Pelvic Floor

Question 1

What is the purpose of the pelvic floor?

Answer 1

Support contents of pelvic cavity
Micturition
Defecation
Sexual intercourse
Supports the weight of the uterus in pregnancy
Directs movements and rotation of the fetus in labour

Question 2

Where is the pelvic floor?

Answer 2

Extends from symphysis pubis to the sacrum and between lateral walls of pelvis and across pelvic outlet

Question 3

Outline the deep muscle layer

Answer 3

Most important layer in terms of physiology of the bladder, vagina, texture and uterus.
Collectively deep muscles known as the Levator ani muscles.
Attached anteriorly to the pubic bone, laterally to the ischial spines, posteriorly to the coccyx and sacrum.
3 groups of muscles:
Pubococcygeus
Iliococcygeus
Ischiococcygeus

Question 4

Outline the pubococcygeus muscles

Answer 4

Muscles extend from the inner aspect of the pubic bone to the coccyx.
3 bands- surround urethra, vagina, anus
Crossing fibres at the perineum

Question 5

Outline the iliococcygeus

Answer 5

Extend from the inner aspect of the iliac bone and fibres from each side meet in the midline in the perineum before extending to the coccyx

Question 6

Outline the Ischiococcygeus

Answer 6

Arise from ischial spine and pass to lower sacrum and upper coccyx
Help support joints of the pelvis

Question 7

Outline the superficial muscle layer

Answer 7

Much smaller than Levator ani

Vitally important in maintaining the overall strength of the pelvis

Question 8

What are the external urethral and anal sphincters?

Answer 8

Anal sphincter surrounds anal orifice some fibres extending to perineal body to attach to the coccyx.
External sphincter of the urethra- arises and embed in the pubic bone having passed above and below the urethra.
Control defecation and micturition

Question 9

What is the perineal body?

Answer 9

The muscles and connective tissue situated between the vaginal and rectal canals
Most likely to be damaged in childbirth
A lot of the pelvic floor muscles join here.

Question 10

What does the perineal body consist of?

Answer 10

Layer of skin at base
Bulbocavernosus and transverse perinei of superficial muscles
Pubococcygeus of deep muscles

Question 11

What is the function of the perineal body?

Answer 11

Assist in birth process
Assist in defeacation
May become torn in childbirth

Question 12

How does the pelvic floor change in pregnancy?

Answer 12

Relaxed due to relaxin hormone

This aids birth however may cause incontinence at later stages in pregnancy

Question 13

How does the pelvic floor change in labour?

Answer 13

Muscles of the pelvis floor will aid the expulsive action of the birth canal
All tissues in the birth canal become distended
Rectum and pelvic floor pushed downward and outwards

Question 14

What is a first degree tear?

Answer 14

Minor damage involving the fourchette and perineal skin

Question 15

What is a second degree tear?

Answer 15

Involves fourchette and muscles of pelvic floor

Question 16

What is a third degree tear?

Answer 16

Involving the external anal sphincter as well as the structures of a second degree tear

Question 17

What is an episiotomy?

Answer 17

Surgical incision into perineum before delivery to aid the birth of the fetus
Incision of the fourchette,mother skin of the perineum, the posterior vaginal wall and superficial muscles of the pelvic floor.
Mediolateral - 45 degree angle from the anus and ischial tuberosities. Associated with smaller blood loss and easier to repair