Urinary incontinence and prolapse Flashcards
Functions of pelvic floor?
- Separates pelvic cavity (above) from perineum (below)
- Plays important role in providing support to pelvic organs
- Plays an important role in maintaining continence (urinary & faecal)
3 layers of pelvic floor?
Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane
Pelvic diaphragm?
Deepest later of pelvic floor
Levator ani and coccygeus
Appearance of pelvic diaphragm?
Sling
Name areas
What forms most of pelvic diaphragm?
Levator ani
What are the attachments of the levator ani?
Is levator ani contracted or relaxed?
Tonically contracted most of the time
Innervation of levator ani?
Pudendal nerve and nerve to levator ani
Most medial part of levator ani?
Puborectalis
3 parts of levator ani?
Puborectalis
Pubococcygeus
Iliococcygeus
What must relax to allow urination and defeceation?
Levator ani
Name muscles of levator ani
Additional support to pelvic floor?
Endopelvic fascia
Pelvic ligaments
Where does the deep perineal pouch lie
Below the fascia covering the inferior aspect of pelvic diaphragm
Above perineal membrane
What does the deep perineal pouch contain?
Part of urethra (and vag in females)
Bulbourethral glands (male)
Neurovascular bundle for penis/ clitoris
Extensions of ischiocanal fat pads and muscles
Name the areas
Do male or females have deep transverse perineal muscle?
Males
What is perineal membrane?
Thin sheet of tough, deep fascia
Lies superficial to deep perineal pouch
Where does the perineal membrane attach
Laterally to the sides of the pubic arch, closing urogenital triangle
Openings in perineal membrane?
Urethra
Vagina in females
Name this membrane
Where does the female superficial peroneal pouch lie?
Below perineal membrane
Where is the female erectile tissue contained?
Superficial perineal pouch
What does the superficial perineal pouch contain?
Clitoris and crura
Bulbs of vestibule
Associated muscles - bulbospingiosus (covers bulb) and ischiocavernous (covers crura)
Greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and nerve
Name the areas
Where does male perineal pouch lie?
Below the perineal membrane
What does male superficial perineal pouch contain?
Root of penis (bulb, crura and associated muscles)
Associated muscles - bulbospingiosus and ischiocavernosus
Proximal; spongy urethra, superficial transverse perineal muscle & branches of internal pudendal vessels and nerve
What is male bulb made from?
Corpus spongiosum
What is male crura made from?
Corpus cavernosum
Name areas of male superficial perineal pouch
Perineal body?
Ball of tissue
Contains fibrous tissue and skeletal and smooth muscle
Important in support of pelvic floor
where is perineal body in females?
In between rectum and most posterior part of vagina
Where is perineal body in males?
Slightly anterior to rectum, behind urethra
Which muscles converge at perineal body?
Bulbospongiosis, external anal sphincter, perineal muscles (superficial and deep), slips of muscle from levator ani, external urethral sphincter and muscular coating of rectum
When does pelvic floor actively contract?
Coughing, sneezing and vomiting
What structures help maintain urinary continence?
External urethral spincter
Compressor urethrae
Levator ani
What structures help maintain faecal continence?
Tonic contraction of puborectalis bends anorectum anteriorly
Active contraction maintains continence after rectal filling
1st degree uterine prolapse?
Just cervix dropped into vagina
2nd degree uterine prolapse?
Cervix drops just inside opening of vagina
3rd degree uterine prolapse?
Cervix just outisde of vagina
4th degree uterine tear?
Entire uterus outside of vagina
