Anatomy - Urinary Incontinence and Prolapse Flashcards
what are the main roles of the pelvic floor?
provides support to pelvic organs
maintaining continence
what are the three layers of the pelvic floor?
pelvic diaphragm
muscles of perineal pouches
perineal membrane
what is the deepest layer of the pelvic floor?
the pelvic diaphragm
what two muscle groups make up the pelvic diaphragm?
levator ani
coccyges
what is the anterior gap between the medial borders of the pelvic diaphragm called?
urogenital hiatus
what is the role of the urogenital hiatus?
allows passage for the urethra and vagina
which muscle of the pelvic diaphragm is located more anterior and medial?
levator ani
which muscle of the pelvic diaphragm is located more posterior and lateral?
coccygeus
what muscle forms most of the pelvic diaphragm?
levator ani
what three muscles make up levator ani?
iliococcygeus
pubococcygeus
puborectalis
what nerves innervate levator ani?
pudendal
nerve to levator ani
what is the endopelvic fascia?
connective tissue that fills in the empty spaces around the pelvic organs
what is the endopelvic fascia made of?
some loose, areolar tissue and some fibrous tissue
what are the pelvic ligaments made of?
fibrous, thickened endopelvic fascia
name the four pelvic ligaments
uterosacral
transverse cervical
lateral ligament of bladder
lateral rectal ligaments
what is another name for the transverse cervical ligaments?
cardinal ligaments
where does the deep perineal pouch lie?
below the fascia of the inferior pelvic diaphragm
above the perineal membrane
what is found in the deep perineal pouch?
part of the urethra + vagina bulbourethral glands in males neuromuscular bundle for penis/clitoris fat muscles
what is another name for the bulbourethral glands?
Cowper’s glands
what is the role of Cowper’s glands?
create lubricating fluid in the male urethra
what muscles are found in the deep perineal pouch?
external urethral sphincter
compressor urethrae
males = deep transverse perineal muscle
females = band of smooth muscle
where is the perineal membrane located?
superficial to the deep perineal pouch
what is the perineal membrane?
a thin sheet of tough, deep fascia
where does the perineal membrane attach?
laterally to the side of the pubic arch
closes the urogenital triangle
where does the superficial perineal pouch lie?
below the perineal membrane
what does the superficial perineal pouch contain in females?
female erectile tissue associated muscle greater vestibular glands superficial transverse perineal muscle branches of pudendal vessels and nerve
what elements make up the female erectile tissue?
clitoris
crura
bulbs of the vestibule
what are the clitoris and crura made from?
corpus cavernosum
what are the associated muscles of the female erectile tissue?
bulbospongiosus
ischiocavernosus
what muscle lies over the crura?
ischiocavernosus
what muscle lies over the bulb?
bublospongiosus
what does the superficial perineal pouch contain in males?
the root of the penis
proximal spongy urethra
superficial transverse perineal muscle
pudendal vessels and nerve
what makes up the root of the penis?
bulb
crura
bulbospongiosus and ischiocavernosus
what is the bulb of the penis made from?
corpus spongiosum
what is the crura of the penis made from?
corpus cavernosum
what three muscles are involved in the maintenance of urinary continence?
external urethral sphincter
compressor urethrae
levator ani
what muscle is involved in the maintenance of faecal continence?
puborectalis
what effect does tonic contraction of puborectalis have?
bends the anorectum anteriorly
what is the aim of active contraction of the puborectalis?
maintaining faecal continence after rectal filling
what is vaginal prolapse?
herniation of the urethra, bladder, rectum or recto-uterine pouch through the supporting fascia
how does vaginal prolapse present?
a lump in the vaginal wall
what is uterine prolapse?
descent of the uterus into the vagina
what is first degree uterine prolapse?
when the cervix is dropping slighyly into the vagina
what is second degree uterine prolapse?
when the cervix drops to a level just inside the opening of the vagina
what is third degree uterine prolapse?
when the cervix is outside of the vagina
what is fourth degree uterine prolapse?
when the entire uterus is outside of the vagina
how can uterine prolapse present?
dragging sensation
a feeling of a lump
urinary incontinence
how can uterine and vaginal prolapses be treated?
sacrospinous fixation
what is involved in sacrospinous fixation?
sutures placed in the sacrospinous ligament just medial to the ischial spine
performed vaginally
what are the risks associated with sacrospinous fixation?
risk of injury to the pudendal neuromuscular bundle and the sciatic nerve
