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ESA 4 - Reproductive System > Pelvic Floor > Flashcards

Pelvic Floor Flashcards

1
Q

What is the pelvic floor?

A

A muscular and fibrous tissue diaphragm

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2
Q

Where is the pelvic floor?

A

It fills the lower part of the pelvic canal, and closes the abdominal cavity

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3
Q

What does the pelvic floor define?

A

The upper border of the perineum

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4
Q

What does the pelvic floor support?

A

The pelvic organs

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5
Q

What is the pelvic floor pierced by?

A
  • Urethra
  • Vagina
  • Rectum
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6
Q

How are the structures piercing the pelvic floor held closed at rest?

A

By muscle tone

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7
Q

What can the pelvic floor be split into?

A
  • Pelvic diaphragm
  • Superficial muscles and structures
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8
Q

What does the pelvic diaphragm consist of?

A

Levator ani and cocygeus, and related fascial coverings

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9
Q

What are the superficial muscles and structures of the pelvic wall?

A
  • Anterior/urogenital perineum
  • Posterior/anal perineum
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10
Q

What is the pelvic side wall made up of?

A
  • Ischium of pelvis
  • Sacrospinous and sacrotuberous ligaments
  • Obturator membrane
  • Obturator nerve
  • Obturator internus
  • Piriformis and coccygeus
  • Branches of sacral plexus
  • -Fascia (includes arcus tendineus)
  • Levator ani muscles
  • Internal iliac vessels and branches
  • Ureters
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11
Q

What happens to the fascia of the obturator internus?

A

It condenses to become the origin of the levator ani

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12
Q

What is the pelvic floor made up of?

A
  • Levator ani
  • Coccygeus
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13
Q

Where does the levator ani originate from?

A

From the posterior aspect of the pubic bone, the fascia over the obturator internus, and ischial spine

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14
Q

Where do the anterior fibres of the levator ani attach?

A

Around the prostate or vagina

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15
Q

Where do the intermediate fibres of the levator ani go?

A

Around rectum (puborectalis) and into anococcygeal body (pubococcygeus)

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16
Q

Where do the posterior fibres of the levator ani attach?

A

Anococcygeal body and coccyx (iliococcygeus)

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17
Q

What does the coccygeus lie over posteriorly?

A

The sacrospinous ligament

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18
Q

What is the pelvic floor attached to?

A

The pelvic side wall

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19
Q

Where is the pelvic floor attached to the pelvic side wall?

A

At the ischial spine and the arcus tendineus fascia pelvis

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20
Q

What is the purpose of the urogenital hiatus in the pelvic floor?

A

It allows passage of urethra, vagina, and rectum

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21
Q

What is found between the levator ani and the perineum?

A

The ischiorectal fossa

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22
Q

What is the ischiorectal fossa continuous with?

A
  • The perineal space
  • Ischiorectal fat of buttocks
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23
Q

What is the result of the ischiorectal fossa being continuous with the perineal space?

A
  • Perineal/buttock abscesses can spread, causing inflammation in the pelvis
  • Infection in the pelvis can track to the buttocks
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24
Q

What passes along the lateral wall of the ischiorectal fossa?

A

The pudendal nerve

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25
Q

Where can the subperitoneal space be seen?

A

Above the levator ani muscles, but below the peritoneum

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26
Q

What is the importance of the subperitoneal space?

A
  • It is where the uterine artery enters
  • Ureters pass through the space
  • Lymphatic drainage from the uterus and cervix leaves through here
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27
Q

What is the posterior vaginal wall associated with?

A

The rectum (lower 1/3 to the top)

28
Q

What is the anterior vaginal wall associated with?

A

The urethra and bladder

29
Q

What is the posterior fornix in contact with?

A

The peritoneal cavity

30
Q

What blood vessels run in the pelvic floor?

A
  • Branches of the anterior trunk of the internal iliac artery
  • Ovarian artery
  • Uterine artery
31
Q

What are the branches of the anterior trunk of the internal iliac artery?

A
  • Pudendal artery
  • Vaginal artery
  • Inferior rectal artery
32
Q

Where does the ovarian artery come from?

A

Directly from the abdominal aorta

33
Q

What is found above the ovarian vessels?

A

An extension of peritoneum, called the suspensory ligament/infundibulopelvic ligament, which spans between the pelvic brim and ovary

34
Q

What is the uterine artery inside?

A

The transverse cervical ligament

35
Q

Which nerve is important in the pelvic floor?

A

Pudendal nerve (S2, 3, 4)

36
Q

Where does bifurcation of the aorta occur?

A

In front of the sacral promontory

37
Q

What are the functions of the pelvic floor?

A
  • Supports pelvic organs
  • Contributes to continence
  • Contributes to process of childbirth
  • Contributes to truncal stability
38
Q

How does the pelvic floor contribute to continence?

A

Allows sphincter pressure to resist bladder pressure, thus sphincter mechanism is direct and indirect

39
Q

How does the pelvic floor contribute to the process of childbirth?

A

Pressure from the body moving down, and the shape of the pelvic floor means that they baby rotates for delivery of the shoulder

40
Q

How does the pelvic floor contribute to truncal stability?

A

Gives a muscle tone for the abdominal pressure to press against

41
Q

What do the pelvic floor muscles do at rest?

A
  • Pull urethra against pubic symphysis
  • Faecal continence, until ready to reflex where the pelvic floor then relaxes
42
Q

How do the pelvic floor muscles contribute to faecal continence when at rest?

A

They pull the anorectal flexure anteriorly (90 degrees)

43
Q

What are the main muscles of the pelvic floor?

A
  • The levator ani
  • Coccygeus
  • Ischiocavernosus
  • Bulbospongiosus
44
Q

What is the levator ani made up of?

A
  • Puborectalis
  • Pubococcygeus
  • Iliococcygeus
45
Q

Where are the ischocavernosus and bulbiospongiosus found?

A

In the anterior section of the pelvic floor

46
Q

What is the perineum?

A

A fibromuscular sheet

47
Q

What does the perineum do?

A

Closes the pelvic outlet

48
Q

What does the perineum form?

A

The lower limit of the perineal space

49
Q

Where is the perineum located?

A

Between the levator muscles and inferior skin

50
Q

What is the perineal space continuous with?

A

The ischiorectal fossa

51
Q

What is the perineum made up of?

A
  • Perineal muscles
  • Perineal body
52
Q

What is the perineal body made up of?

A
  • Urogenital diaphragm
  • Transverse perineal muscles
  • Ischiocavernosus
  • Bulbospongiosus
  • Perineal
53
Q

Where is the anterior/urogenital diaphragm?

A

It fills the gap of the pubic arch, stretching between the converging ischiopubic rami

54
Q

Describe the structure of the anterior/urogenital diaphragm

A

It is a triangular sandwich with striated muscle fibres between 2 layers of fascia (superior fascia, sphincter urethrae, inferior/superior facsia)

55
Q

What is the posterior triangle/anal perineum?

A

A triangle between the ischial tuberosities on each side, and the coccyx

56
Q

What does the anal perineum comprise?

A
  • Anus
  • Levator ani
  • Ischiorectal fossa
57
Q

Why may long distance cyclists can erectile dysfunction?

A

Because they can compress their pudendal nerves

58
Q

What is the clinical relevance of the superficial perineal pouch?

A

It is the site of collection of urine if the urethra is ruptured below the perineal membrane

59
Q

What is the perineal body>

A

The connective tissue mass in the centre of the perineum

60
Q

What does the perineal body do?

A
  • Anchors the perineal muscles and the rectum
  • Acts as a central fulcrum for pelvic support
61
Q

What does the perineal body form?

A

Part of level 3 of endopelvic fascia levels of support

62
Q

What is level 1 of endopelvic fascia support?

A

Uterus iwth its uterosacral ligament

63
Q

What is level 2 of endopelvic fascia support?

A

Fascial layers (acrus tendineus)

64
Q

What is level 3 of endopelvic fascial support?

A
  • Muscles
  • Perineal body
  • Perineal membrane
65
Q

With respect to endopelvic fascial support, what can happen in a prolapse?

A
  • Loss from level 1 - all falls down
  • Fascia on level 2 can break
  • Poor repair of perineal body, such as after childbirth, can cause prolapse
66
Q

What is the most common type of prolapse?

A

Level 3

ESA 4 - Reproductive System (31 decks)

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