The Pelvic Floor

Question 1

Describe the roles of the pelvic floor. (5)

Answer 1

Continence - urinary and faecal.
Intra-abdominal pressure - maintains the high pressure needed in coughing etc.
Childbirth - facilitates childbirth.
Support the pelvic organs - suspension of organs (cardinal ligaments, uterosacral ligaments, round ligament of uterus), attachment point for the vagina.

Question 2

Describe the deep muscles of the pelvic floor. (6)

Answer 2

The U shaped Levator Ani muscles that fan out to encircle the urethra, vagina and rectum. There are three: pubococcygeus, puborectalis and iliococcygeaus. The midpoint of these attachments is the perineal body.

Question 3

Describe the superficial muscles of the pelvic floor. (3)

Answer 3

Bulbospongiosus - around labia
Ischiocavernosus - along the line of the ischium
Superficial transverse perineal.

Question 4

Describe the urogenital diaphragm. (2)

Answer 4

Sheet of dense fibrous tissue that spans the anterior half of the pelvic floor and attaches to the urethra, vagina and perineal body.

Question 5

Describe the neurovascular supply to the pelvic floor. (3)

Answer 5

Pudendal nerve
Pudendal artery
Pudendal vein.

Question 6

Explain the purpose of an episiotomy. (5)

Answer 6

An episiotomy is cutting of bulbospongiosus and transverse perineal muscles to allow for a big baby or instrumental delivery and to prevent tears. (1st degree involves vaginal mucosa, 2nd degree involves perineum, 3rd degree tear involves anal sphincter, 4th degree involves the rectal mucosa)

Question 7

Describe the different types of pelvic organ prolapse. (8)

Answer 7

Anterior - cystoceole, urethrocoele, or cystourethrocoele.
Middle - uterus prolapse of varying degrees, or a ‘vault’ prolapse of vagina following a hysterectomy.
Posterior - rectocoele or enterocoele (bowel in the rectouterine space).

Question 8

Describe the risk factors (5), examinations (3)and management (4) for pelvic organ prolapse.

Answer 8

Risk factors: age, parity, vaginal delivery, oestrogen deficiency including menopause, chronic increased abdominal pressure.
Examinations: lumps, constipation, smoking ‘coming down’
Management depends on how the pt is coping, severity, general health:
Non-surgical - pessaries, pelvic floor exercises.
Surgical - hysterectomy, mesh supports.