Pelvic Floor Lecture 2 Flashcards
Describe the alignment of the ASIS with the pubic bone for women and men
for men its inline and for women the pelvis is slightly tilted forward
Lots of sacral sitting may cause what
weak pelvic floor muscles because they are not working against gravity
What does the angle of the spine in the sacral region do to the pelvic area?
condenses/pushes it in
Perineum
surface region in both males and females between the pubic sympyhsis and coccyx
What 2 triangles make up the perineum?
urogential and anal
List the *anatomical borders of the perinuem
anterior - pubic symphysis
inferior border - tip of coccyx
lateral border - ischiopubic rami and sacrotuberous ligament
Perineal body runs unbetween triangles
List the *surface borders of the perinuem
anterior - mons pubis
inferior - intergluteal cleft
lateral - medial surface of thigh
What structures lies directly under the lateral border of the perineum?
Ischiocavernosis lies directly under the ischiopubic ramus/ST ligament
What 3 branches does the pudendal nerve split into?
rectal
dorsal
perineal
Pudendal neuralgia is
pain with sitting because the nerve stretches
What is the inguinal canal
passage way from the abdominal cavity though the anterior abdominal wall, formed by the folds of the external obliques aponeurosis
Contains the inguinal ring
What are the contents of the inguinal canal?
MALES - spermatic cord
FEMALES - round ligament of the uterus
Inguinal nerve
blood and lymph vessels
Inguinal ligament attachments
fibrous band from ASIS to puberic tubercle
Sacroiliac joint type
synovial
Pubic symphysis joint type
fibrocartilaginous disc between pubic bones
Sacrococcygeal joint
cartilaginous
symphysis
Know the location of the anterior longitudinal ligament, iliolumbar ligament, sacroiliac ligament, sacrospinous and sacrotuberous ligament
What are the borders of the pelvic inlet?
anterior - pubic symphysis
posterior - sacral promontory and sacral wings/ala
lateral - arcuate line on the inner surface of the ilium and the pectineal line on the superior pubic ramus
Borders of the pelvic outlet
Anterior - pubic arch (inferior border of ischiopubic rami)
Posterior - tip of coccyx
lateral - ischial tuberosities and margin of ST ligament
Describe the differences between the male and female pelvis
male is more heart shaped and female more of a wider circle
males is heavier
males sacral promontory more prominent and have a more narrow pubic arch
males have ischial spines more medially
What msucles make up the 1 layer of the pelvic floor
ishiocavernosus
bulbospongiosus
superficial transverse perineum
What two muscles does the perineal body connect
bulbospongiosus and external anal sphincter
Layer 2 of the pelvic floor
urogenital diaphragm - the middle muscle layer
external urethral sphincter deep
transverse perineal muscle
compressor urethrae
Whats the main function of the second layer of the pelvic floor?
stop flow of urine
What muscle makes up the walls of the bladder?
Detrusor
What feature of the male reproductive system helps with leakage?
prostate gland helps close urethra
sits on top of pelvic floor
Layer 3 of pelvic floor
levator ani:
puborectalis
pubococcygeus
iliococcygeus
coccygeus
(walls = obturator internus and piriformis)
Which of the leavator ani muscles does not connect to the coccyx or sacrum?
puborectalis
Coccygeus attachments (what structure does it follow?)
ischial spine to coccyx, follows sacrospinous muscle below it
Layer 3 walls
obturator internus and piriformis
piriformis coming off of sacrum in the back
obturator internal more on the lateral anterior side (obturator foramen)
What layer is referred to as the pelvic diaphragm?
the second layer
If your levator ani muscles are tight, what issues might you have at the hip?
Levator ani is connected via tissue to the obturator internus, so a tight levator ani would pull on your obturator internus (pull inwards), which connects to the greater trochanter of the femur and can medially rotate the femur
What muscle keeps the rectum at 90 degrees, preventing you from pooping without squating?
puborectalis - wraps around rectum and connects to pubic bone
The internal and external anal sphincter muscles are ___
connected via smooth muscle
What spinal levels does the sensory innervation of the pelvis span?
T12-S4
pudendal nerve entrapment
pudendal canal!
Who is the pudendal nerves travel buddy
pudendal artery - you can feel pulse
What artery supplies most of the pelvis? List the arterial supply
internal iliac artery anterior trunk
obturator artery
inferior gluteal artery
internal pudendal artery
(posterior trunk - superior gluteal)
Functions of the pelvic floor
support
sphincter
sexual
stability
blow and lymph pump
When you contract the pelvic floor the perineal body goes
up
What muscle often co-contracts with the pelvic floor?
transverse abdominis
How often should you pee a day? What about poop?
4-8x pee
1-2/day or every other day or 3 times a day - 3/week is normal range
What are common overactive urinary issues?
frequency, urgency and nocturia
may not be a weakness issue always but may need coordination of the muscles
sometimes tight pelvic floor causes urgency - C-section scar near bladder can contribute to this
Stress incontinence
leakage of urine with increased intra-abdominal pressure (cough, sneeze, laugh, exercise, sit to stand)
pregnancy
Urge incontinence
leakage associated with a strong urge often on the way to the bathroom
OAB is urgency and frequency without leakage
mixed incontinence
combo, usually one predominant
overflow incontinence
leakage from full baldder, urge to go missed or blockage to urethra
functional incontinence
patient with mobility issues preventing getting to the bathroom in time
What are some negative affects of consitpation?
pushes on bladder - urinary incontence
full colon - back pain
pelvic floor prolapse
condition in which one or more of the pelvic organs (bladder, uterus, rectum, small intestine) descend or bulge into the vaginal canal due to weakness or damage to the pelvic floor muscles
What are some postural changes that occur during pregnancy?
COG shifts anteriorly
increase lumbar lordosis
anterior pelvic tilt
posterior head position
What are some cardiovascular changes with pregnancy?
increased CO
decreased blood pressure
increased fluid volume
What are some respiratory changes with pregnancy?
increased tidal volume
decreased total lung capacity
dyspnea
What degree of perineal tears can contribute to fecal incontinence?
3rd or 4th
In a C section, muscles are not ___
sewn back together
What is diastasis recti?
separation of rectus abdominis (in middle)
c-section or weak pelvic floor can cause
you will see midline budging
What can endometriosis contribute to
urinary or bowel dysfunction or pain with urination and bowel movements
