216- pelvic floor disorders

Question 1

three mm of levator ani according to this lady

Answer 1

puborectalis, pubococcygeus, iliococcygeus

Question 2

what type of mm fibers are there in levator ani and what innervates

Answer 2

type 1 and 2, roots of s2-4

Question 3

genital hiatus

Answer 3

opening in pelvic floor for passage of urethra, rectum, vagina

Can become to big due to weakness of levator and lead to prolapse

Question 4

CT support of female pelvic organs

Answer 4

broad ligament, cardinal ligament, uterosacral ligament

Question 5

what is pelvic organ prolapse

Answer 5

vaginal hernia of one of pelvic organs

Question 6

perineal level support

Answer 6

bulbocavernosus, perineal membrane, transverse perineal mm, levator ani, external anal sphincter

Question 7

three types of prolapse

Answer 7

anterior vaginal wall support (cystocele)

Loss of apical support (uterine prolapse) (cardinal and uterosacral ligaments, broad lig is just orientation)

Posterior vaginal wall support (rectocele)

Question 8

three levels of pelvis support

Answer 8

I. apical. (cardinal, uterosacral ligament) defect results in uterine descent

II. midlevel. (lateral support) defect leads to cystocele or rectocele)

III. distal (urethral, perineal). defect leads to urinary or fecal incontinence

Question 9

basic problem in stress and urge incontinence

Answer 9

stress- urethra (valve) problem due to sneezing, coughing

Urge- bladder (reservoir, detrussor)

Question 10

receptors on detursor and urethra

Answer 10

detrusor: beta adrenergic (relaxes with symp stim) and cholinergic
Bladder neck/urethra: alpha adrenergic (contracts with symp stim)

Question 11

what has to relax in order to defecate

Answer 11

IAS (automatically occurs following rectal distension) followed by EAS and puborectalis

Question 12

what are modifiable risk factors for anal sphincter injurY?

Answer 12

vaginal delivery, esp with tools (forceps, vacuum, episiotomy), macrosomia