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General Anatomy > Pelvic floor muscles > Flashcards

Pelvic floor muscles Flashcards

1
Q

How is the pelvic floor formed

A

Formed by the bowl/funnel shaped pelvic diaphragm

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2
Q

What is the pelvic diaphragm made up of

A

Coccygeus
Levator ani muscles
Fascias covering the superior and inferior aspect of these muscles

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3
Q

Where is the pelvic diaphragm

A

It lies within the lesser pelvis, separating the pelvic cavity from the perineum
Pelvic diaphragm stretches between the anterior, lateral and posterior walls of the lesser pelvis, giving it the appearance of the hammock suspended from these attachments, closing much of the ring of the pelvic girdle

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4
Q

What are the muscles of levator ani

A

Pubococcygeus
Puborectalis
Iliococcygeus
Levator ani forms a dynamic floor for supporting the abdominal viscera

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5
Q

What is the proximal and distal attachments, nerve innervation and function of pubococcygeus

A

Dorsal surface of pubis and fascia of obturator internus
Annococcygeal body between tip of coccyx and the anal canal and sacrum
Function: elevation of pelvic floor
Nerve Innervation: nerve to levator ani (branches of S4), inferior rectal nerve (from pudendal nerver S3,S4), coccygeal plexus

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6
Q

What is the proximal and distal attachments, nerve innervation and function of puborectalis

A

Dorsal surface of pubis and fasica of obturator internus
Same as pubococcygeus–>unites with it to make a ‘U’ shaped sling around the rectum
Function: controls defecation by pulling anorectal junction forward, which aids in contraction of the anal sphincter
Nerve Innervation: nerve to levator ani (branches of S4), branch of pudendal nerve (S2-4)

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7
Q

What is the proximal and distal attachments, nerve innervation and function of iliococcygeus

A

Posterior aspect of arcus tendinous levator ani and ischial spine
Anococcygeal body and coccyx
Function: Helps support pelvic viscera and lateral coccyx
Nerve Innervation: nerve to levator ani (branches S4), inferior rectal nerve (from pudendal nerve- S3,S4), coccygeal plexus

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8
Q

What is the anococcygeal body

A

also called anococcygeal ligament

strong, fibrous body that joins coccyx to fibres of levator ani muscle and external anal sphincter

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9
Q

What is the proximal and distal attachments, nerve innervation and function of pubovaginalis (female) & puboprostaticus/levator prostatae (male)

A

Posterior pelvic surface of the body of pubic bone
Central perineal tendon–> posterior to vagina (females) posterior to prostate (males)
Nerve innervation: anterior rami of S3 and S4
Function: act to separate the base of pelvic cavity from the ischiorectal fossa lying inferiorly
Act in coordination with the other levator ani to support pelvic viscera

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10
Q

What is the proximal and distal attachments, nerve innervation and function of ishiococcygeus (coccygeus)

A

ischial spine
Lower 2 sacral and upper 2 coccygeal vertebras blends with sacrospinous ligament on its external surface
Nerve innervation: anterior rami of S4,S5–> nerve to levator ani
Function: supports pelvic viscera,flexion of coccyx, stabilises sacro-iiac joint
It is considered more as a ligament that muscle

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11
Q

What is the proximal and distal attachments, nerve innervation and function of bulbospongiosus in males

A

Median Raphe, ventral surface of bulb pf penis abd central tendinous point
Corpora spongiosum and cavernosa, fascia of bulb of penis–> deep penile fascia
Nerve Innervation: Deep branch of perineal nerve (branch of pudendal nerve)
Function: Empties urethra, acts as a sphincter to compress bulb of penis, assists erection, propels semen down urethra

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12
Q

What is the proximal and distal attachments, nerve innervation and function of bulbospongiosus in females

A

Perineal body, then divided to wrap around vagina
Fascia of corpus cavernosa
Nerve innervation: deep branch of perineal nerve (branch of pudendal nerve)
Function: Empties urethra, acts as a sphincter to reduce lumen of vagina and assists erection of clitoris, compresses deep veins and decreases vaginal orifice

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13
Q

What is the proximal and distal attachments, nerve innervation and function of ischiocavernosus

A

Ischial ramus and medial surface of ischial tuberosity
Crus of penis or clitoris and corpus cavernosum
Nerve innervation: deep branch of perineal nerve (branch of pudendal nerve)
Function: Maintains erection of penis /clitoris by compression of outflow veins

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14
Q

What is the tone of the pelvic floor muscles

A

they are tonically (continuous tone of muslce, hence continuous tension/contraction) contracted most of the time to support the abdominopelvic viscera and to assist in maintaining urinary and faecal continence

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15
Q

When are the pelvic floor muscles actively contracted

A 
During activities such as:
Forced expiration
Coughing
Sneezing
Vomiting
Fixation of trunk during movements of UL
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16
Q

Why are the pelvic floor actively contracted during some activities

A

Occurs primarily to increase support of viscera during periods of increased intra-abdominal pressure and secondarily to contribute to increased pressure (to aid expulsion)

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17
Q

How does puborectalis contraction to maintain faecal continence

A

Active contraction
Contracts immediately after rectal filling or during peristalsis when rectum is full and the involuntary sphincter muscle is inhibited (relaxed)

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18
Q

What role do the levator ani muscles play in urination and defecation

A

Increased intra-abdominal pressure for defecation is provided by contraction of the thoracic diaphragm and muscles of the anterolateral abdominal wall
Acting together, the parts of the levator ani elevate the pelvic floor after their relaxation and the consequent descent of the pelvic diaphragm that occurs during urination and defecation

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19
Q

What is the perineal body

A

The fibromuscular structure located between the vagina/testicles and anus

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20
Q

What are the attachments of the perineal body

A

Attaching to the sides of the ishiopubis rami by the deep transverse perineal muscle

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21
Q

Why is the perineal body known as the ‘central tendon’

A

because many pelvic floor structures intersect with the perineum at this structure

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22
Q

What is the proximal and distal attachments, nerve innervation and function of deep transverse perineal

A

Inner aspect of ishiopubic ramus
Median raphe (male), perineal body and external anal sphincter
Nerve Innervation: deep branch of perineal nerve (branch of pudendal nerve)
Function: fixes perineal body, supports the function of the levator ani and urethra sphincter

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23
Q

What is the perineal membrane

A

Fascial thickening not a muscle
Fascial attachments at pubis symphysis
Fascial attachments at ischial spine
Suspensory ligament that provides extra support to prevent descent of perineal body

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24
Q

What is the urogenital diaphragm

A

Also called ‘triangular ligament’
Strong, muscular membrane that occupies the area between the symphysis pubis and ischial tuberosity
Stretches across the triangular anterior portion of the pelvic outlet
It is external and inferior to the pelvic diaphragm

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25
Q

What is the proximal and distal attachments, nerve innervation and function of superficial transverse perineal

A

Ischial tuberosity
Perineal Body
Nerve innervation: Deep branch of perineal nerve (branch of pudendal nerve)
Function: reinforces action of deep transverse perineal muscle to stabilise perineal body–> poorly/variable developed

26
Q

What is the proximal and distal attachments, nerve innervation and function of external anal sphincter

A

Perineal body encircles anal canal
Coccyx
Nerve innervation: Inferior rectal (anal) nerve
Function: part of voluntary sphincter of anal canal–> tone keep anus closed, defecation muscles relaxed

27
Q

Describe the internal anal sphincter

A

Part of the inner surface of canal
Composed of concentric layers of circular muscle tissue
Not under voluntary control

28
Q

What makes up the urogenital triangle

A

Bulbocavernosus (bulbospongiosus in men)
Ischiocavernosus
Superficial transverse perineal
External anal sphincter

29
Q

What makes up the urogenital diaphragm

A 
Urethral sphincter 
Compressor urethrae
Sphincter urethral vaginalis
Deep transverse perineal
Perineal mebrane
30
Q

What is the pelvic diaphragm

A

Wide but thin muscular layer of tissue
forms the inferior border of the abdominopelvic cavity
Composed of a broad, funnel-shaped sling of fascia and muscle
Extends from the symphysis pubis to the coccyx, from one lateral wall to another

31
Q

What is the pelvic diaphragm made up of

A 
Levator ani (pubococcygeus, pubovaginalis, puborectalis, iliococcygeus)
Coccygues
Piriformis
Obturator internus
Arcus of tendinous of levator ani
Arcus tendinous fascia pelvic
32
Q

Male and female organs in pelvic cavity, function and nerve innervation

A

read notes

33
Q

Explain role of pelvic floor muscles in inspiration

A

For inspiration lung pressure must be lower than atmospheric pressure to allow air in
Rib cage moves up and out, diaphragm contracts/flattens to increase lung volume=decrease lung pressure
When diaphragm contract, pushes down on abdominal organs=increase in abdominal presssure
Pelvic floor muscles relax, dropping down and increasing abdominal space= decrease abdominal pressure

34
Q

Explain role pf pelvic floor in expiration

A

Lung pressure must be higher than atmospheric pressure= air moves out
Diaphragm relaxes to decrease lung volume=increase lung pressure
Causes decreased pressure in abdominal cavity, hence pelvic floor contracts to decrease abdominal space and increase pressure

35
Q

What is continence

A

Self control

ability to retain urine/faeces

36
Q

Explain importance of pelvic floor in continence

A

Urethra, vagina(females) and rectum pass through the pelvic floor and are surrounded by pelvic floor muscles
During increased intra-abdominal pressure, the pelvic floor muscles must contract to provide support
Pelvic floor muscles contract= urethra, vagina, rectum closed
Contraction is important in preventing involuntary loss of urine or rectal contents
Pelvic floor muscles also relax in order to void
A contraction of PFM also causes a reflex inhibition of the detrusor muscle= smooth muscle found in bladder wall (remains relaxed to allow storage of urine and contracts during urination to release
Hence weakness/damage to PFM=incontinence

37
Q

What is the bladder wall muscle and describe its fibres

A

Detrusor muscle
3 different layers of fibres in different directions
Allows for better ‘squeeze’

38
Q

How many ureteric orifices are there and what are they

A

2 ureteric orifices

they are the openings of the ureter in the bladder

39
Q

What forms the trigone of the bladder

A

Internal urethral sphincter and ureteric orifices

40
Q

What is micturition

A

the act of emptying the bladder (urination)
Involves autonomic reflexes (parasympathetic) and some voluntary control
Micturition= autonomic + voluntary (pudendal nerve)

41
Q

What is the micturition reflex

A

when bladder is full, stretch receptors in the bladder wall trigger the micturition reflex
Sensory nerves are stimulated:
-To void
-To ignore/hold on

42
Q

How does the body void micturition

A

Detrusor muscle that surrounds the bladder contracts
Internal urethral sphincter relaxes
Allowing urine to pass out of the bladder through the ureteric orifice and sphincter
Both these reactions are involuntary

43
Q

How does the body hold on/ignore the micturition reflex

A

Voluntary inhibition of the detrusor contractions
Voluntary contraction of internal and external uretheral sphincters
Contraction of pelvic floor muscle (poor PFM=incontinence)

44
Q

How and where is micturition coordinated

A

Coordinated in Pons
Autonomic reflexes are parasympathetic from S2-4 (via pelvic nerve) to create contraction to allow voiding and then relax to fill (hence parasympathetic=contract bladder)
Bladder relaxed to fill via increased sympathetic input via thoracic 11&12 and lumbar 1,2 spinal levels through mesenteric ganglion
Which becomes post ganglionic fibres and travel through hypogastric nerve to bladder to relax the wall and constrict the internal sphincter

45
Q

Explain the process of micturition

A

Full bladder
Pelvic floor muscles relax–> except internal and external urethral sphincter
Contraction of abdominal wall muscles= increase intra=abdominal pressure
Contraction of detrusor muscle
Internal urethral sphincter relaxes–> sympathetic
External urethral sphincter relaxes–> pudendal n=urine flow
Continued contraction of detrusor
Complete emptying of bladder
Bladder relaxation (detrusor relaxes)
Contraction of internal sphincter
Contraction of external uretheral sphincter–> actions from bulbospongiosus, pudendal nerve

46
Q

How does spinal injury affect micturition

A

Cervical and thoracic SC lesion= spinal reflex control of micturition (micturition reflex) still intact but connection to pons not in tact
Hence no voluntary control of micturition
Leave the reliance on the micturition reflex control, therefore overfilling stimulates the reflex to void the bladder
Bladder is not completely emptied dur to loss of voluntary contribution
Hence stasis/retention/infection= need for catherters
Catheters= risk of infection=kidney infection=delirium

47
Q

What is defecation

A

Final act of digestion

48
Q

Explain the process of defecation

A

Faeces from sigmoid-rectum
Distends rectum–> stimulates stretch receptors and sends sensory impulse to spinal cord (stimulates defecation reflex)
Motor impulses from cord via parasympathetic fibres to descending colon, sigmoid, rectuma nd anus
Contraction of longitudinal rectal muscle fibres= shortens rectum and increases internal pressure
Shorter rectum+ increases internal pressure + voluntary contraction of abdominal wall and diaphragm+ parasympathetic relaxation of internal anal sphincter + voluntary relaxation of external anal sphincter = defecation
Peristaltic waves propel the faeces out of the rectum
As faeces exit, the anus is drawn up over the passing mass by pelvic diaphragm to prevent prolapse (pushing out of the body)

49
Q

How many muscular constrictors are there in the anus

A

2–> internal and external anal sphincter

They allow the faeces to be passes or retained

50
Q

How is the infant defecation reflex different

A

Autonomic–>Voluntary control of external anal sphincter not yet developed
Distended rectum+ stretch receptor + sensory impulses to spinal cord = stimulates defecation reflex
Motor impulses from the cord via parasympathetic fibres to descending colon, sigmoid, rectum, anus
Contraction of longitudinal rectal muscle fibres therefore shorten rectum and increasing internal pressure

51
Q

Describe the basic physiological affects of pregnancy on female pelvis

A

lesser pelvis experiences the most effects
Hormonal changes cause the tissues to soften and become more elastic to prepare for delivery and accommodate growing baby
As uterus increases in weight, progressively more vulnerable to stretch and associated weakness
During vaginal delivery, pelvic floor muscles and tissues stretch well beyond normal limits causing pelvic floor weakness immediately after delivery
Trauma and damage to the PFM and nerves can occur during vaginal delivery contributing to post natal pelvic floor dysfunction

52
Q

How can you prevent/recover from pelvic floor damage

A

Pelvic floor exercise can help in recovery and prevention of long-term problems of the pelvic floor after pregnancy and delivery

53
Q

What effect does the hormone relaxin have on the pelvis during pregnancy

A

Produced and secreted by the corpus luteum of ovary and later by placenta
‘Relaxes’ ligaments in pelvis
Increase stability of the pubic symphysis and ligaments of the SIJ and sacrococcygeal joint
Helps dilate the uterine cervix during labor–> easing delivery
Increased flexibility of ligaments around SIJ results in ligaments being lax and muscles which usually stabilise the joint aren’t able to work as efficiently due to the change in joint structure
Added load of foetus on pelvis results in an unstable pelvis which often causes pain

54
Q

What is the adult nulliparous uterus

A

Nulliparous= female who hasn’t given birth/become pregnant
Piriform (pear shaped)
right angle with vagina

55
Q

Describe the post parturition uterus

A

Parturition=giving birth
Almost returns to normal
Slightly larger than nulliparous

56
Q

Explaint he uterus changes

A

Menstruation= slightly enlarged, rounder, more vascular
Pregnancy= enlarged (hypertrophy of muscle fibres and new ones), walls thinner with progression
Post parturition= Nearly normal, muscle layers thicker, larger cavity
Old age= atrophy,paler and denser, constriction

57
Q

Lymph drainage of uterus

A

Upper body+uterine tube= aortic nodes
Lower body= external iliac nodes
Cervix= external and internal nodes, rectal & sacral nodes
READ NOTES

58
Q

What is the perinuem

A

Area of soft tissue between thighs and butt
Female–> from anterior aspect of vagina to ischial tuberosities to coccyx to distal end of sacrum
Male–> posterior aspect of scrotum to ischial tuberosities to coccyx

59
Q

What 2 regions is the perinuem divided into

A

Urogenital region

Anal region

60
Q

What is the obsteric perineum

A

The region from the posterior aspect of vagina to anterior aspect of anus

General Anatomy (13 decks)

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