Pelvic Floor Flashcards
State the components forming the pelvic floor
- Levator ani
- Urogenital diaphragm
- Perineal membrane
Describe the appearance of the levator ani
- Levator ani forms the bulk of the pelvic floor
- Consists of the pubococcygeus, puborectalis and iliococcygeus muscles
- Encircles the urethra, vagina and the rectum
Describe the perineal membrane
- Thick fascial membrane which provides attachments for external genitalia
- Have holes for urethra and vagina
- Provide a point of insertion for levator ani muscles
Describe the blood and nerve supply to the muscles of the pelvic floor
- Blood supply comes from the internal and external pudendal arteries and drains through corresponding veins
- Lymphatic drainage mainly through inguinal glands
- Nerve supply from branches of pudendal nerve
Identify common causes of pelvic floor dysfunction
- Pelvic floor dysfunction is when the muscles of the pelvic floor become weak or too tight
- Stretching of the fibres during childbirth may also cause dysfunction
- Stretching of muscles, ligaments, pudendal nerve
- Disruption of perineal body
- Obesity
- Surgery near the pelvic floor area
- Lack of oestrogen - menopause, COCP
- Collagen deficiency - Marfan’s
- Steroid treatment
- Pelvic floor dysfunction includes pelvic organ prolapse and incontinence
Describe the different types of pelvic organ prolapse
- Refers to loss of support for the uterus, bladder, colon or rectum, leading to prolapse into the vagina
- Anterior compartment prolapse - bladder compresses vagina
- Middle compartment prolapse - uterus may prolapse and fall through vagina
- Posterior compartment prolapse - rectum or loops of bowel may prolapse into vagina
State the risk factors of pelvic organ prolapse
- Age
- Vaginal delivery - 4x increased risk after first child, 11x increase after > 4 deliveries
- Postmenopausal oestrogen deficiency
- Obesity
- Genetic connective tissue disorders - Marfan’s, Ehlers Danlos
Describe the symptoms of a pelvic organ prolapse
- Feel a lump
- Feels like sitting on a ball
- For rectal prolapse - feeling of having full bowels and anal pain
Describe what an episiotomy is
Incision of the perineum to increase vaginal opening and aid childbirth
State the complications of a pelvic floor injury
Complications include haemorrhage, extension of the anal sphincters, infection, perineal pain, dyspareunia
Describe the types of female genital mutilation
- Type 1 - partial or total removal of the clitoris (clitoridectomy)
- Type 2 - partial or total removal of the clitoris and the labia minora
- Type 3 - narrowing of the vaginal orifice by sealing it off
- Type 4 - other harmful procedures to the female genitalia for non-medical purposes
Outline the legal requirements for recording and reporting FGM
- Female genital mutilation must be reported for women under 18
- Requires identification and put into database
List the acute consequences of FGM
- Haemorrhage
- Severe pain - performed with no anesthesia
- Genital swelling
- Acute urinary retention
- Shock
- Death
List the chronic consequences of FGM
- Urinary problems - painful urination, UTI
- Vaginal problems - discharge, itching
- Menstrual problems - painful, difficulty in passing blood
- Scar tissue and keloid
- Sexual difficulties
- Chronic pain
- Urinary outflow obstruction
What is the importance of the perineal body
Central point of attachment for perineal musculature and important in supporting the pelvic organs
