Anatomy - Urinary Incontinence and Prolapse

Question 1

Where is the pelvic floor?

Answer 1

Seperates pelvic cavity from perineum

Question 2

What are the 3 layers of the pelvic floor?

Answer 2

Pelvic diaphragm (deepest)

Muscles of perineal pouches

Perineal membrane

Question 3

What muscle groups make up the pelvic diaphragm?

Answer 3

levator ani and coccygeus

Question 4

What are the 3 parts of the levator ani?

Answer 4

puborectalis

pubococcygeus

iliococcygeus

Question 5

What must relax to allow urination and defecation?

Answer 5

levator ani (tonically contracted most of the time)

Question 6

What is the innervation of levator ani?

Answer 6

pudendal nerve and nerve to levator ani

Question 7

Label the pelvic ligaments.

Answer 7

Question 8

What do the pelvic ligaments do?

Answer 8

Provide additional support to pelvic organs

Question 9

What does the pelvic floor do?

Answer 9

provides support to pelvic organs and maintains continence

Question 10

What is the endo pelvic fascia?

Answer 10

connective tissue ‘packing’

Question 11

Where is the deep perineal pouch?

Answer 11

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

Question 12

What does the deep perineal pouch contain?

Answer 12

part of the urethra (and vagina in F)

bulbourethral glands (M)

neurovascular bundle for penis/clitoris

xtensions of the ischioanal fat pads and muscles

Question 13

What is the perineal membrane and where is it?

Answer 13

thin sheet of tough, deep fascia

superficial to deep perineal pouch

Question 14

What forms the last passive support of the pelvic organs?

Answer 14

Perineal membrane along with the perineal body

Question 15

Where is the superficial perineal pouch?

Answer 15

below the perineal membrane

Question 16

What does the superficial perineal pouch contain in a male?

Answer 16

root of the penis (corpus spongiosum, corpus cavernosum, associated muscles - bulbospongiosus and ischiocavernosus)

also proximal spongy urethra, superficial transverse pernieal muscle and branches of internal pudendal vessels and pudendal nerve

Question 18

What does the superficial perineal pouch contain in a female?

Answer 18

female erectile tissue and associated muscle (clitoris and corpus cavernosum, bulbs of vestibule and associated muscles - bulbospongiosus and ischiocavernosus)

greater vestibular glands, superficial transerve perineal muscle, branches of internal pudendal vessels and pudendal nerve

Question 19

When does the pelvic floor actively contract?

Answer 19

coughing, sneezing, vomiting

Question 20

How does the pelvic floor help maintain faecal continence?

Answer 20

tonic contraction of puborectalis bends the anorectum anteriorly

active contraction maintains continence after rectal filling

Question 21

What can cause injury to the pelvic floor?

Answer 21

pregnancy, childbirth (stretching, tearing, pudendal nerve damage)

chronic constipation

obesity

heavy lifting

chronic cough or sneeze

previous injury to pelvis

menopause

Question 22

What is a vaginal prolapse?

Answer 22

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

urethrocele, cystocele, rectocele, enterocele

Question 23

How does uterine prolapse present?

Answer 23

dragging sensation

feeling of a lump

urinary incontinence

Question 25

What is a first degree uterine prolapse?

Answer 25

to upper vagina

Question 26

what is a 2nd degree uterine prolapse?

Answer 26

to the introitus

Question 27

what is a 3rd degree uterine prolapse?

Answer 27

cervix is outside the introitus

Question 28

What is sacrospinous fixation?

Answer 28

sutures placed in sacrospinous ligament, just medial the ischial spine to repair cervical/vault descent

Question 29

What are the risks in sacrospinous fixation?

Answer 29

risk of injury to pudendal NVB and sciatic nerve

Question 30

What is the surgery for stress incontinence?

Answer 30

trans-obturator approach

mesh through obturator canal

create a sling around urethra

incisions throguh vagina and groin