Topic 11: The Pelvic Floor Flashcards
Pelvic organs - lower urinary tract
bladder & urethra
Pelvic organs - reproductive
Female- uterus, vagina
Male- prostate
Pelvic organs - lower GIT (gastrointestinal tract)
Rectum, anal canal
Anterior compartment of pelvic organs
Bladder, urethra
Middle compartment of pelvic organs
Uterus, vagina/ prostate
Posterior compartment of pelvic organs
Rectum, anal canal
Pelvic Organs of the female
Bladder, urethra, uterus, vagina, rectum, anus
Pelvic Organs of the male
bladder, urethra, prostate, rectum, anus
Functions of the pelvic floor
- the pelvic floor = made up of both muscle and fascia
- helps support the pelvic (&abdominal) viscera
- contributed to increases in intra-abdominal pressure and then helps maintain intra-abd pressure
- act as sphincters for the passageways through the pelvis - urethra, vagina, anus
- assist in childbirth – form a ‘gutter’ for the head of the foetus
Pelvic floor muscles
Levator Ani --> helps raise pelvic floor - iliococcygeus - pubococcygeus - puborectalis Coccygeus
Coccygeus Proximal attachments
Spine of ischium
Coccygeus Distal attachments
- lateral coccyx
- lower lateral sacrum
Coccygeus actions
- increases intra-abd pressure
- stops organs from coming out (viscera)
- pulls coccyx anteriorly & repositions it
Coccygeus nerve supply
?
Puborectalis PA &DA
- originates lateral from the symphysis on both sides and encircles the rectum (anorectal junction)
Puborectalis function
Sphincter for the rectum
- acts as a ‘sling’
When contracted- shortens + pinches off the rectum
Kinks the rectum to stop ‘fecal incontinence’
Puborectalis nerve supply
Nerve to Levator Ani
Pubococcygeus PA
- posterior surface of body of pubis
- tendinous arch
Pubococcygeus DA
- coccyx
- perineal body
- anococcygeal raphe
Pubococcygeus Actions
- supports the vagina and prostate in females + males respectively
- aids ejaculation & assists proper positioning of foetus’ head
- increases intra-abdominal pressure
Pubococcygeus nerve supply
Nerve to Levator Ani
Iliococcygeus PA
- ischial spine
- tendinous arch
Uterosacral ligaments
suspends & supports the uterus and cervix in position
Iliococcygeus actions
- supports the viscera in the abdominal cavity
- increases intra-abdominal pressure
Endopelvic fascia
- complex web made up of loose connective tissue, adipose tissue, and smooth muscle
- provides a conduit for passage of nerves & blood vessels to the organs – helps run them to the right areas
- helps maintain the organs in place (supports muscles)
Rectovaginal or Rectovesical/ rectoprostatic fascia
Between rectum & either vagina (female) or bladder plus prostate (male)
Iliococcygeus DA
- coccyx
- perineal body
- anococcygeal raphe
Pubocervical fascia
between bladder/ urethra & vagina
The Perineum
Superficial layer of muscles
- inferior to pelvic floor muscles
two main regions of perineum
- urogenital triangle
2. anal triangle
Iliococcygeus nerve supply
Nerve to Levator Ani
Urogenital Triangle
Urinary + genital organs come through here (anteriorly)
Anal triangle
Anal muscles come through here
Urogenital triangle muscles
- ischiocavernosus
- bulbospongiosus
- superficial transverse perineal
- deep transverse perineal
Anal triangle muscles
External anal sphincter
Perineal muscles functions
- provide added closure to vagina & anus
- support & fix the perineal body
- maintain erection of penis/ clitoris
Male bulbospongiosus
around base of penis
female bulbospongiosus
around vaginal opening
Perineal Body
- irregular fibromuscular mass
- located in the midline between the anus and the vagina/ bulb of the penis
- site of convergence for both muscle + fascia which form the pelvic floor
Nerve supply to pelvic floor
Nerve to levator ani - with slight input from the Pudendal nerve
Nerve supply to the perineum
Pudendal nerve- with slight input from the nerve to levator ani
