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Repro > The Pelvic Floor > Flashcards

The Pelvic Floor Flashcards

1
Q

What does the pelvic floor form the upper border of?

A

The perineum

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2
Q

What pierces the pelvic floor?

A

Urethra Vagina Rectum

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3
Q

Functions of the pelvic floor?

A

Support the abdominopelvic viscera through tonic contraction Resistance to increase in intra-pelvic/abdominal pressure during coughing, lifting heavy objects Urinary and fecal continence

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4
Q

What two parts does the pelvic floor separate?

A

The perineum and the abdominal cavity

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5
Q

What shape is the pelvic diaphragm?

A

Bowl or funnel shaped

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6
Q

What are the two significant holes in the pelvic floor?

A

Urogenital hiatus - anteriorly situated allowing passage of urethra and vagina in females Rectal hiatus - centrally positioned gap allows passage of anal canal

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7
Q

What is between the two holes in the pelvic floor?

A

The perineal body - a fibrous node that joins the pelvic floor to the perineum

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8
Q

How is urinary and fecal continence maintained by the pelvic floor?

A

Muscle fibres have a sphincter action on the rectum and urethra Can relax to allow urination and defacation

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9
Q

What are the main muscles that make up the pelvic floor?

A

Levator ani -pubococcygeus -puborectalis -iliococcygeus Coccygeus

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10
Q

Innervation of the levator ani muscles?

A

Branches of the pudendal nerve S2-4

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11
Q

Attachments of the levator ani muscles?

A

Anteriorly - pubic bodies of hip bone Laterally - thickened fascia of obturator internus called the tendinous arch Posteriorly - ischial spines of hip bone

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12
Q

What is the pelvic floor?

A

A muscular and fibrous tissue diaphragm which fills the lower part of the pelvic canal Closes the abdominal cavity

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13
Q

Describe the positioning of the puborectalis

A

U-shaped sling, extending from the pubic bone, past the urogenital hiatus, around the anal canal.

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14
Q

What does tonic contraction of the puborectalis create?

A

Bends the canal anteriorl, creating the anorectal angle (90*) at the anorectal junction.

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15
Q

Main function of the puborectalis?

A

Faecal continence

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16
Q

Which muscle makes up the main constituent of the levator ani?

A

Pubococcygeus

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17
Q

Describe the positioning of the pubococcygeus

A

Arise from the body of the pubic bone and anterior aspect of the tendinous arch

Fibres travel around the margin of the urogenital hiatus and run posteriomedially, attaching at the coccyx and anococcygeal ligament

Loop around the vagina (pubovaginalis) and prostate as they run inferiorly and medially

Some fibres terminate in the perineal body

18
Q

Describe the position of the iliococcygeus

A

Thin muscle fibres, start anterioly at the ischial spines and posterior aspect of the tendinous arch.

Attach posteriorly to the coccyx and anococcygeal ligament

19
Q

Innervation of the coccygeus?

A

Anterior rami of S4 and S5

20
Q

Describe the position of the coccygeus muscle.

A

Smallest and most posterior

Originates from ischial spines and travels to lateral aspect of the sacrum and coccyx, along supraspinous ligament

21
Q

What is the role of the levator ani muscle during birth?

A

Supports fetal head during cervix dilation in birth

22
Q

What is at high risk of damage during the second phase of birth?

A

Levator ani and pudendal nerve

Especially pubococcygeus and puborectalis as they are situated most medially

23
Q

What can injury to the pelvic floor muscles lead to?

A

Urinary stress incontinence

Rectal incontinence

Prolapse of pelvic viscera

24
Q

What can cause prolapse of the vagina?

A

Trauma or decrease in tone to muscles

Damage to the perineal body in childbirth

25
Q

How can damage to the perineal body be avoided in childbirth?

How?

A

Episiotomy - surgical cut to the peritoneum

Prevents uncontrolled tearing of perineal muscles

26
Q

Risks of an episiotomy?

A

Can cause damage to the vaginal mucosa and submucosa

27
Q

What leads to rectal herniation?

A

When medial fibres of the puborectalis are torn within the perineal body

28
Q

Risk factors for prolapse?

A

Age

Multiple vaginal deliveries

Family history

Weight

Chronic coughing

29
Q

How can the pelvic floor be repaired?

A

Surgically

30
Q

How can the pelvic floor damaged in child birth?

A

Stretch of the pudendal nerve causing neuropraxia and muscle weakness

Stretch and damage of pelvic floor and perineal muscles

Stretch and rupture of ligaments that support the muscles - ineffective muscle action

31
Q

Risk factors of pelvic floor dysfunction?

A

Age

Menopause - atrophy of tissues after oestrogen withdrawal

Obesity

Chronic cough

Intrinsic connective tissue laxity due to intrinsic conditions

32
Q

What do continence surgeries do?

A

Increase support to sphincter mechanism and prevent descent of bladder neck

33
Q

What can be used in continence surgeries?

A

Vaginal tape

Colpsuspension

34
Q

Side effects of continence surgery?

A

Voiding difficulty/urinary retention

Overactive bladder disease (obstruction)

35
Q

What is done in prolapse procedures?

A

Replace prolapsed organs

Restore connective tissue supports

Maintain function

36
Q

Problems with prolapse procedures?

A

Recurrence

New incontinence

Dyspareunia

37
Q

Which muscles can be felt on contracting the rectum?

A

External anal sphincter

Puborectalis

38
Q

How can childbirth lead to incontinence?

A

The pubococcygeus can be torn - Can lead to herniation of the bladder or prolapse with subsequent incontinence

The puborectalis can be torn with the perineal body leading to herniation of the rectum - faecal incontinence or difficulty in defacation.

39
Q

What is the aim of an episiotomy?

A

Avoid damage to the perineal body

40
Q

What tissues need to be repaired after an episiotomy?

A

Vaginal mucosa and submucosa, perineal skin, muscles and fascia of the perineum

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