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Scientific Basis of Midwifery > Pelvic Floor > Flashcards

Pelvic Floor Flashcards

1
Q

What are some long-term problems that women may suffer from an NVD?

A
  • Pain
  • Dyspareunia (pain during sex)
  • Urinary, flatal and faecal incontinence
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2
Q

Why is it not good to have a face presentation?

A

The facial bones cannot slide over each other like the skull bones

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3
Q

What is used to treat chronic pelvic pain?

A

Peripheral nerve block

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4
Q

Describe the pelvic floor

A
  • Funnel shaped
  • Formed mostly of deep levator ani muscle and coccygeus muscle
  • Made up of ligaments, fascia, muscles and blood vessels
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5
Q

Describe the muscles of the pelvic floor

A

Packed into the diamond shape of the pelvic outlet bordered by the SP, ischial tuberosities and the coccyx

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6
Q

Where is the perineum located?

A
  • Between the thighs and buttocks
  • The vagina, uretha and anal canal are enclosed within the perineum
  • Urethra sits 1cm below clitoris
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7
Q

Name the superficial muscles of the pelvic floor

A
  1. Ischiocavernosus
  2. Urethral sphincter
  3. Bulbocavernosus
  4. Transverse Perinei
  5. Eternal anal sphincter
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8
Q

Name the deep muscles of the pelvic floor

A
  1. Pubococcygeus
  2. Iliococcygeus
  3. Ischiococcygeus
  4. Puborectalis
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9
Q

What is vaginismus sometimes caused by?

A

Spastic contraction of the Levator muscle

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10
Q

What are the functions of the pelvic floor?

A
  • 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
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11
Q

What does the pelvic floor help with?

A
  • Process of childbirth and rotation of presenting part
  • Defacation
  • Sexual functioning and arousal
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12
Q

Describe the structure of the perineal muscle

A
  • 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
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13
Q

Explain how the perineal muscles work

A
  • Excitability –> Contractibility –> Extensibility –> Elasticity
  • Protein collagen provides firmness and strength
  • Elastin works with collagen to provide flexibility
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14
Q

What are the functions of the internal anal sphincter muscles?

A
  • 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
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15
Q

Describe the external anal sphincter muscle

A
  • Constricts the anal canal and keeps the anus closed

- Primary muscle for maintaining faecal continence

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16
Q

Describe the blood supply to the pelvic floor

A
  • Supplied by 2 internal iliac arteries

- Drainage by corresponding veins

17
Q

Which muscles make up the perineal body

A
  • Bulbocarvernosus
  • Transverse perineal muscle
  • Pubococcygeus
  • Anal sphincter muscle
  • Deep and superficial muscles
  • All but anal sphincter are cut in an episiotomy
18
Q

Why is an episiotomy never done straight down?

A

It would hit the anal sphincter

19
Q

Describe the changes in the pelvic floor during pregnancy

A
  • 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
20
Q

Describe the intrapartum changes to the pelvic floor

A
  • 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
21
Q

How can perineal damage and morbidity be minimised in pregnancy?

A

Antenatal perineal massage

22
Q

How can perineal damage and morbidity be minimised in labour?

A
  • 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
23
Q

How can perineal damage and morbidity be minimised in the puerperium?

A
  • Audit of perineal wound healing

- Sensitivity towards sexuality and resumption of sexual intercourse

24
Q

Give some techniques to help women find their pelvic floor muscles

A
  • When emptying bladder, try to stop stream
  • Imagine you are trying to avoid passing wind
  • Use mirror to watch and squeeze muscles down below
25
Q

How are pelvic floor exercises performed?

A
  • 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

Scientific Basis of Midwifery (22 decks)

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