The pelvic floor

Question 1

How do the pelvic floor muscles maintain contenance?

Answer 1

• The external urethral sphincter contracts to stop leakage from the bladder
• The puborectalis muscle acts like a sling around the bladder and rectum, maintaining a 80 degree flexion at the opening of the urethra

Question 2

How can the pelvic floor be damaged and what effects does this have?

Answer 2

Damaged by:
- CHILDBIRTH (ligament stretch, muscle stretch, nerve stretch, muscle and perineal body tear)
This weakens the pelvic floor leading to incontinence and pelvic organ prolapse.

Question 3

What muscle makes up the majority of the deep layers of the pelvic floor?

Answer 3

Levator ani muscles- pubococcygeus and iliococcygeus muscles

Question 4

What is the urogenital hiatus?

Answer 4

A u shaped hole in the front of the levator ani muscles, where the vagina, rectum and urethra run through

Question 5

What is the function of the pelvic floor muscles?

Answer 5

• suspend organs in the right place
• resist rises in intra abdominal pressure
• maintain continence
• facilitate defecation and micturition

Question 6

What muscle makes up the external urethral sphincter?

Answer 6

The deep perineal muscles

Question 7

What is the role of he perineal body?

Answer 7

A point of attachment for the pelvic floor muscles to fuse at

Question 8

What 3 muscles make up the superficial perineal muscles in women?

Answer 8

ischiocavernous muscle, bulbocavernous muscle, external anal sphincter muscle

Question 9

What is vaginismus?

Answer 9

Constant contraction of the pelvic floor muscles, making penetrative sex painful

Question 10

What blood vessels supply the pelvic floor muscles?

Answer 10

pudendal arteries and veins

Question 11

To where do the lymphatics of the pelvic floor muscles drain?

Answer 11

Inguinal nodes

Question 12

What nerve supplies the pelvic floor muscles?

Answer 12

The pudendal nerve

Question 13

What is a cystocele?

Answer 13

prolapse of the urethra or bladder into the vagina

Question 14

what is a rectocele?

Answer 14

Prolapse of the anus into the vagina

Question 15

what is a uterine prolapse?

Answer 15

uterus prolapsing down into the vagina

Question 16

What are the risk factors for pelvic organ prolapse?

Answer 16

• obesity
• old age
• lots of vaginal deliveries
• big babies
• post menopause
• chronic cough

Question 17

Which pelvic floor muscles are cut during a episiotomy?

Answer 17

Superficial transverse perineal and bulbospongiosus muscle, theyre cut at a mediolateral angle to direct tearing away from the perineal body and anus

Question 18

When are episiotomies indicated?

Answer 18

• large babies
• abnormal deliveries
• use of instruments
• regid perineum

Question 19

Describe the 4 degrees of perineal tears

Answer 19

1st= superficial only
2nd= torn perineal muscles
3rd= torn perineal muscles and anal sphincter 
4th= torn perineal muscles, anal sphincter and rectum

Question 20

Define female genital mutilation

Answer 20

All procedures or injury involving partial or total removal of the external female genitalia, whether for cultural or for non theraputic reasons

Question 21

What are the acute and long term consequences of FGM?

Answer 21

acute: sepsis, hiv, haemorrhage, pain
late: PTSD, sexual difficulties, keloid scars, urine and menses obstruction

Question 22

What are your obligations when you encounter someone with FGM

Answer 22

If under 18 report to social services, in over 18s it needs to be reported to a database. If you’ve corrected it for delivery, you cannot redo it even if she asks.

Question 23

What are the 4 types of FGM?

Answer 23

1- clitoris only removed
2- clitoris and labia minora +/- labia majora removed
3- sealing the labia major together +/- removal or the labia minora and clitoris (infibulation)
4- anything else (burning clitoris, cutting it, pricking or piercing it ect)