Pelvic Floor Flashcards
What is the main function of the pelvic floor?
To support the pelvic organs (Vagina, uterus, bladder, ovaries and rectum)
Describe the 3 levels of support of the pelvic organs
- Support:
- Strong vertical, anti-gravity support mainly from Cardinal, Uterosacral and Round ligaments - Attachment;
- Support coming from attachments on the pelvic organs
- (E.g vagina supported by its attachment to Endopelvic Fascia, Levator Ani muscles and Perineal Body) - Fusion;
- Support that arises from fusion of different tissues
- (E.g Perineal body and Urogenital Diaphragm)
Other than support list 4 functions of pelvic floor
- Maitain Intra-abdominal pressure (during sneezing/ coughing/ laughing)
- Facilitate defecation and micturition
- Maintain unitary and faecal continence
- Faciltiate childbirth
The Pelvic floor is composed of 3 Deep and 3 Superficial muscles
Describe the arrangement and name the 3 DEEP muscles
- These 3 muscles make up the Levator Ani muscles
- U shaped muscles, act like a sing
- Pubococcygeus
- Puborectalis
- Iliococcygeus
What structures are encircled and supported by the Deep Pelvic Floor Muscles/ Levator Ani Muscles
- Urethra
- Vagina
- Rectum
What is the midpoint of the attachments of the Levator Ani muscles
Perineal body
What are the 3 superficial muscles of the pelvic floor?
Are they found in men or women?
- Ischiocavernous
- Bulbospongiosus (More medial)
- Superficial transverse perineal muscle
Both genders
Which 2 muscles can undergo Iatrogenic damage during medio-lateral epitostomy in childbirth?
Why is this done?
Bulbospongiosus and transverse perineal muscles
To avoid damage to perineal body
What are 3 occasions an epitostomy is done?
Why is one of these done?
- Large baby
- Difficult delivery
- Using instruments such as forceps during delivery
To prevent perineal body damage
List 4 complications of an Epiostomy
- Infection
- Haemorrhage
- Damage to anal sphincter
- Dyspareunia (Recurring pain in pelvis/ genital region before/ during/ after sexual intercourse)
What is the central point between vagina and rectum?
Its main function is?
What is it attached to posteriorly?
Perineal body, acts as site of attachment for pelvic floor muscles
Posteriorly attached to External Anal Sphincter
What is the Urogenital Diaphragm?
Name 3 things it attaches to
A dense sheet of fibrous tissue that spans the anterior half of the pelvic floor.
- Urethra
- Vagina
- Perineal body
Name the blood supply, lymphatic drainage and innervation to the pelvic floor muscles
Blood:
- Internal and external pudendal arteries and veins
Lymph:
- Inguinal nodes
Innervation:
- Pudendal nerve
List 4 examples of Pelvic Floor Dysunction
- Pelvic organ prolapse
- Urinary incontinence (Stress incontinence to be exact)
- Female genial mutilation
- Vaginismus
What is pelvic organ prolapse?
What are 5 ways it affects quality of life?
Prolapse of Uterus/ Bladder/ Colon (possibly into vagina) due to loss of support
- Altered sense of body image leading to depressive symptoms
- Source of pain/ infection
Disturbance to;
- Anorectal functiom
- Urinary function
- Sexual function
Pelvic organ prolapse can be classified by compartment that prolapse has occurred in and the organ that has prolapsed
What are the 3 possible compartment in can occur in?
- Anterior
- Middle
- Posterior
What are 3 types of Anterior Compartment Pelvic Organ Prolpase
- Cystocoele: Bladder prolapses
- Urethrocoele: Urethra prolpases
- Cysourethrocoele: Both prolapse
Describe Middle Compartment Pelvic Organ Prolpase
Uterus prolpases into vagina to various degrees
List 2 types of Posterior Compartment Pelvic Organ Prolpase
- Rectocoele: Rectum prolpase
- Enterocoele: Loops of bowel entering Rectouterine pouch
List 7 risk factors of pelvic organ prolapse
- Age
- Parity (No. of pregnancies resulting in childbirth)
- Vaginal delivery
- Obesity
- Chronic raised intra abdominal pressure
- Oestrogen deficiency
- CT/ Neurological disorders
How will a patient with Pelvic Organ Prolpase present?
- Will feel a ‘lump’/ something ‘coming down’
- Possibly symptoms related to where prolapse occurs
List some management plans for patient with Pelvic Organ Prolpase
(Remember prolpases can occur)
Non surgical;
- Insertion of Pessaries to provide additional support
Surgical;
- Removal of uterus
- Use of mesh support in a vault prolpase
What is a vault prolpase
Prolapse of apex of vagina
Can occur after a hysterectomy, as ligaments have to be cut
Describe stress inctoninence in pelvic floor dysfunction
Raised intra abdominal pressure causes leaks of urine as support to urethral sphincter is inadequate
What are the risk factors for stress incontinence?
Same as those for Pelvic Organ Prolpase, ESPECIALLY Age and Oestrogen Deficiency
POP RFs:
- Age
- Parity (No. of pregnancies resulting in childbirth)
- Vaginal delivery
- Obesity
- Chronic raised intra abdominal pressure
- Oestrogen deficiency
- CT/ Neurological disorders
What are some symptoms of stress incontinence?
Passing urine on;
- Coughing
- Laughing
- Other activities than increase abdominal pressure (sneezing)
What are 2 methods of management of stress incontinence/
- Pelvic floor muscle training (1st Line)
- Surgical intervention to create slings to support urethral sphincter
What is Vulval pain often related to?
Tension of Levator ani muscles
What are 3 Acute consequences of FGM?
- Pain
- Sepsis
- Haemorrhage
What are 5 Chronic consequences of FGM?
- Psychological effects/ trauma
- Sexual dysfunction
- Difficulty conceiving/ fertility issues
- Chronic pain
- Menstrual disorders
What are 2 examples of posterior compartment pelvic floor dysfunction?
- Constipation/ incomplete evacuation
- Anal inctoninence due to anal sphincter injury
(Anal sphincter is attached to Levator Ani muscles, so any damage can lead to loss voluntary control of defecation)
