Pelvic Floor and Endopelvic

Question 1

Given the line of gravity of the hip, what motion is the natural tendency? What bone in the pelvis softens to allow for baby birth?

Answer 1

1. Extension at hip

2. Pubis symphasis

Question 2

What is the definition of the true pelvis. What is above it and below it?

Answer 2

Literally from the pelvic floor/pelvic diaphragm/LEVATOR ANI to the pelvic brim. Above = abdomen (brim to top of the ilium). Below = perineum.

Question 3

What nerve runs through obturator canal? What does this nerve innervate? What do these muscles do?

Answer 3

1. Obturator nerve
2. Medial thigh muscles
3. Adduction of lower limb

Question 4

What muscle goes through greater sciatic foramen? What nerve? What arteries?

Answer 4

1. Piriformid
2. Sciatic nerve
3. Superior and inferior gluteal arteries

Question 5

What structures pass posterior to ischial spine?

Answer 5

Puedendal nerve and internal peudendal blood vessels

Question 6

What category of structures run directly through the pelvic floor?

Answer 6

Effluent tubes

Question 7

Urethra, vagina, and anal canal all go through pelvic floor to get to perineum. What path does peudendal nerve take?

Answer 7

In order:

1. Exit greater sciatic nerve into gluteal region
2. Wrap around ischial spine
3. Re-enter the lesser sciatic foremen (which is in perinium)

Question 8

Why does the pelvic floor contract upwards when the diaphragm contracts downwards (when you inhale)? Who is most at risk?

Answer 8

(Physics). You need a reactive force to counteract the force of the diaphragm, otherwise, the contents at the pelvic floor will escape through the outlet. Post menopausal woman….excreting urine.

Question 9

Job of endopelvic fascia

Answer 9

STATIC support for pelvic viscera. Covers pelvic walls, floor, and viscera.

Question 10

Describe cause and effects of pubocervical fascial defects.

Answer 10

Cystocele
Cause: Weakening of pubocervical fascia, leading to the urinary bladder moving posteriorly upon increased abdominal pressure and subsequent consequences:
Dyspareunia (painful sex)
Urinary tract SUI
Difficulty peeing since the ureter won’t straighten out.

Risk factors: age, obesity, hysterectomy (damage to fascia during surgery).

Determine by needing to push in vagina anteriorly

Question 11

Describe cause and effects of rectorvaginal fascial defects.

Answer 11

Rectocele
Effects: Posterior vaginal wall prolapse
Risk: multiple vaginal deliveries, age, hysterectomy
Symptoms: Pressure, dyspareunia, difficulty peeing.
Dectect by needing to push in cele posteriorly. Pushing this back in place just for patient to be able to defacate.

Question 12

Fixing urinary incontinence

Answer 12

Note that naturally, urethra wants to move backwards. This is what leading to peeing. Goal is to add new source of support.

Question 13

Where are important nerves in male prostate located?

Answer 13

Fascia surrounding the prostate….withing puboprostatic ligament. Damage to these nerves is a guaranteed loss of control in voiding.

Question 14

Uterus parietal setup = ?

Answer 14

Secondarily peritoneal (starts up submesentary then reaches peritoneal)