Lecture 19 - The Pelvic Floor Flashcards
What are the functions of the pelvic floor?
Support the pelvic organs
Maintain Intra-abdominal pressure during coughing, vomiting, sneezing and micturition
CONTINENCE
FACILITATE CHILDBRITH
Facilitate defaecation adn micturtiion
What are the main pelvic organs the pelvic flor supports?
Vagina
Uterus
Ovaries
Bladder
Rectum
What are some structures that go through the pelvic floor?
Urethra
Vagina
Anus
What are the 3 mechanisms of support for the pelvic floor?
Suspension
Attachment
Fusion
What are the 3 ligaments important in suspension in the pelvic floor?
Cardinal ligament
Uterosacral ligaments
Round ligament
What does the cardinal ligament do?
Transverse ligament between the cervix and vagina holding them in place
What does the uterosacral ligament do?
Holds the back of the cervix and upper vagina laterally
What does the round ligament do?
Maintains the anteverted postiion of the uterus
What provides the attachment in the pelvic floor?
Arcus tendinosus fascia pelvis (THE WHITE LINE)
Endopelvic fascia
How does the endopelvic fascia run?
From lateral to medial.
Stretches like a hammock from the white line laterally to the vaginal wall medially
What fascia compresses the urethra when intraabdominal pressure increases to help matintain urinary continence?
Endopelivc fasica
What structures are fused in the pelvic floor?
Urogenital diaphragm and perineal body
What structures are fused to support the lower half of the vagina?
Endopelvic fascia to perineal body posteriorly, levator ani laterally and urethra anterioly
What structures make up the pelvic floor?
Levator ani muscles
Urogential diaphragm/perinal membrane
Perineal body
Perineal muscles
Posterior compartment
Look at the last slide:
Image 1
What are the muscles labelled 1:
Levator ani muscles
What are the 3 levator ani muscles?
Puborectalis
Pubococcygeus
Iliococcygeus
What is the origin and insertion of puborectalis?
Pubic symphysis to rectum
What is the origin and insertion of pubococcygeus?
Pubis to coccyx
What is the origin and insertion of iliococcygeus?
Ilium to coccyx
Look at the last slide at image 2
Label:
1 = sacrum
2 = ilium
3 = iliococcygeus
4 = pubococcygeus
5 = Puborectalis \
Look at slide 18 and label:
1 = piriformis
2 = Puborectalis
3 = pubococcygeus
4 = iliococcygeus
What is the next more superficial layer to the levator ani muscles?
Perineal muscles
What are the 2 most important perineal muscles?
Transverse perineal muscles
Bulbospongiosus
What is an episiotomy?
Cutting the perinum to aid birth to help ensure tearing of the perineum doesn’t occur
Go to slide 23:
Label the perineal muscles:
1 = transverse perineal muscles
2 = bulbospongiosus
What is the next more superficial layer to the perineal muscles?
Urogenital diaphragm
What is the urogenital diaphragm?
A triangular sheet of dense fibrous tissue in the anterior half of the pelvis
What is the function of the urogenital diaphragm?
Supports the pelvic floor
Atttatches medially to the urethra, vagina and perineal body
What makes up the perineal body?
Insertion point of levator ani muscles
Where is the perineal body located and what does it attach to?
Central position on pelvic floor between the vagina and rectum
Attathces posteriorly to the external anal sphincter and coccyx
Go to the last slide and label image 3:
1 = clitoris
2 = bulbospongiosus
3 = perineal body
4 = levator ani muscles
What is the blood supply and nerve supply to the pelvic floor?
Pudendal arteries and veins
Pudendal nerve
What nodes drain the lymphatics from the pelvic floor?
Inguinal lymph nodes
What are the spinal nerve roots of the pudendal nerve?
S2, S3, S4
What are the layers of the pelvic floor from deep to more superficial?
Levator ani
Perineal muscles
Urogential diaphragm
Perineal body
What is pelvic organ prolapse?
When there’s a loss of support to the uterus, bladder, colon or rectum leading to prolapse into the vagina
What can a pelvic organ prolapse cause?
Functioanl disturbances to:
-anorectal
-urinary
-sexual
What is an anterior compartment/bladder related pelvic organ prolapse called?
Cystocele
Urethrocoele (urethra)
Cystourethocoele
What structure is not supported in a middle compartment pelvic organ prolapse?
Uterus
What is the term for an entire uterus prolapse?
Procidentia
What structure prolapses in a posterior compartment pelvic organ prolapse?
Rectum
What can the rectum prolapse into in a posterior compartment pelvic Organ prolapse?
Rectovaginal space (Pouch of Douglas)
What are the causes and risk factors for pelvic organ prolapse?
Post menopausal oestrogen deficieny
Child birth
Perineal Trauma
Obesity
Connective tissue disease
Why does obesity increase risk of pelvic organ prolapse?
Increased Intra-abdominal pressure
What are some connective tissue disorders increasing risk of pelvic organ prolapse?
Marfan’s
Ehlers Danlos syndrome
How can we try and reduce the risk of pelvic organ prolapse due to child birth?
Episiotomy
Encouraging mother to not push when head not crowning
What structures are cut thorough in an episiotomy?
Bulbocavernous muscle
Transverse perineal muscle
What are the symptoms of prolapse?
Dragging sensation
Lump
Feeling of incomplete emptying of bladder
Double voiding
What causes stress incontinence?
What causes urge incontinence?
Stress = pelvic floor dysfunction
Urge = bladder dysfunction
What is femal genital mutilation? (FGM)
Partial or total removal of external female genitalia or other injury to femal genital organs
Why may FGM be carried out?
Culture
Social acceptance
Fear of social exclusion
Go to slide 54 and label the vulva:
1 = labia minora
2 = labia majora
What are some consequences of FGM?
Haemorrhage
Sepsis
Blood borne infections
Sexual difficulties
Fertility issues
Chronic
Fear of childbirth
PPH
PTSD
What is the legality of FGM?
Illegal to perform
Illegal to close back up after episiotomy
Why is the pelvic floor importnat?
Support
Continence
Aiding micturition
Defaecation
Childbirth
What is the main central structure of the pelvic floor?
Perineal body
