Pelvic Floor Flashcards
What are the functions of the pelvic floor
Support pelvic organs
Maintain intra-abdominal pressure
Facilitate defaecation and micturition
Maintain urinary and faecal continence
Facilitate childbirth
Name and describe how support of the pelvic organs is maintained
Suspension - vertical support working against gravity. Cardinal, uterosacral and round ligaments help keep pelvic organs in right place
Attachment - arcus tendinosus fascia pelvis and endopelvic fascia serve as attachment points for muscles and ligaments
Fusion - fusion at urogential diaphragm and perineal body helps to support pelvic organs
What forms the pelvic floor
Levator ani muscles
Urogential diaphragm/perineal membrane
Perineal body
Perineal muscles
Posterior compartment
Describe the levator ani muscles
These muscles form a sheet that stretches backwards and inwards from either side of pelvis to meet in midline
Muscles originate from back of pubic bone, white line over obturator internus and medial aspect of ischial spines
Where do fibres of levator ani muscles insert
Some insert into urethra
Some insert into vagina
Some insert into rectum
Some insert into lower coccyx and anococcygeal raphe
Fibres inserting into urethra and vagina help form perineal body
Which muscles form the levator ani
Pubococcygeus
Puborectalis
Iliococcygeus
What are the perineal muscles and which are the two to note
Layer of muscles superficial to levator ani
Most commonly involved in perineal trauma
Two to note are:
Transverse perineal muscles - superifical and deep
Bulbospongiosus
What is the urogential diaphragm
Triangular sheet of dense fibrous tissue that spans anterior half of pelvic outlet
Arises from inferior ischiopubic ramus -> attaches medially to urethra, vagina and perineal body
Describe the perineal body
Central point of insertion of levator ani muscles
Attached posteriorly to external anal sphincter and coccyx
Supports perineal structures
What is the blood supply, innervation, venous and lymphatic drainage of the pelvic floor
Blood supply - internal and external pudendal arteries and veins
Lymphatic drainage - inguinal lymph nodes
Innervation - pudendal nerve
What are the types of pelvic floor dysfunction
Pelvic floor prolapse
Incontinence
Posteiror compartment pelvic floor dysfunction
FGM
Vaginisums
Vulval pain syndrome
What is vulval pain syndrome
Where patient experiences pain without having any obvious findings on examination
Describe POP
Loss of support for uterus, bladder, colon or rectum leading to prolapse of one or more of these organs into the vagina
Has an anatomical, functional and mental impact on patient
Classified as either: cystocele, middle compartment or rectocele - can have post-hysterectomy vault prolapse
What are the symptoms of a POP
Feeling of fullness/pressure in pelvis
Feeling of incomplete empyting of bladder/bowel
Repeated bladder infections
Pain/urinary leakage during coitus
Vaginal bleeding or discharge
Urinary incontinence
Rectal pressure/fullness
Difficulty with bowel movements
What risk factors are assocaited with POP
Age - wear and tear on pelvic floor muscles
Parity - increases risk, espically vaginal delivery
Obesity and other causes of chronically raised intra-abdominal pressure
Neurological
Genetic CT disorders
Post-menopausal oestrogen deficiency
How is POP managed
Non-surgical management - pessaries. Used before surgery or if patient cannot undergo surgery
Surgical management - definitive treatment but risk of recurrence and complications. E.g. anterior/posterior repair, vaginal hysterectomy
What are obstetric anal sphincter injuries, what they can cause and how can they be prevented
Perianal tears involving anal sphincter complex
Can result in significant morbidity - incontinence
Can be prevented during childbirth by performing a episiotomy, perinel portection at crowning and encourage mother not to push when head is crowning
What is an episiotomy
Where a cut is made through the bulbospongiosus and transverse perineal muscles to give the baby more room during childbirth and prevent damage to the perineal body
Describe the type of urinary incontinence that occurs due to pelvic floor dysfucntion and how it is treated
Stress urinary incontinence is caused by pelvic floor dysfunction as there is an inability of the external urethral sphincter to close -> increased pressure on bladder allows urine to flow
Management is through pelvic floor exercises -> surgical treatment if symptoms persist - colpususpension
What is female genital mutilation
All procedures involving partial or total removal or external female genitalia or other injury to the female gential organs, whether for cultural or other non-therapeutic reasons
What are the types of FGM
- Partial or total removal of clitoris or prepuce
- Partial or total removal of clitoris and labia minor, with or without excision of labia majora
- Narrowing of vaginal orifice with creation of a covering seal by cutting and appositioning labia minora and/or labia majora, with or without excision of clitoris
- All other harmful procedures to female genitalia for non-medical purposes
What are the consequences of FGM
Acute - haemorrhage, shock, infection, sepsis, death
Late - sexual difficulties, relationship issues, fertility issues, chronic pain, PTSD, urinary outflow obstruction, difficult cytological screening, dysmenorrhoea
Obstetric - fear of childbirth, increased chance of C/S, post-partum haemorrhage
Psychological - trust issues, flashbacks, feeling betrayed, anger issues, sense of shame
Describe the presentation and causes of posterior compartment pelvic floor dysfunctoin
Presentation: vaginal/rectal bulge, constipation, incomplete evacuation, dyssynergic defaecation, anal incontinence
Causes: structural, drugs, dehydration, immobility, pregnancy, pos-operative pain
