The Pelvic Flaw Flashcards
What are the functions of the pelvic floor?
Support the pelvic organs -vagina, uterus, ovaries, bladder and rectum.
Maintain intra-abdominal pressure during coughing, vomiting, sneezing and laughing.
Facilitate defaection and micturition.
Maintain urinary and faecal continence
Facilitate childbirth
How does the pelvic floor support?
3 mechanisms:
Suspension
Attachment
Fusion
What does it mean by suspension of the pelvic floor?
Vertical support
Working against gravity
Strength required
The cardinal ligaments - holding the cervix and upper vagina in place
The uterosacral ligaments - holding the back of the cervix and upper vagina
The round ligament - maintain the anteverted position of the uterus
What does it mean by attachment of the pelvic floor?
Provided by the:
- Arcus tendinous fascia pelvis (ATFP) -also known as the white line.
- Endopelvic fascia - stretches like a hammock from the while line laterally, to the vaginal wall medially.
Urethra lies anterior and above it, this hey compressed against it during increased intra-abdominal pressure. Important in maintaining urinary continence.
What does it mean by fusion?
Implies link, connection, inseparable.
Involves the urogenital diaphragm and the perineal body.
The lower half of the vagina is supported by fusion of the vaginal endopelvic fascia to the perineal body posteriorly, the elevator ani laterally and the urethra anteriorly.
What is the composition of the pelvic floor?
Mainly elevator ani muscles
Urogenital diaphragm / perineal membrane
Perineal body
Perineal muscles
Posterior compartment.
What are the levator ani muscles?
They encircle the urethra, vagina and rectum and reach the coccyx forming a broad, U-shaped sheet that stretches backwards and inwards from either side of the pelvis to meet in the midline.
what are the three levator ani muscles?
Pubococcygeus
Puborectalis
Iliococcygeus
What are the perineal muscles?
Bulbospongiosus
Ischiocavernosus
Superficial transverse perineal
Next layer after the elevator ani
Superficial
Most commonly involved in perineal trauma - accidental, sexual or obstetric
What is the urogenital diaphragm?
Triangular sheet of dense fibrous tissue
Spans the anterior half of the pelvic outlet.
Arises from the ischiopubic ramus
Attaches medially to the urethra, vagina and perineal body.
Thereby supporting the pelvic floor.
What is the perineal body?
Occupies a central position (and role) on the pelvic floor, between the vagina and rectum.
Point of insertion of the elevator ani muscles
Attaches posteriorly to the external anal sphincter (EAS) and the coccyx.
Support of the perineal structures rely on it.
What is the blood supply?
External and internal pudental arteries and drains through the corresponding veins.
What is the lymphatic drainage?
Inguinal lymph nodes
What is the nerve supply?
Branches of pudental nerve, which derives its fibres form ventral branches of the second, third and fourth sacral nerve
What is a pelvic organ prolapse?
Loss of support for the uterus, bladder, colon or rectum, leading to prolapse of one or more of these organs into the vagina.
Common - up to 40% of women experience a degree of pelvic organ prolapse in their lifetime.
Although not life-threatening, has a significant impact on the quality of life, perception of body image can cause depressive symptoms.
