Pelvic Foor Flashcards
Function of the pelvic floor
- support pelvic organs
- maintain intrabdominal pressure during coughing, vomiting, sneezing etc.
- facilities defaecation + micturition
- maintain continence
- facilities childbirth
Outline the 3 mechanism of how pelvic floor provides support
- Suspension: provides sling like support inferiorly in pelvis against gravity
- Attachment: vagina is support by attachments to endopelvic fascia, levator ani muscles + perineal body
- Fusion: of urogenital diaphragm + perineal body
What are the levator ani muscles?
Puborectalis
Pubococcygeus
Iliococcygeus
List the deep pelvic floor muscles
puborectalis
pubococcygeus
iliococcygeus
coccygeus
What maintains the anteverted position of the uterus?
Round ligament
List the superficial pelvic floor muscles
Bulbospongiosus
Ischiocavernosus
Superficial + deep transverse perineal
Ligaments of the pelvic floor
- cardinal/transverse ligaments
- pubocervical ligaments
- uterosacral/rectouterine ligaments
Nervous supply to the pelvic floor
Pudendal nerve S2-4
Blood supply to pelvic floor
Pudendal arteries
What do the levator ani muscles take part in forming?
Perineal body
What is the urogenital diaphragm?
- triangular sheet of dense fibrous tissue
- spans anterior half of pelvic floor
- attaches to urethra, vagina + perineal body
- supports pelvic floor
Lymphatic drainage of pelvic floor
Inguinal lymph nodes
Types of pelvic floor dysfunction
Pelvic organ prolapse
Vaginismus
Stress urinary incontinence
Female genital mutilation
Risk factors of pelvic organ prolapse
- increase age
- given birth
- number of vaginal deliveries
- oestrogen deficiency (menopause)
- obesity (raised intra abdominal pressure)
Management of pelvic organ prolapse
Depends on severity + how patient is coping
- surgical: mesh supports, hysterectomy if central
- non-surgical: pessaries to provide support +/- topical oestrogen + pelvic floor exercises
Symptoms of pelvic organ prolapse
- dragging/bugling sensation in vagina
- lump
- feeling of incomplete emptying of bladder
- double voiding
How can a pelvic organ prolapse be classified?
- anteior: bladder or urethra
- central: uterus
- posterior: rectum or colon
Types of anterior pelvic organ prolapse
- cystocele: bladder prolapses into vaginal space
- urethrocele: urethral collapse
- cytourethrocele: bladder + urethra
Types of posterior pelvic organ prolapse
- rectocele: rectum prolapses into vaginal space
- enterocele: loops of colon pressing across Rectouterine space
What is a vault prolapse?
Central pelvic organ prolapse when the superior portion of vagina collapses downwards after a hysterectomy
Risk factors for stress urinary incontinence
Increased age
Oestrogen deficiency (menopause)
Managment of stress urinary incontience
Pelvic floor exercises
Surgical sling to support urethral sphincter
How are vaginal tears graded?
- grade 1: extends into vaginal mucosa
- grade 2: extends into perineal muscles
- grade 3: extended into anal sphincter
- grade 4: extends into rectum
What is a central pelvic organ prolapse called post hysterectomy?
Vault prolapse
What is an episiotomy?
A surgical incision made to perineum during child birth if there is risk of tearing, distressed baby or instrumental delivery
What is involved in a episiotomy?
Cutting of bulbospongiosus + transverse perineal muscles at oblique angle to relieve pressure + allow for more space
Define female genital multination
All procedures involving partial or total removal of external female genitalia or other injury
Types of FGM
1- partial/total removal of clitoris
2- partial/total removal of clitoris + labia minora
3- removal of labia minora + sewing labia majora together only leaving a small hole for urine + menstrual blood
4- any other harmful procedure e.g. piercing, cutting
Consequence of FGM
- haemorrhage > sepsis or death
- blood born infections
- chronic pain
- sexual + fertility issues
- urinary outflow obstruction
- flashbacks/PTSD
- self esteem issues
How does the perineal body function to maintain pelvic organ support?
Central point of attachment for perineal muscles
Why can vaginal childbirth delivery cause pelvic floor dysfunction?
- damage to pelvic floor muscles
- stretch of ligament support
- stretch of pudenal nerve
- perineal body injury
What are pessaries?
What are they used for?
- removable devices that go inside your vagina > provide support to your pelvic organs
- used for non surgical treatment of pelvic organ prolapse or stress UI
What is vaginismus?
The body’s automatic reaction to the fear of vaginal penetration > contraction of vaginal muscles
