Anatomy - Urinary Incontinence and Prolapse Flashcards
Where is the pelvic floor?
Seperates pelvic cavity from perineum
What are the 3 layers of the pelvic floor?
Pelvic diaphragm (deepest)
Muscles of perineal pouches
Perineal membrane
What muscle groups make up the pelvic diaphragm?
levator ani and coccygeus
What are the 3 parts of the levator ani?
puborectalis
pubococcygeus
iliococcygeus
What must relax to allow urination and defecation?
levator ani (tonically contracted most of the time)
What is the innervation of levator ani?
pudendal nerve and nerve to levator ani
Label the pelvic ligaments.
What do the pelvic ligaments do?
Provide additional support to pelvic organs
What does the pelvic floor do?
provides support to pelvic organs and maintains continence
What is the endo pelvic fascia?
connective tissue ‘packing’
Where is the deep perineal pouch?
Lies below the fascia covering the inferior aspect of the pelvic diaphragm and above the perineal membrane
What does the deep perineal pouch contain?
part of the urethra (and vagina in F)
bulbourethral glands (M)
neurovascular bundle for penis/clitoris
xtensions of the ischioanal fat pads and muscles
What is the perineal membrane and where is it?
thin sheet of tough, deep fascia
superficial to deep perineal pouch
What forms the last passive support of the pelvic organs?
Perineal membrane along with the perineal body
Where is the superficial perineal pouch?
below the perineal membrane
What does the superficial perineal pouch contain in a male?
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
What does the superficial perineal pouch contain in a female?
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
When does the pelvic floor actively contract?
coughing, sneezing, vomiting
How does the pelvic floor help maintain faecal continence?
tonic contraction of puborectalis bends the anorectum anteriorly
active contraction maintains continence after rectal filling
What can cause injury to the pelvic floor?
pregnancy, childbirth (stretching, tearing, pudendal nerve damage)
chronic constipation
obesity
heavy lifting
chronic cough or sneeze
previous injury to pelvis
menopause
What is a vaginal prolapse?
herniation of urethra, bladder, rectum or rectouterine pouch through supporting fascia
urethrocele, cystocele, rectocele, enterocele
How does uterine prolapse present?
dragging sensation
feeling of a lump
urinary incontinence
What is a first degree uterine prolapse?
to upper vagina
what is a 2nd degree uterine prolapse?
to the introitus
what is a 3rd degree uterine prolapse?
cervix is outside the introitus
What is sacrospinous fixation?
sutures placed in sacrospinous ligament, just medial the ischial spine to repair cervical/vault descent
What are the risks in sacrospinous fixation?
risk of injury to pudendal NVB and sciatic nerve
What is the surgery for stress incontinence?
trans-obturator approach
mesh through obturator canal
create a sling around urethra
incisions throguh vagina and groin
