Pelvic Floor

Question 1

What are the functions of the pelvic floor ?

Answer 1

• support pelvic organs (vagina,uterus,ovaries,bladder,rectum)
• maintain/resist intra-abdominal pressure during coughing ,sneezing…
• facilitate defaecation and micturition
• continence
• facilitate childbirth

Question 2

How are the pelvic organs suspended (vertical support ) ?

Answer 2

Cardinal ligaments, uterosacral ligaments , round ligament , broad ligaments

Question 3

How is the vagina supported in the pelvic cavity and what mechanism prevent prolapse of vaginalis and uterus when increased intra abdominal pressure ?

Answer 3

Supported by endopelvic fascia,perineal body, levator ani muscles and perineal muscles

Directed horizontally in standing position , uterus is anteverted and flexed so increased abdo pressure cause compression of uterus agains vagina

Question 4

What is the main attachement of the endopelvic fascia ?

Answer 4

Arcus tendinosus fascia pelvis aka white line , obturator internus
To vaginal wall , urethra medially

Question 5

Why does weakness to endopelvic fascia can lead to stress urinary incontinence ?

Answer 5

Urethra lies anteriorly and above endopelvic fascia, in raised abdo pressure gets compressed against it

Question 6

What makes the pelvic floor ?

Answer 6

Endopelvic fascia
Pelvic diaphragm : levator ani , coccygeus
Urogenital diaphragm : perineal membrane
Perineal body
Perineal muscles : bulbospongiosus , superficial transverse perineal , external anal sphincter

Question 7

What are the components or the levator ani muscles ?and describe insertion

Answer 7

• puborectalis
• pubococcygeus
• Iliococcygeus

U shaped sheet from back of body of pubic bone , white line, obturator internus , ischial spines

Encircle urethra vagina,rectum

Insert on perineal body , coccyx

Question 8

Which layer lies just superficial to pelvic diaphragm ? What are the attachements?

Answer 8

Urogenital diaphragm , aka perineal membrane

From ischiopubic Ramus to urethra,vagina,perineal body

Question 9

What is the perineal body , what is its function ?

Answer 9

Fibrous ulnar mass at junction of urogenital and anal triangles
Point of insertion for pelvic diaphragm muscles and perineal muscles

Function : resist tears between vagina and external anal sphincter , support of perineal structures , against prolapse

Question 10

Name the perineal muscles

Answer 10

• bulbospongiosus
• superficial transverse perineal
• external anal sphincter
• ischiocavernous

Question 11

Which muscles are involved in an episiotomy ?

Answer 11

Superficial transverse perineal

Bulbospongiosus

Question 12

What is the blood supply to the pelvic floor ?

Answer 12

Internal and external pudendal arteries

Question 13

What is the innervation and lymphatic drainage of pelvic nerve ?

Answer 13

Pudendal nerve

Inguinal nodes

Question 14

What pelvic dysfunction can occur ?

Answer 14

Pelvic organ prolapse
Urinary incontinence
Posterior compartment pelvic floor dysfunction
Trauma

Question 15

What is pelvic organ prolapse ?

What are the consequences ?

Answer 15

Loss of support of pelvic organs , uterus,bladder,colon,or rectum , leading to prolapse of one or more of these organs into vagina

Impact on quality of life: anorectal, urinary,anorectal functional disturbances

Question 16

What are the different types of POP ?

Answer 16

Anterior compartment prolapse : cystocele, urethrocele, cystourethrocele

Middle compartment : uterine prolapse , post hysterectomy vault prolapse

Posterior compartment : rectocele, enterocele (loops of bowel in pouch of Douglas)

Question 17

What are the risk factors of pop ?

Answer 17

Age
Parity
Vaginal delivery 
Post menopausal oestrogen deficiency 
Obesity (increased intra abdominal deficiency )
Neurological 
Marfans, ehlers danlos

Question 18

What is an episiotomy ? Why ?

Answer 18

Surgical cut in the perineum to avoid uncontrolled tear that can damage the perineal body