Pelvic Floor and Perineum Flashcards
What is the pelvic floor?
Muscular and fibrous diaphragm Fills lower part of pelvic canal Closes the abdo cavity Defines upper border of perineum Supports pelvic organs
What pierces the pelvic floor?
Urethra
Vagina
Rectum
What is the approximate sub-pubic arch angle of females and males?
Females = >90 Males = <90
What does the ischial spine separate?
Greater and lesser sciatic notches
Describe a pudendal nerve block
Locate ischial spine for insertion of needle
Pain relief during childbirth
What are the 3 parts of the levator ani?
Puborectalis
Pubococcygeus
Iliococcygeus
Which viscera are associated with anterior vaginal wall?
Urethra
Bladder
What is the perineal body?
Condensation of CT - irregular and fibromuscular
Point of attachment for muscles of pelvic floor and perineum
At junction between 2 triangles
Lies just deep to skin
Which ligament helps to create the greater and lesser sciatic foramen?
Sacrospinous lig
What is the perineum?
Fibromuscular sheet with closes the pelvic outlet
Lower limit of perineal space
How do we divide the perineum?
Anterior (urogenital) and posterior (anal) triangle
What is the role of bulbospongiosus in females and males?
Female - muscle tone for perineum and vaginal opening
Male - maintaining an erection
Why is a midline tear in childbirth dangerous?
Endangers the anal sphincter
Faecal incontinence
What type of episiotomy is favoured in the UK?
Mediolateral
Give some risk factors for prolapse
Childbirth Age Menopause Obesity Chronic cough CT laxity
Where is the theoretical line that can divide the perineum?
Between the ischial tuberosities
What is found in the anal triangle?
Anal aperture
External anal sphincter
2 ischioanal fossa
What are the ischioanal fossa?
Spaces lateral to the anus
Contain fat and CT
Aid expansion of anal canal
What is found in the urogenital triangle?
External genitalia
Urethra
The perineal membrane only occurs which part of the perineum?
Urogenital (anterior) triangle
What are the layers of the urogenital triangle, deep to superficial?
Deep perineal pouch Perineal membrane Superficial perineal pouch Deep perineal fascia Superficial perineal fascia Skin
What is the deep perineal pouch and what does it contain?
Potential space between the pelvic floor and the perineal membrane
Contains part of urethra and external urethral sphincter
Males: (also contains) bulbourethral glands and deep transverse perineal muscles
What is the role of the perineal membrane?
Provides attachments for muscles of superficial external genitalia
Helps support pelvic viscera
What is the superficial perineal pouch and what does it contain?
Potential space between perineal membrane and perineal fascia
Contains erectile tissue of penis and clitoris
Contains 3 muscles: ischiocavernosus, bulbospongiosus and superficial transverse perineal
And contains Bartholin’s glands
