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
State the important muscles of the deep and superficial perineal muscles
- Deep layer of perineal muscles
- Compressor urethrae and external urethral sphincter
- Deep transverse perineal
- Superficial layer of perineal muscles
- Muscles of superficial perineal pouch - bulbospongiosus and ischiocavernosus important in ejaculation
- External anal sphincter
What is the main function of pelvic organ muscles
- Continence - pelvic floor muscles ensure that the bladder and rectum are correctly supported
- Maintain anorectal flexure
- Pelvic organ support
