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Reproductive System > Session 3: Pelvic Floor Anatomy > Flashcards

Session 3: Pelvic Floor Anatomy Flashcards

1
Q

Give functions of the pelvic floor.

A

Support (this is the main support) of the pelvic organs Continence to maintain urinary and faecal continence Maintain high intra-abdominal pressure Child birth Sexual function

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2
Q

Which are the main pelvic organs that are supported by the pelvic floor?

A

The vagina, uterus, ovaries, bladder and rectum

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3
Q

There are three levels of support, which?

A

Suspension Attachment Fusion

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4
Q

Explain suspension support.

A

This is an ‘anti-gravity’ support to prevent vertical collapse of the pelvic organs. This is done mainly by the cardinal ligaments, the uterosacral ligaments and to a lesser extent also the round ligament.

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5
Q

Role of the cardinal ligaments.

A

Holding the cervix and upper vagina in place.

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6
Q

Role of the uterosacral ligaments.

A

Holding the back of the cervix and upper vagina laterally

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7
Q

Role of the round ligament.

A

Maintain the anteverted position of the uterus. It originates from the uterus and attaches into labia majora.

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8
Q

Explain attachment support.

A

Pelvic organs are attached by several structure such as; endopelvic fascia, levator ani muscles and the perineal body as well as arcus tendinosus fascia pelvis.

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9
Q

Explain fusion support.

A

Fusion of different tissue support the pelvic organs. Examples are the urogenital diaphragm and the perineal body.

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10
Q

Composition of the pelvic floor.

A

Muscles (deep and superficial muscles) Perineal body Urogenital diaphragm

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11
Q

What are the deep muscles of the pelvic floor?

A

The levator ani muscles.

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12
Q

What are the levator ani muscles function?

A

To encircle the urethra, vagina and the rectum to provide support for respective organs.

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13
Q

Which are the levator ani muscles?

A

Pubococcygeus

Puborectalis

Iliococcygeus

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14
Q

What is the midpoint of attachment of the levator ani muscles?

A

The perineal body

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15
Q

What are the superficial muscles (also called the perineal muscles) of the pelvic floor?

A

Bulbopongiosus

Ischiocavernosus

Superficial transverse perineal

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16
Q

When might the bulbospongiosus and transverse perineal muscles be damaged?

A

During medio-lateral episiotomy in childbirth.

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17
Q

Why is medio-lateral episiotomy done in childbirth?

A

Can be done if the baby is large, during a difficult delivery or using instruments such as forceps during a delivery.

It is done to avoid damage to the perineal body because of its critical role in providing pelvic floor support as a site of attachment.

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18
Q

Complications of medio-lateral episiotomy.

A

Damage to bulbospongiosus and transverse perineal muscles

Infection

Haemorrhage

Dyspareunia (painful intercourse)

Damage to anal sphincter

However it is done to prevent 2nd or 3rd degree tears.

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19
Q

What is the perineal body?

A

A central point found between the vagina and the rectum or between the scrotum and rectum in men.

A site of attachment for the pelvic floor muscles and other structures that provide support for the pelvic floor.

It has a central role in the support of the pelvic organs.

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20
Q

What is the urogenital diaphragm?

A

A sheet of dense fibrous tissue that is found and spans the anterior half of the pelvic floor.

Attaches to the urethra, vagina and perineal body.

It provides support to the pelvic organs.

21
Q

Main innervation of the pelvic floor.

A

Pudendal nerve

22
Q

Main branches of the pudendal nerve

A

Inferior rectal nerve

Perineal nerve

Dorsal nerve of the penis

23
Q

What does the perineal nerve innervate?

A

Bulbospongiosum

Ischiocavernosus

Levator ani muscles

24
Q

What can damage to the pudendal nerve cause?

A

Problems with pelvic floor support as the levator ani muscles will be weaker. They will not stop functioning all together because they still have innervation directly from the S4 nerve root’s anterior ramus.

Also the inferior rectal nerve will be damaged causing urinary and faecal incontinence.

Impotence (dorsal nerve of the penis)

25
Q

Main blood supply of the pelvic floor.

A

Internal and external pudendal arteries and their veins

26
Q

Lymphatic drainage of the pelvic floor.

A

Inguinal lymph nodes

27
Q

Nerve roots of the pudendal nerve.

A

S2-S4

28
Q

Mnemonic for the sacral part of the lumbosacral plexus and their nerve roots.

A

Salmon Is So Perfectly Pink

Superior gluteal nerve (L4, L5, S1)

Inferior gluteal nerve (L5, S1, S2)

Sciatic nerve (L4, L5, S1, S2, S3)

Posterior femoral nerve (S1, S2, S3)

Pudendal nerve (S2, S3, S4)

29
Q

Give examples of pelvic floor dysfunctions.

A

Pelvic organ prolapse

Vaginismus

Urinary incontinence

Vulval pain syndrome

30
Q

What are pelvic organ prolapses?

A

It’s the loss of support of a pelvic organ. Most commonly uterus, bladder or colon.

They can prolapse into the vagina.

31
Q

Complications of pelvic organ prolapses.

A

Quality of life problems

Anorectal, urinary and sexual dysfunction

Disturbed sense of body image

Depressive symptoms

Source of infection and/or pain

32
Q

Pelvic organ prolapses can be classified into categories.

Which?

A

Based on which organ prolapse and where it prolapse to.

Divided into:

Anterior compartment

Middle compartment

Posterior compartent

33
Q

Give examples of anterior compartment POPs.

Explain them.

A

Cystocoele relates to bladder

Urethrocoele relates to urethra

Cystourethrocoele relates to both

34
Q

Give examples of middle compartment POPs.

Explain them.

A

Uterine prolapse - Uterus prolapse into vaginal apex

Uterus procidentia - if the entire uterus prolapse into the vagina

Vault prolapse - the apex of the vagina prolapse into the vaginal canal

35
Q

How can a vault prolapse occur?

A

During a hysterectomy the supportive ligaments have to be cut.

This can lead to a vault prolapse.

36
Q

Give example of posterior compartment POPs.

Explain them.

A

Rectocoele - when the rectum prolapses

Enterocoele - when loops of bowel involved enter the pouch of douglas.

37
Q

Causes and risk factors of pelvic organ prolapses.

A

Age

Parity

Mode of delivery

Oestrogen deficiency

Chronic increased abdominal pressure (obesity)

Connective tissue disorders (EDS, Marfan’s)

Neurological problems like damage to pudendal nerve, Spina bifida and muscular dystrophy

38
Q

How will patients present with a POP.

A

Saying they feel a lump down below

‘Something coming down’

Constipation

39
Q

Management of POPs.

A

Depend on quality of life, severit of prolapse and how fit they are for surgical intervention.

Non-surgical options include:

Pessaries like ring pessaries.

Surgical options include:

Hysterectomy

Mesh support in a vault prolapse

40
Q

What type of urinary incontinence can come about with dysfunction of the pelvic floor.

A

Stress incontinence.

41
Q

Explain stress incontinence.

A

Increased abdo pressure causes leaks of urine because the support to the urethral sphincter via the pelvic floor is not adequate.

42
Q

Risk factors of stress incontinence.

A

Same as those of POPs.

Age and oestrogen deficiency mainly.

43
Q

How may patients present with stress incontinence.

A

Passing urine during any sort of increased abdo pressure like coughing and sneezing.

44
Q

Management of stress incontinence.

A

Muscles training

Surgical intervention if appropriate which involves creating ‘slings’ of support to the urethral sphincter.

45
Q

Most common cause of Vulval pain syndromes.

A

Often related to tension of the levator ani muscles.

46
Q

Explain female genital mutilation and its complications.

A

A cultural practice of damaging the female external genitalia.

Severe pain, potential sepsis or haemorrhage. Psychological effects, sexual dysfunction and difficulty conceiving. Chronic pain and menstrual disorders.

47
Q

Types of female genital mutilations.

A

Type 1: Clitoridectomy (partial or total removal of clitoris)

Type 2: Excision (partial or total removal of the clitoris and the labia minora)

Type 3: Infibulation (Narrowing of the vaginal orifice by a seal made by cutting and appositioning the labia minora and/or labia majora)

Type 4: All other harmful procedures to the female genitalia like pricking, piercing, incising, scraping and cauterising.

48
Q

Main complications of posterior compartment pelvic floor dysfunction.

A

Constipation

Incomplete evacuation

Anal incontinence

Loss of voluntary control of defecation.

Reproductive System (31 decks)

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