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Repro > Pelvic floor muscles > Flashcards

Pelvic floor muscles Flashcards

1
Q

What are the functions of the pelvic floor?

A
  • control of defeacation and micturition
  • maintain intra-abdominal pressure during sneezing, coughing, laughing etc
  • maintan continence
  • facilitate childbirth
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2
Q

A main function of pelvic floor is support of pelvic organs. What are the 3 mechanisms of support?

A
  1. suspension
  2. attachment
  3. fusion
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3
Q

What is suspension?

A

“holding up the muscles” - maintains an anti-gravity position by providing strong vertical support

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4
Q

What structures allow suspension?

A

cardinal and uterosacral and round ligaments

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5
Q

What does the cardinal ligament do?

A

holds the cervix and upper vagina in place

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6
Q

What does the uterosacral ligament do?

A

holds the back of the verve and upper vagina laterally

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7
Q

What does the round ligament do?

A

maintains the anteverted position of the uterus

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8
Q

What is the attachment mechanism?

A

the support that comes from attachments on the pelvic organs

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9
Q

What is significant about the endopelivc fascia?

A

it stretch like a hammock and the urethra lies anterior and above it so when intra abdominal pressure increases., urethra is compressed - important for urinary continence

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10
Q

What is the fusion mechanism?

A

support that arises from fusion of different tissues e.g. urogenital diaphragm and perineal body

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11
Q

What are the deep muscles of the pelvic floor?

A

the levator ani muscles -they encircle the urethra, vagina and rectum

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12
Q

What are the muscles of elevator ani?

A

iliococcygeus
puborectali
pubococcygeus

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13
Q

What is the midpoint of these attachments?

A

perineal body (central point between the vagina and the rectum)

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14
Q

What are the superficial muscles?

A

bulbospongiosus
ischiocavernosus
superficial transverse perineal

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15
Q

Which muscles are most commonly involved in injury and what is the mechanism of injury?

A

the superficial muscles - perineal trauma - accidental, sexual or obstetric (during childbirth)

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16
Q

What is the urogenital diaphragm?

A

triangular sheet of dense fibrous tissue that spans half of the pelvic outlet and support the pelvic floor

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17
Q

What is the blood supply to the pelvic floor muscles?

A

pudendal arteries and drainage through pudendal veins

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18
Q

What is the lymph drainage of the pelvic floor muscles?

A

inguinal lymph nodes

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19
Q

What is the nerve supply to the pelvic floor muscles?

A

the pudendal nerve (S234)

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20
Q

What is pelvic floor dysfunction?

A

refers to a wide range of symptoms and conditions that can arise as a result of problems to do with the pelvic floor

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21
Q

What type of pelvic floor dysfunctions can you get?

A
  • pelvic organ prolapse
  • urinary incontinence
  • posterior compartment pelvic floor dysfunction
  • obstetric trauma including episiotomy
  • FGM
  • vulval pain syndromes
22
Q

What is pelvic organ prolapse?

A

loss of support for the uterus, bladder, rectum, colon - prolapses into vagina

23
Q

What disturbances can POP cause?

A

anorectal, urinary and sexual function issues

24
Q

How are POP classified?

A

by the compartment that the prolapse has occurred

25
Q

What is an anterior compartment prolapse related to?

A

bladder (cystoceole)
urethra (urethrocoele)
Both - cystourethrocoele

26
Q

What is a middle compartment prolapse related to?

A 
the uterus prolapsing into the vagina
-uterine prolapse 
entire uterus (procidential)
27
Q

Can the uterus prolapse after a hysterectomy? WHY?

A

the apex may still prolapse - the supportive ligament have to be cut when removing the uterus

28
Q

What is a posterior prolapse related to?

A

the rectum prolapsing into the posterior part of the vagina (rectocele)
- loops of bowel may prolapse into the rectovaginal space (pouch of douglas) (enterocoele)

29
Q

What are the causes and risk factors of POP?

A

AGE! - weight and mode of delivery (these 3 are most common)

  • connective tissue disorders
  • lack of oestrogen
  • neurological
  • chronic cough (increased intra abdominal pressure)
30
Q

What mode of delivery is more commonly associated with POP?

A

vaginal delivery

31
Q

What is the typical symptoms associated with POP?

A

feeling a lump down below and feeling “something coming down”
-constipation

32
Q

What is the management for POP?

A
  • need to consider nature of symptoms/severity/how is it impacting the patient
  • sexual activity
  • future pregnancies
  • fitness for surgery
  • work/physical activity
33
Q

What are the non-surgical options?

A

pessaries (hold up pelvis and organs)

34
Q

What is the surgical management?

A
  • removal of uterus

- mesh suppor in a vault prolapse

35
Q

What is stress urinary incontinence?

A

incontinence affect by the dysfunction of the pelvic floor causing the urethral sphincter to allow leakage

36
Q

What is urge incontinence?

A

problems with the bladder not the pelvic floor

37
Q

What are the risk factors for stress incontinence?

A

-age and oestrogen deficiency

38
Q

What are typical symptoms of stress incontinence?

A

-passing urine on coughing/laughing/vomiting

39
Q

What is the management for stress incontinence?

A

pelvic floor muscle training

surgical intervention to create slings to support urethral sphincter

40
Q

What vulval problems can you get?

A

patients can experience pain with no obvious finding on examination - often related to tension of the levator ani

41
Q

What is vaginismus?

A

taut pelvic floor and muscle spasms that won’t let anything in or out - have painful sex

42
Q

What is FGM?

A

All procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or non-therapeutic reasons

43
Q

What is type 1 FGM?

A

-partial or total removal of the clitoris

44
Q

What is type 2 FGM?

A
  • partial or total removal of the clitoris and labia majora
45
Q

What is type 3 FGM?

A

Narrowig of the vaginal orifice with creation of a covering seal by sewing together the labia minor and majora

46
Q

What is type 4 FGM?

A

all other harmful procedures to the female genitalia for non-medical purposes

47
Q

What are the consequences and complications of FGM?

A

Haemorrhage -septic shock and infection
Sexual difficulties/fertility issues/urinary outflow obstruction
Obstetric - fear of childbirth, PPH
Psychological - PTSD, flashbacks

48
Q

What is posterior compartment pelvic floor dysfunction?

A

presents as - constipation, incomplete evacuation, anal incontinence, vaginal or rectal lump

49
Q

What are the causes of posterior compartment pelvic floor dysfunction?

A

structural, drugs (opiates), dehydration, pregnancy, immobility

50
Q

What is the commonest cause of faecal incontinence in women?

A

obstetric anal sphincter injury

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