SM_224b: Pelvic Floor Disorders and Urogyn / Uro Flashcards
Describe the bony pelvis
Bony pelvis
Describe ligaments of the pelvis
Ligaments of the pelvis
____ is the primary support of pelvic viscera and is composed of ____, ____, and ____
Levator ani is the primary support of pelvic viscera and is composed of puborectalis, pubococcygeus, and iliococcygeus
- Sling around rectum, vagina, and urethra
Pelvic diaphragm is composed of ____ and ____
Pelvic diaphragm is composed of levator ani muscles and coccygeus muscle
Describe the levels of pelvic organ support
Levels of pelvic organ support
- Level I: uterosacral and cardinal ligaments, apical support
- Level II: arcus tendineuous fascia pelvis, lateral / longitudinal support
- Level III: perineal muscles, distal support
Describe nerves of inguinal region
Nerves of inguinal region
- Dorsal nerve to clitoris
- Perineal nerve
- Inferior rectal nerve
Endopelvic fascia is ____ anchored to ____
Endopelvic fascia is loose connective tissue anchored to parietal fascia of muscles
- Collagen, elastin, smooth muscle
Describe muscle fibers and innervation of levator ani muscles
Muscle fibers and innervation of levator ani muscles
- Type I fibers: slow twitch, baseline tone
- Type II fibers: fast twitch, voluntary contractions
- Innervation: anterior roots of S2-4, no pudendal contribution
Parietal fascia is ____, has a ____ vascular supply, covers ____, and provides attachment to ____
Parietal fascia is dense connective tissue, has a limited vascular supply, covers pelvic muscle, and provides attachment to the bony pelvis
Visceral fascia suspends ____ and is a conduit for ____
Visceral fascia suspends viscera over the pelvic floor and is a conduit for nerves, vessels, and lymph system
Pelvic floor is ____
Pelvic floor is muscles, ligaments, and connective tissue in the lowest part of the pelvis
- Supports internal organs: bladder, uterus, rectum, vagina
Describe pelvic floor disorders
Pelvic floor disorders
- Prolapse of pelvic organs: vagina, bladder, rectum
- Urinary control problems: urinary incontinence
- Bowel control problems: fetal incontinence
Risk factors for pelvic floor disorders are ____, ____, ____, ____, and ____
Risk factors for pelvic floor disorders are aging, obesity, constipation, childbirth, and smoking
Risk factors for pelvic organ prolapse are ____, ____, and ____
Risk factors for pelvic organ prolapse are genetic predisposition, aging tissue, and pelvic floor injury (childbirth, chronic illness, overweight, tobacco use)
Pelvic organ prolapse symptoms are ____, ____, ____, and ____
Pelvic organ prolapse symptoms are bulge, urinary incontinence or voiding difficulties, bowel problems, and sexual discomfort
- Straining, stool trapping, fecal incontinence
Surgical treatment of pelvic organ prolapse involves concepts of ____ or ____
Surgical treatment of pelvic organ prolapse involves concepts of reconstructing a functional vagina and obliterating the vaginal canal / closing the genital hiatus
- Surgical choices: reconstructive (native tissue, mesh augmented), obliterative
___ is a common surgical technique for pelvic organ prolapse
Sacrocolpopexy is a common surgical technique for pelvic organ prolapse
- Mesh from vagina to sacrum
- Anatomic superiority, durability, increased complications compared to vaginal approach
Minimally invasive surgery options for pelvic organ prolapse are ____, ____, and ____
Minimally invasive surgery options for pelvic organ prolapse are uterosacral ligament suspension, sacrospinous ligament suspension, and colpocleisis
___ innervates the striated muscle of the urethral sphincter
Pudendal nerve (S2-4) innervates the striated muscle of the urethral sphincter
- Neuromuscular injury can lead to stress urinary incontinence
Urinary urgency usually with frequency and nocturia and leakage with urgeny are ___
Urinary urgency usually with frequency and nocturia and leakage with urgeny are overactive bladder / urge incontinence
Urgency urinary incontinence results from ____ and ____, leading to ____
Urgency urinary incontinence results from loss of CNS control and activation of muscarinic receptors on the bladder, leading to spontaneous bladder contraction
Describe common surgeries for stress incontinence
Stress incontinence
- Burch colposuspension
- Autologous fascial sing
- Minimally invasive midurethral slings
- Pessary
Describe management of urgency incontinence
Urinary incontinence management
- Tier 1: conservative management (bladder retraining, fluid management)
- Tier 2: medications (antimuscarinic, B3 agonist)
- Tier 3: sacral neuromodulation, intravesical onobotulinum toxin
Risk factors for fecal incontinence are ____, ____, ____, and ____
Risk factors for fecal incontinence are female, age, poor overall health, and physical limitations
Describe the anatomic sites and reflexes involved in anal continence
Anatomic sites and reflexes involved in anal continence
- Rectosigmoid junction: rectosigmoid junction guarding reflex
- Anus: rectoanal inhibitory reflex
- Anal sphincter complex: internal anal sphincter, external anal sphincter
Describe the rectosigmoid junction guarding reflex
Rectosigmoid junction guarding reflex
- GI contents stop in terminal sigmoid colon: reservoir for fluid absorption
- As filling continues, the rectosigmoid junction pressure increases
- Pressure builds until a threshold maximum
- Rectosigmoid junction opens
- Contents flow from sigmoid into rectum for evacuation
Describe the recto-anal inhibitory reflex
Recto-anal inhibitory reflex
- Internal anal sphincter relaxes and samples contents: gas, liquid, solid
- If defecation desired: puborectalis relaxes -> anorectal angle increases -> external anal sphincter relaxes -> stool passes
- If defecation not desired: external anal sphincter contracts -> doubles pressure in anal canal -> puborectalis muscle contracts -> stool is maintained in rectum
Compare and contrast the internal anal sphincter and external anal sphincter
Internal anal sphincter and external anal sphincter
- Internal anal sphincter: circular smooth muscle, enteric nervous system, involuntary, contributes 80-85% resting tone
- External anal sphincter: striated muscle, somatic innervation, voluntary, contributes 15-20% resting tone
Fecal incontinence can result from ____ or ____
Fecal incontinence can result from functional abnormalities or structural abnormalities
- Functional abnormalities: constipation / fecal impaction, stool characteristics, physical mobility, drugs, cognitive impairment
- Structural abnormalities: anal sphincter muscle injury, rectal abnormalities, pudendal nerve injury, CNS injury
____ via ____ or ____ is the most common treatment for fecal incontinence resulting from functional abnormalities
Altering stool consistency via daily psyillium-husk fiber supplement or low dose loperamide prn is the most common treatment for fecal incontinence resulting from functional abnormalities
