The Pelvic Floor Flashcards
What is the function 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 defaecation and micturition
maintain urinary and faecal continence
facilitate childbirth
Name the structures that make up the pelvic floor
Levator ani muscles
Urogenital diaphragm/perineal membrane
Perineal body
Perineal muscles
Posterior compartment
Describe the muscles of the levator ani
U shaped sheet = from either side of pelvis to mid-line
Encircles urethra, vagina, rectum = forming the perineal body
Muscles = pubococcygeus; puborectalis and iliococcygeus, coccygeus
Name the muscles of the levator ani
Pubococcygeus, puborectalis, iliococcygeus, coccygeus
What is the perineal body?
Central position on the pelvic floor between vagina and rectum
Insertion for levator ani muscles
Supports perineal structures
What happens as a result of perineal body dysfunction?
Vaginal probs
Anal probs
Urinary probs
What is the urogenital diaphragm?
Triangular sheet of dense fibrous tissue = support pelvic floor
Attaches medially to the urethra, vagina and perineal body
What is included in the term ‘pelvic floor dysfunction’?
Pelvic organ prolapse (POP)
Incontinence- urinary
Posterior compartment pelvic floor dysfunction
Obstetric trauma including episiotomy
FGM
Vaginismus = muscles in permeant state of tension
Vulval pain syndromes
Describe pelvic organ prolapse
Loss of support for the uterus, bladder, colon, rectum = prolapse into the vagina
Functional disturbances = anorectal, urinary, sexual
40% of women
How is pelvic organ prolapse classified?
Anterior compartment = bladder prolapse
Middle compartment = uterus prolapse
Posterior compartment = rectum prolapse
Post-hysterectomy vault = vaginal vault prolapse, prolapse of vaginal cuff
What are the risk factors for pelvic organ prolapse?
Age
Parity
Vaginal delivery- 4x increased risk after 1st child; 11x increase after >/= 4 deliveries
Postmenopausal oestrogen deficiency
Obesity and causes of chronic raised intra-abdominal pressure
Neurological = spina bifida, muscular dystrophy
Genetic CT disorders
What is an episiotomy?
Surgical cut made at the opening of the vagina during childbirth to aid diff delivery/prevent rupture of tissues
Cut medio-lateral
Structures = vaginal ep, transverse perineal muscle, bulbocavernosus muscle, perineal skin
Define FGM
all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs, whether for cultural or other non-therapeutic reasons
What are the consequences of FGM?
Haemorrhage- can be severe, leading to shock
Severe pain- usually performed with no anaesthesia, but even when medicalised
Sepsis- severe infection
Tetanus
Acute urinary retention
Hepatitis, HIV
Death
Sexual/conceiving diff
Chronic pain
Keloid scar
Labial fusion
Postpartum haemorrhage
Episiotomy
Psychological = PTSD, anger, flashbacks, trust issues
Briefly outline the types of FGM
1 = removal of clitorus
2 = removal of clitorus, labia minora, with/without excision of labia majora
3 = sealing vaginal orrifice
4 = all other harmful procedures
