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Repro > The pelvic floor > Flashcards

The pelvic floor Flashcards

1
Q

Function of the pelvic floor

A

Support the pelvic organs

Maintain intra-abdominal pressure when coughing etc

Urinary and faecal continence

Childbirth

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2
Q

What do pelvic floor muscles form?

A

Sling under the rectum, uterus and bladder
Sling is perforated where the urethra, vagina and anal canal go through

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3
Q

Where are the pelvic floor muscles attached to?

A

Coccyx
Pubic bone

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4
Q

How do the pelvic floor muscles support the organs there? 3 ways

A

Suspension
Attachment
Fusion

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5
Q

What does suspension do?

A

Provides support working against gravity (sling like)

Using cardinal ligaments, uterosacral ligaments and round ligaments (round pulls uterus anteriorly)

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6
Q

What do the cardinal ligaments do?

A

Hold cervix and upper vagina in place (lateral cervix and vagina to lateral pelvic wall aka transverse ligament)

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7
Q

What do the uterosacral ligaments do?

A

Hold back of cervix and upper vagina

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8
Q

What is attachment provided by?

A

Arcus tendinosus fascia pelvis - the white line

Endopelvic fascia - hammock from white line laterally

Vagina attaches to levator ani, endopelvic fascia and perineal body

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9
Q

Urethra and fascia of pelvis interaction

A

Urethra lies anterior and above so gets compressed against it during increased abdo pressure
Maintains urinary continence

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10
Q

Fusion is provided by

A

Perineal body and urogenital diaphragm

Perineal body is where endopelvic fascia fuses posterior, levator ani laterally and urethra anteriorly

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11
Q

What makes up the pelvic floor?

A

Levator ani muscles + coccygeus (deep)
Urogenital diaphragm/perineal membrane
Perineal body
Perineal muscles (superficial)
Posterior compartment

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12
Q

Levator ani muscles

A

Puborectalis (pubic symphysis to rectum)

Iliococcygeus (ilium to coccyx)

Pubococcygeus (pubic symphysis to coccyx)

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13
Q

What do the levator ani muscles form?

A

Broad U shaped sheet
Stretches back and inwards from either side to meet in midline
Encircles urethra, vagina and rectum to coccyx

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14
Q

Perineal muscles to know

A

Transverse perineal muscles (superficial and deep) (across laterally)

Bulbospongiosus muscle - encircles vagina and urethra

Ischiocavernosus

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15
Q

Urogenital diaphragm - what is it?

A

Triangle sheet of dense fibrous tissue
Spans anterior half of pelvis
From inferior ischiopubic ramus –> urethra, vagina and perineal body

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16
Q

Importance of perineal body

A

Central position on pelvic floor between vagina and rectum
Where levator ani insert
Attached to external anal sphincter and coccyx

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17
Q

Blood supply to pelvic floor muscles

A

Internal and external pudendal arteries and veins

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18
Q

Lymphatic drainage of pelvic floor

A

Inguinal lymph nodes

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19
Q

Nerve supply to pelvic floor muscles

A

Pudendal nerve (S2, S3, S4)

20
Q

Pelvic floor dysfunctions

A

Pelvic organ prolapse
Vaginismus
Urinary incontinence
FGM

21
Q

What is pelvic organ prolapse?

A

Loss of support for uterus, bladder, colon or rectum
Leads to prolapse of these into vagina
Impacts quality of life and body image

22
Q

Functional disturbances of pelvic organ prolapse

A

Urination problems
Sexual problems
Anorectal problems

23
Q

Anterior compartment prolapse known as

A

Cystocele - bladder to vagina

Urethrocoele - urethra to vagina

Cystourethrocele - both to vagina

24
Q

What happens in cystocele?

A

Bladder pushes against vagina
Causes pouching within vaginal canal

25
Q

Middle compartment prolapse name

A

Uterus or vaginal apex prolapse - uterine prolapse

If entire uterus - procidentia

26
Q

Can you still get middle comparment prolapse after hysterectomy?

A

Yes - apex of vagina can prolapse (post hysterectomy vault prolapse)

27
Q

Posterior comparment prolapse names

A

Rectum into posterior vagina - vagina-rectocele

Loops of bowl into rectouterine pouch - enterocele

28
Q

Risk factors for pelvic organ prolapse

A

Age

Number of pregnancies

Vaginal delivery - 4x risk after 1st, 11x risk after 4+

Obesity - increased intra-abdo pressure

29
Q

What is perineal trauma?

A

Trauma involving any of the perineal muscles

30
Q

What is obstetric anal sphincter injuries? (OASIS)

A

Can be perineal trauma involving the anal sphincter complex

31
Q

Types of perineal trauma/OASIS

A

3rd/4th degree tears
Morbidity risk

32
Q

Prevention of OASIS/perineal trauma

A

Episiotomy - cut in oblique direction to increase area

Perineal protection during crowning (putting pressure)

Telling mother not to push when head is crowning - let it slide

33
Q

Episiotomy cut

A

Mediolateral cut through transverse perineal muscle and bulbospongiosus

34
Q

Extra risk factors for pelvic organ prolapse

A

Post menopausal oestrogen deficiency

Neuro - spina bifida, muscular dystrophy

Genetic connective tissue - Marfans, Ehlers Danlos

35
Q

Symptoms of prolapse

A

Dragging sensation

Lump

Feeling of incomplete emptying of bladder - double voiding

36
Q

Management of prolapse

A

Pessary to hold organs in place

37
Q

What is urinary incontince caused by PELVIC FLOOR?

A

Stress incontinence

38
Q

What is urge incontinence?

A

urinary incontinence caused by problems with bladder and not pelvic floor

39
Q

How do pelvid floor muscles help urethra?

A

Strong muscles keep urethra closed - help sphincters

40
Q

What is FGM? (female genital mutilation)

A

Procedures involving partial or total removal of external female genitalia or other injury to genital organs

41
Q

Why does FGM happen?

A

Religious practices
Culture - purification
Social acceptance - marriage and family honour
Fear of social exclusion

42
Q

Types of FGM

A

Type 1 - clitoroidectomy

Type 2 - excision (removal of clitoris and labia minora +/- majora)

Type 3 - Infibulation (narrowing of vaginal orifice)

Type 4 - Other harmful practices: burning clitoris or making small cut next to it
Cutting/scarring vaginal opening

43
Q

Consequences of FGM

A

Acute - haemorrhage, sepsis, death

Late - sexual difficulties, fertility issues, chronic pain, urinary outflow obstructed, smear test difficulty

Obstetric - fear of birth, postpartum haemorrhage risk, vaginal lacerations

Psychological - flashbacks, self esteem, PTSD

44
Q

Is FGM legal?

A

NO - ID and database

45
Q

Deep vs superficial muscles of pelvic floor

A

Deep - levator ani (pubococccygeus, iliococcygeus, puborectalis), coccygeus

Superficial - bulbospongiosus, tranverse perineal muscles, ischiocavernosus

Repro (22 decks)

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