L3: clinical anatomy of the pelvic floor

Question 1

List the functions of the pelvic floor

Answer 1

Support
Continence
Intra-abdominal pressure (maintaining a high pressure)
Childbirth

Question 2

Describe the three levels of support by the pelvic floor

Answer 2

1) Suspension – maintains an anti-gravity position by providing strong vertical support (cardinal ligaments & uterosacral ligaments)
2) Attachment – support that comes from attachments on the pelvic floor
3) Support that arises from fusion of different tissues

Question 3

Describe the deep muscles of the pelvic floor

Answer 3

Made up predominately by the levator ani muscles
U-shaped set of muscles that act like a sling, to encircle the urethra, vagina & rectum and provide support for these organs
1) Pubococcygeus
2) Puborectalis
3) Iliococcygeus
Midpoint of these attachments is the perineal body

Question 4

Describe the superficial muscles of the pelvic floor

Answer 4

1) Bulbospongiosus
2) Ischiocavernosus
3) Superficial transverse perineal
Bulbospongiosus and transverse perineal muscles can undergo iatrogenic damage during medio-lateral episiotomy in childbirth -> done to avoid damage to the perineal body (integral role in pelvic floor support as a site of attachment)

Question 5

Describe the perineal body and urogenital diaphragm

Answer 5

Perineal body – central point between the vagina and rectum
-main function: act as a site of attachment for pelvic floor muscles & other structures that provide support for the pelvic floor
Urogenital diaphragm – sheet of dense of fibrous tissue that spans the anterior half of the pelvic floor (attaches to the urethra, vagina and perineal body)
Innervation: pudendal nerve

Question 6

What are the different types of pelvic organ prolapse?

Answer 6

Anterior compartment – relates to bladder and/or urethra
-cystoceole: bladder
-urethrocoele: urethra
-cystourethrocoele: both
Middle compartment – uterus prolapsing into the vagina
Posterior compartment – relates to bowel or surrounding structures
-rectocoele: rectum
-enterocoele: loops of bowel involved entering the rectouterine pouch

Question 7

What can dysfunction of the pelvic floor result in?

Answer 7

Dysfunction of the pelvic floor typically results in stress incontinence
-increased abdominal pressure causes ‘leaks’ of urine: support to the urethral sphincter is inadequate

Question 8

Describe the causes and risk factors of pelvic organ prolapse

Answer 8

Age
Parity 
Mode of delivery (particularly vaginal delivery) 
Oestrogen deficiency
Chronic increased abdominal pressure

Question 9

What is female genital mutilation?

Answer 9

Cultural practice of damaging the female external genitalia
Significant consequences -> severe pain, potential sepsis or haemorrhage
Illegal in the UK (needs to be reported & is a safeguarding issue if the girl is <18 years old)

Question 10

Describe a medio-lateral episiotomy

Answer 10

Procedure done if baby is large, there is difficult delivery or using instruments such as forceps during a delivery
Bulbospongiosus and transverse perineal muscles can undergo iatrogenic damage
Done to avoid damage to the perineal body because of its integral role in providing pelvic floor support as a site of attachment

Question 11

List complications of a medio-lateral episiotomy

Answer 11

Infection
Haemorrhage
Dyspareunia
Damage to the anal sphincter