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Reproductive systems > The pelvic floor > Flashcards

The pelvic floor Flashcards

1
Q

What are the functions of the pelvic floor?

A
  • Pelvic organ support
  • Maintains intra-abdominal pressure during coughing, vomiting, sneezing and laughing
  • Facilitates defecation and urination
  • Maintains urinary and faecal continence
  • Facilitates childbirth
  • Sexual function
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2
Q

In what ways does the pelvic floor provide support?

A
  1. Suspension
  2. Attachment
  3. Fusion
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3
Q

How does suspension allow the pelvic floor to provide support?

A
  • Maintains pelvic organs in pelvic cavity
  • Provides strong sling-like support of inferiorly in pelvis
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4
Q

How does attachment allow the pelvic floor to provide support?

A
  • Vagina is supported by attachments to endopelvic fascia, levator ani muscles, and perineal body
  • Important in maintaining urinary continence - urethra is compressed by attachments when intra-abdominal pressure is raised
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5
Q

How does fusion allow the pelvic floor to provide support?

A
  • Interplay between muscles, fascia and ligaments helps keep pelvic structures in correct place
  • Urogenital diaphragm and perineal body fuse
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6
Q

Which structures make up the pelvic floor?

A
  • Levator ani muscles
  • Urogenital diaphragm/perineal membrane
  • Perineal body
  • Perineal muscles
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7
Q

What are the levator ani muscles?

A
  1. Puborectalis - originates from pubis symphysis
  2. Pubococcygeus - originates from pubis symphysis and inserts onto coccyx pubis
  3. Iliococcygeus - originates from ischium and inserts onto coccyx pubis
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8
Q

What are the deep muscles of the pelvic floor?

A
  • Levator ani muscles
  • U-shaped
  • Encircle vagina, urethra, and rectum
  • Spread in fan shape
  • Act like a sling to support pelvic organs
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9
Q

What key structure do the levator ani muscles form?

A
  • Perineal body - muscle fibres insert as they encircle vagina/urethra to form this
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10
Q

What are the superficial muscles of the pelvic floor?

A
  • Perineal muscles
  • Most commonly involved in perineal trauma (accidental, sexual, and obstetric)
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11
Q

What are the names of the perineal muscles?

A
  • Bulbospongiosus (encircles labia/base of penis)
  • Ischiocavernosus (along line of ischium)
  • Superficial transverse perineal muscle
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12
Q

What is the function of the perineal muscles?

A
  • Aid in continence
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13
Q

What are the ligaments of the pelvis?

A
  • Cardinal ligaments
  • Pubocervical ligaments
  • Uterosacral ligaments
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14
Q

Describe the anatomical location of the cardinal ligaments

A
  • Situated along inferior border of broad ligament of uterus
  • Arise from side of cervix and lateral fornix of vagina
  • Attach to lateral pelvic wall at level of ischial spine
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15
Q

Describe the anatomical location of the pubocervical ligaments

A
  • Attach from cervix to posterior surface of pubic symphysis
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16
Q

Describe the anatomical location of the uterosacral ligaments

A
  • Attach cervix to sacrum
  • Support uterus
17
Q

What is the urogenital diaphragm?

A
  • Triangular sheet of dense fibrous tissue
  • Spans anterior half of pelvic outlet
  • Arises from inferior ischiopubic ramus
  • Attaches medially to urethra, vagina and perineal body
  • Supports pelvic floor
18
Q

What is the perineal body?

A
  • Central position between vagina and rectum
  • A number of ligaments and muscles coalesce here
  • Levator ani muscles insert here
  • Attached posteriorly to external anal sphincter and coccyx
  • Support of perineal structures rely on it
19
Q

What is the blood supply to the pelvic floor?

A
  • Internal and external pudendal arteries (drains through corresponding veins)
20
Q

What is the innervation of the pelvic floor?

A
  • Pudendal nerve (S2, S3, S4)
21
Q

What is the lymphatic drainage of the pelvic floor?

A
  • Inguinal lymph nodes
22
Q

What are some common causes of pelvic floor dysfunction?

A
  • Pelvic organ prolapse
  • Vaginismus
  • Urinary incontinence
  • Female Genital Mutilation
23
Q

What is pelvic organ prolapse?

A
  • Refers to loss of support for uterus, bladder, colon or rectum
  • Leads collapse of one of these organs into vagina
24
Q

What are the side effects of POP?

A
  • Decrease in quality of life
  • Anorectal, urinary, sexual functional disturbances
  • Pain
  • Infection
  • Depressive symptoms
25
Q

How are prolapses classified?

A
  • Anterior
  • Central
  • Posterior
26
Q

Describe a prolapse of the anterior compartment

A
  • Cystocoele - bladder prolapses into vaginal space
  • Urethrocoele - urethral collapse
  • Cystourethrocoele - bladder and urethra both prolapse
27
Q

What is a central prolapse?

A
  • Uterus collapses down into vaginal space
  • If entire uterus prolapses = procidentia
  • Can still occur after hysterectomy = vault prolapse
28
Q

Describe a prolapse of the posterior compartment

A
  • Rectocoele - rectum prolapses into vaginal space
  • Enterocoele - loops of bowel prolapse into Pouch of Douglas
29
Q

What are the risk factors for prolapse?

A
  • Increased age
  • Parity
  • Oestrogen deficiency
  • Increased abdominal pressure (e.g. due to obesity)
  • Neurological (spina bifida, muscular dystrophy)
  • Genetic connective tissue disorder (Marfan’s, Ehler Danlos)
30
Q

Outline perineal trauma and obstetric anal sphincter injuries (OASIS)

A
  • Can involve any of the perineal muscles
  • OASIS involves the anal sphincter complex
  • 3rd and 4th degree tears
  • Can result in significant morbidity
31
Q

How can we help prevent tearing while a woman is giving birth?

A
  • Episiotomy
  • Perineal protection at crowning
  • Encouraging the mother not to push when the head is crowning
32
Q

What are the symptoms of prolapse?

A
  • History of a dragging sensation or a lump
  • Feeling of incomplete emptying of the bladder
  • Double voiding
33
Q

How do we manage pelvic floor prolapse?

A
  • Pessaries provide additional support
  • Topical oestrogen
  • Pelvic floor exercises
  • Hysterectomy, mesh supports
34
Q

What is stress urinary incontinence?

A
  • Urine leaks from bladder during episodes of high intra-abdominal pressure
  • Occurs if pelvic organs are inadequately supported by pelvic floor
35
Q

What is female genital mutilation?

A
  • All procedures involving partial or total removal of external female genitalia or other injury to female genital organs, whether for cultural or other non-therapeutic reasons
36
Q

What are the types of FGM?

A
  • Type 1 - partial or total removal of clitoris and/or prepuce
  • Type 2 - partial or total removal of clitoris and labia minora. May or may not excise labia majora.
  • Type 3 - narrowing of vaginal orifice with creation of a covering seal by cutting and appositioning labia minora/majora with or without excision of clitoris
  • Type 4 - all other harmful procedures to female genitalia for non-medical purposes
37
Q

What are some of the consequences and complications of FGM?

A
  • haemorrhage, shock, sepsis, blood-borne infections, death
  • sexual difficulties, fertility issues, chronic pain
  • increased risk of C-section, post-partum haemorrhage, fear of childbirth
  • PTSD, flashbacks

Reproductive systems (20 decks)

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