Pelvic Floor

Question 1

What are the boundaries of the false pelvis, true pelvis and perineum?

And pelvic floor

Answer 1

False pelvis - pelvic brim to iliac crest

True pelvis - above the pelvic floor to the pelvic brim - (because the brim from the lateral side is diagonal, the greater sciatic foramen is included)

Pelvic floor runs diagonallly from body of pubis to the ischial spine.

Perineum - under the pelvic floor (lesser sciatic foramen)

Question 2

What is the purpose of the pelvic diaphragm?

What runs directly through it?

Answer 2

It supports the pelvic viscera.

It has sphincteric control over visceral functions:
Females 
-bladder - urethra - urine 
-uterus - vagina - baby
-rectum - anal canal - fecal matter 

Responds to changes in intra-abdominal pressure - when you cough or sneeze, you thoracic diaphragm is lowering and increasing pressure on the abdominal cavity and pelvic floor. This puts pressure on forcing the crap out of the body.

The pelvic floor will contract and shorten acting as a sphincter and countering the increased pressure.

Question 3

What is the only muscle of the levator ani which attaches to the tendinous arch do we need to know?

Answer 3

Puborectalis.

Question 4

What are the members of the pelvic fascia?

Answer 4

Endopelvic fascia attaches bilaterally to the white lines

Two fascia sheets:

1. Pubocervical: divides the bladder and anterior wall of the vagina
2. Rectovaginal: divides the posterior wall of the vagina and the anterior wall of the rectum

Two ligaments:
1. Uterosacral ligament
2. Cardinal ligament (transverse cervical)
Support the uterus

Question 5

What is going on during stress urinary incontinence?

Answer 5

The pubocervical fascia acts like a sling for the urethra. Normally increased intraabdominal pressure will force the urethra against the sling and keep it closed.

If the pubocervical fascia is torn on one side, then the urethra will roll posterior towards to torn side and keep it open during increased intra-abdominal pressure.

A remedy is an artificially introduced urethral sling.

Question 6

What is a cystocele?

What is a rectocele?

How does one tell the difference?

Answer 6

Cystocele is when the bladder is moving posteriorly and there is weakness or lack of a pubocervical fascia.

The bladder is actually pushing the anterior wall of the vaginal canal out the vaginal opening.

Rectocele occurs when the rectum is moving anteriorly, pushing the posterior wall of the vaginal canal out of the opening.

To tell the two apart, push the hernia up or down. If it retracts when pushed upwards its a cystocele.