The Pelvic Floor Flashcards
Give some of the functions of the pevlic floor
- Supports the pelvic organs- (vagina, uterus, ovaries, bladder & rectum)
- maintains intra-abdominal pressure in coughing, laughing, vomiting etc.
- facilitate defaecation and micturition (urination)
- maintains urinary and faecal continence
- facilitate childbirth
What are the 3 mechanism by which the pelvic floor provides support?
- Suspension
- Attachment
- Fusion
Which ligaments of the pelvic floor provide support via suspension
- cardinal ligament - holds cervix and vagina in place
- uterosacral ligament- holds back of cervix and upper vagina laterally
- round ligament- maintains anteverted postion of uterus
Which 2 forces act on the pelvic floor?
- Gravity
- Intra-abdominal pressure
What ligaments provide attachment for the pelvic floor?
- Arcus tendinosus fascia pelvis (ATFP) or ‘white line’
- Endopelvic fascia (stretches from white line laterally → vaginal wall medially)
Explain how the pelvic floor supports the peritoneal contents by fusion
The lower half of the vagina is supported by fusion of the vaginal endopelvic fascia to the perineal body posteriorally, urethra anerioraly and levator ani laterally
What are the different muscles of levator ani?
- Puborectalis
- Pubococcygeus
- Iliococcygeus
What is the perineal body?
Area between vagina and rectum where all levator ani muscles insert
What are the 2 types of perineal muscle?
- Transverse perineal (superficial and deep)
- Bulbospongiosus - around the vagina
Which muscles of the pelvic floor are most commonly involved in perineal trauma?
The Perineal muscles
What is the urogenital diaphragm?
- a triangular sheet of dense fibrous tissue
- spans anterior half of pelvic outlet
- Supports the pelvic floor
Describe the blood supply of the pelvic floor
Internal and external pudenal arteries supply muscles
Deoxygenated blood drains via pudenal veins
What is the lymphatic drainage of the pelvic floor muscles?
Inguinal lymph nodes
What nerves supply the muscles of the pelvic floor?
Pudenal nerve
(arises from S2, S3 and S4)
What is Pelvic Organ Prolapse?
Loss of support of the uterus, bladder, colon or rectum leading to prolapse into the vagina
What is the incidence of pelvic organ prolapse?
~40% of women will have some degree of POP in their lifetime
What is a cystocele (or anterior prolapse)?
Where the bladder prolapses into the vagina
What is a urethrocele?
Where the urethra prolapses into the vagina
What is cystourethrocoele?
Where both the bladder and the urethra prolapse into the vagina
What is middle compartment prolapse?
Prolapse of the uterus into the vagina
What is post hysterectomy vault prolapse and how does it happen?
Where the apex of the vagina prolapses into the vagina
Occurs because the supporting ligaments have been removed when the uterus was removed
What is an enterocele?
Where the rectum prolapses into the rectovaginal space
Give some of the risk factors that increase risk of prolpase
- Age
- Having been pregnant
- Vaginal delivery (x4 increase after 1 child, x11 increase >4 children)
- Obestity
- Chronic raised intra abdominal pressure
- Post menopausal oestrogen deficiency
- neurological
- genetic connective tissue disorder
What are the surgical and non-surgical options for treating someone with prolapse?
Non-surgical: pessaries - hold the pelvic organs between 2 bones
Surgical: definitive treatment
What are obstetric anal sphincter injuries and what is the risk?
Perineal tears of the anal sphincter complex during childbirth
Can cause significant morbidity
What can be done to prevent obstetric anal sphincter injuries?
Episiotomy - reduced risk by 50% of a 3rd degree tear
Involves cutting bulbospongiosus and transverse perineal muscles
Also… encourage mother not to push when head is crowning
What is stress incontinence?
Weakness of muscles of the pelvic floor meaning external urethral sphnicter does not close when intra-abdominal pressure is raised
What is vestibulodynia?
A painful vulva
What is vaginismus and what are the implications?
Pain on vaginal penitration due to involuntary muscle spasm
-cannot have sex or insert tampons
Define FGM
Femal Genital Mutilation
All procedues involving partial or total removal of external female genitalia or other injury to the female genital organs
What are the 4 types of FGM?
What are some of the complications of FGM?
- Haemorrhage
- Sepsis/ Infection
- Sexual difficulties
- Fertility issues
- chronic pain
- fear of childbirth
- psychological flashbacks
How does posterior compartment pelvic floor dysfunction present?
- Vaginal/ rectal lump
- constipation
- incomplete evacuation
- dyssynergic defecation
- anal incontinence
What can cause posterior compartment pevlic floor dysfunction?
- rectocele
- drugs (opiates, iron supplements)
- dehydration
- immobility
- pregnancy
- post-op pain
