Urinary Incontinence and Prolapse Flashcards
What 3 layers make up the pelvic floor?
pelvic diaphragm
muscles of perineal pouches
perineal membrane
What two muscles make up the pelvic diaphragm?
levator ani and coccygeus
What are the features of the pelvic diaphragm?
deepest layer
has the urogenital hiatus + passage for the urethra + vagina for females
What are the 3 parts/muscles of the levator ani?
puborectalis
pubococygeus
ileococygeus
What is the function of the puborectalis?
forms a sling around the rectum - tonic contractions bend the anorectum anteriorly
What is the usual state of the levator ani - contracted or not?
tonically contracted most of the time
relaxes to allow urination and defeacation
What is the levator ani innervated by?
pudendual nerve + nerve to the levator ani
What is then tendineous arch of the levator ani?
thickened layer of fascia that covers the obturator internus
Where do the deep perineal pouch muscles lie?
above the perineal membrane but below the fascia covering the inferior aspect of the pelvic diaphragm
What are the deep perineal pouch muscles?
compressor urethrae
external urethreal spinchter
deep transverse perineal muscles
What is the role of the compressor urethrae and external urethreal spinchter? What is their effect on the urethra?
work together BUT
compressor pushes down on the urethra
spinchter contracts the urethra
What type of muscle is the deep transverse perineal muscles in men?
skeletal muscle
What type of muscle is the deep transverse perineal muscles in women?
smooth muscle
What does the deep transverse perineal muscles contain?
bulbourethral glands
Where does the superficial perineal pouch lie?
beneath the perineal membrane
What does the superficial perineal pouch contain in males?
root of the penis - bulb and crura
What are the characteristics of the bulb in males?
corpus spongiosum covered by bulbospongiosus muscle
What are the characteristics of the crura in males?
corpus cavernosum covered by ischiocavernosum
Apart from the crura and the bulb - what else does the superficial perineal pouch contain in males?
spongy urethra
superficial transverse perineal muscles
branches of the internal pudendual vessels and nerves
What does the superficial perineal pouch contain in females?
bulbs of the vestibule
crura
What are the characteristics of the bulb in females?
paired - bulbospongiosis
What are the characteristics of the crura in females?
corpus cavernosum covered by ischiocavernosus
What is the perineal membrane?
thin sheet of tough deep fascia superficial to the perineal pouch
attaches laterally to the pubic arch - closing the urogenital triangle
What is a urethrocele?
urethra protruding into the vaginal wall
What is a cystocele?
bladder protruding into the vaginal wall
What is a rectocele?
rectum protruding into the vaginal wall
What is a enterocele?
bowel protruding into the vaginal wall
How do prolapses present?
lump in vagina
dragging feeling
urinary incontinence
How are prolapses graded?
1 - in vagina
2 - at introitus
3 - outside vagina
What does a procidenta prolapse mean?
completely outside the vagina
How is the pelvic organ prolapse qunatification system measured?
patient straining = 6 specific sites measured
patient at rest = 3 specific sites measured
each site is measured in relation to the hymen which is fixed
What lifestyle management options are there for prolapse?
loose weight
stop smoking
avoid heavy lifting
reduce constipation
What non surgical management is there for prolapse?
pessarys - tucked behind the pubic symphysis
used for women who are planning for future pregnancies, or women unsuitable for surgery or women awaiting surgery
What surgical management is there for prolapse?
sacrospinous fixation
vaginal hysterectomy
manchester repair
What conditions come under pelvic floor dysfunction?
bladder + bowel dysfunction
prolapse
vulvodynia
chronic pelvic pain
What are the risk factors for urinary incontinence?
women high BMI (must have BMI = 30 to have surgical treatment) smoking diabetes older age
What physical examinations should you do for urinary incontinence?
standing or supine test
post void residual volume
urine analysis
bladder diary
What is the medical treatment for urge incontinence?
1st line: mirabegon - beta 3 adrenigic agonist that relaxes the bladder
2nd line: antecholinergics - stop bladder contracting but get anticholinergic side effects/dementia later in life
botilium toxin into detrouser muscle
What is the medical treatment for stress incontinence?
duloetine - combined noradrenaline and serotonin reuptake inhibitor - increases urethral close pressure
surgery - artificial spinchters, low tension vaginal tape
