Pelvic Floor Flashcards
What are some long-term problems that women may suffer from an NVD?
- Pain
- Dyspareunia (pain during sex)
- Urinary, flatal and faecal incontinence
Why is it not good to have a face presentation?
The facial bones cannot slide over each other like the skull bones
What is used to treat chronic pelvic pain?
Peripheral nerve block
Describe the pelvic floor
- Funnel shaped
- Formed mostly of deep levator ani muscle and coccygeus muscle
- Made up of ligaments, fascia, muscles and blood vessels
Describe the muscles of the pelvic floor
Packed into the diamond shape of the pelvic outlet bordered by the SP, ischial tuberosities and the coccyx
Where is the perineum located?
- Between the thighs and buttocks
- The vagina, uretha and anal canal are enclosed within the perineum
- Urethra sits 1cm below clitoris
Name the superficial muscles of the pelvic floor
- Ischiocavernosus
- Urethral sphincter
- Bulbocavernosus
- Transverse Perinei
- Eternal anal sphincter
Name the deep muscles of the pelvic floor
- Pubococcygeus
- Iliococcygeus
- Ischiococcygeus
- Puborectalis
What is vaginismus sometimes caused by?
Spastic contraction of the Levator muscle
What are the functions of the pelvic floor?
- Supports bladder, vagina, uterus and rectum
- Maintains optimal mechanical orientation of the urethra and anorectal angle for continence
- Puborectalis important to faecal continence
- Counteracts intra-abdominal pressure
What does the pelvic floor help with?
- Process of childbirth and rotation of presenting part
- Defacation
- Sexual functioning and arousal
Describe the structure of the perineal muscle
- Perineal tissue is made up of elongated skeletal muscle made up of actin and myosin
- Attached to pelvis at SP, tuberosities, sacrum and across joints, allowing movement
Explain how the perineal muscles work
- Excitability –> Contractibility –> Extensibility –> Elasticity
- Protein collagen provides firmness and strength
- Elastin works with collagen to provide flexibility
What are the functions of the internal anal sphincter muscles?
- Involuntary smooth muscle attaches to puborectalis
- Contributes to 50-70% of resting closing pressure
- Provides an involuntary barrier to faecal leakage and is relatively inhibited during rectal distension, allowing dilation and passage of faecal mass during defacation
Describe the external anal sphincter muscle
- Constricts the anal canal and keeps the anus closed
- Primary muscle for maintaining faecal continence
Describe the blood supply to the pelvic floor
- Supplied by 2 internal iliac arteries
- Drainage by corresponding veins
Which muscles make up the perineal body
- Bulbocarvernosus
- Transverse perineal muscle
- Pubococcygeus
- Anal sphincter muscle
- Deep and superficial muscles
- All but anal sphincter are cut in an episiotomy
Why is an episiotomy never done straight down?
It would hit the anal sphincter
Describe the changes in the pelvic floor during pregnancy
- Ligaments relax due to hormones relaxin and progesterone; alters composition of connective tissue
- Smooth muscle relaxation
- As presenting part engages, uterine ligaments are displaces towards the pelvic floor, pushing the bladder towards the SP
Describe the intrapartum changes to the pelvic floor
- Resistance of the pelvic floor through muscle contraction is essential for presenting part to rotate within pelvic cavity
- Neurological feedback alters pelvic floor as labour progresses
- Stretching and thinning of perineal muscles facilitated by some muscle relaxation and contraction
How can perineal damage and morbidity be minimised in pregnancy?
Antenatal perineal massage
How can perineal damage and morbidity be minimised in labour?
- Perineal support (hands on delivery)
- Medio-lateral episiotomy at 60degree angle - less risk of tears extending to anal sphincter
- Avoid instrumental delivery
- Bi-digital and sphincter assessment post-delivery
- Use continuous non-locking subcuticular repair technique
How can perineal damage and morbidity be minimised in the puerperium?
- Audit of perineal wound healing
- Sensitivity towards sexuality and resumption of sexual intercourse
Give some techniques to help women find their pelvic floor muscles
- When emptying bladder, try to stop stream
- Imagine you are trying to avoid passing wind
- Use mirror to watch and squeeze muscles down below
How are pelvic floor exercises performed?
- Squeeze pelvic floor muscles intermittently for 10 seconds each time up to 12 times
- Complete 3 sets of exercises per day
- Tight pelvic floor prevents faecal incontinence
