

What are the three layers of the pelvic floor?

A

Pelvic diaphragm

Muscles of perineal pouches

Perineal membrane

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4
Q

What is the deepest layer of the pelvic floor?

A

Pelvic diaphragm

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5
Q

What are the two muscle groups of the pelvic diaphragm?

A

Levator Ani

Coccygeus

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6
Q

What is contained between medial borders in the anterior gap in the pelvic floor ?

A

Urogenital hiatus

Passage for urethra and vagina

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7
Q

What forms most of the pelvic diaphragm?

A

Levator ani

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8
Q

What does the levator ani attach to?

A
  • pubic bones, ischial spines and tendinous arch of levator ani
  • perineal body, coccyx and walls of organs in midline
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9
Q

What are the three parts of the levator ani?

A

Puborectalis

Pubococcygeus

Iliococcygeus

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10
Q

What is the innervation of the levator ani?

A
  • Pudendal nerve
  • Nerve to levator ani
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11
Q

When must the levator ani relax?

A

To allow urination and defecation

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12
Q

What additional support is provided (other than pelvic floor) to the organs of the pelvis?

A

Endo-pelvic fascia

Pelvic ligaments

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13
Q

What is the endo-pelvic fascia?

A

Connective tissue ‘packing’

Some loose areolar tissue

Some fibrous; collagen and elastic fibres

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14
Q

Name the pelvic ligaments?

A
  • uterosacral
  • transverse cervical (cardinal)
  • lateral ligament of bladder
  • lateral rectal ligaments
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15
Q

Where is the deep perineal pouch?

A

Lies below the fascia covering the inferior aspect of the pelvic diaphragm and above the perineal membrane

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16
Q

What is contained in the deep perineal pouch?

A
  • Part of the urethra (and vagina in females)
  • bulbourethral gland in males
  • neurovascular bundle for penis/clitoris
  • extensions of ischianal fat pads and muscles
17
Q

Where is the perineal membrane?

A

Superficial to deep perineal pouch

18
Q

What is the perineal membrane?

A

Thin sheet of tough, deep fascia

Together with perineal body it is the last passive support of the pelvic organs

19
Q

Where does the perineal membrane attach?

A

Laterally to the sides of the pubic arch, closing the urogenital triangle

20
Q

What is contained in the superficial perineal pouch (males)

A
  • root of penis
    • bulb- corpus spongiosum, crura- corpus cavernosa
    • associated muscles- bulbospongiosus and ischiocavernosis
  • proximal spongy (penile) urethra
  • superficial transverse perineal muscle
  • branches of internal pudendal vessels and pudendal nerve
21
Q

Where is the superficial perineal pouch?

A

Below the perineal membrane

22
Q

What is contained in the superficial perineal pouch in women?

A
  • Clitoris and crura- corpus cavernosa
  • Bulbs of vestibule - paired
  • Associated muscles -bulbospongiosus and ischiocavernosus
  • greater vestibular glands
  • superficial transverse perineal muscle
  • Branches of internal pudendal vessels and pudendal nerve
23
Q

When does the pelvic floor actively contract?

A

Coughing, sneezing, vomiting

24
Q

What helps maintain urinary continence?

A

External urethral sphincter

Compressor urethrae

Levator ani

25
Q

What helps maintain faecal continence?

A

Tonic contraction of puborectalis bends the anorectum anteriorly

Active contraction maintains continence after rectal filling

26
Q

What causes injury to the pelvic floor?

A
  • pregnancy
  • childbirth
    • stretching or tearing
    • pudendal nerve damage
  • chronic constipatio
  • obesity
  • heavy lifting
  • chronic cough or sneeze
  • previous injury to pelvis/pelvic floor
  • menopause
27
Q

What does urinary continence depend on?

A

Urinary bladder neck support

External urethral spincter

Smooth muscle in urethral wall

28
Q

What is a vaginal prolapse?

A

Herniation of urethra, bladder, rectum or rectouterine pouch through supporting fascia

Presents as a lump in vaginal wall

29
Q

What are the different types of prolapse?

A

Urethrocele

Cystocele

Rectocele

Enterocele

30
Q

What are the degrees of uterine prolapse

A

1st, 2nd and 3rd

31
Q

How may uterine prolapse present?

A

Dragging sensation

Feeling of a lump

Urinary incontinence

32
Q

How can a uterine prolapse be repaired?

A

Sacrospinous fixation

Sutures placed in sacrospinous ligament- just medial to ischial spine, to repair cervical/vault descent. Performed vaginally. Risk of injury to pudendal NVB and sciatic nerve.

Incontinence surgery

Trans-obturator approach. Place mesh through obturator canal, create a sling around the urethra. Incisions through vagina and groin.

Reproductive & Sexual Health (54 decks)

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