Pelvic Floor

Question 1

Where are the pelvic viscera located?

Answer 1

Pelvic cavity (true pelvis) 
Located within the lesser part of the pelvis, beneath the pelvic brim.

Question 2

what makes put he lateral wall of the pelvic cavity?

Answer 2

Obturator internus and piriformis.

Question 3

What is the pelvic floor?

Answer 3

Funnel shaped musculature structure that attaches to the lesser pelvis, separating the pelvic cavity from the inferior perineum.

Question 4

What are the gaps in the pelvic floor and what do the transmit?

Answer 4

Urogenital hiatus - urethra (anterior)

Rectal hiatus - anal canal (central)

Question 5

What is the pelvic floor formed by?

Answer 5

Pelvic diaphragm

• Coccygeus and levator ani muscles
• Fascia covering the superior and inferior aspect of these.

Superficial muscles and structures

• Urogential perinuem
• Anal perineum

Question 6

What are the functions of the pelvic floor?

Answer 6

Support the abdominal viscera through tonic contraction.
Resist increases in intra-abdominal pressure (coughing, heavy lifting) with sphincter action on rectum and vagina.
Urinary and fecal continence
- Muscle fibres have a sphincter action on rectum and urethra - relax to allow defection.

Question 7

What are the boundaries of the perineum

Answer 7

Ant: pubic symphsis
Post: coccyx
Lateral: inferior pubic rami, ischial rami, ischial tuberosity, sacrotuberous ligaments
Roof: Pelvic floor
Base: Skin and fascia

Question 8

What divides the perineum into the urogenital and anal perineum?

Answer 8

Imaginary line between ischial tuberosities

Question 9

What is found in the urogenital perineum?

Answer 9

Superior fascia
Sphincter urethrae muscles
Superficial fascia (perineal membrane)

Question 10

What are the superficial perineal muscles?

Answer 10

Bulbospongiosus - compresses urethra and vagina
Ischiocavernosus - compresses corpus cavernosum
Superficial transverse perineal muscle - stabilises perineal body

Question 11

What is found in the anal perineum?

Answer 11

Anus (anal orifice)
Levator ani
Ischioanal fossae

Question 12

What are the levator ahi muscles and what innervates them?

Answer 12

Puborectalis
pubococcygeus
Illiococcygeis

Pudendal nerve (S2,S3,S4)

Question 13

Describe puborectalis.

Function?

Answer 13

Extends from pubic bone body around anal canal in U shape
Maintains faecal continence
Relaxes during defecation

Question 14

Describe pubococcygeus

Answer 14

Pubic bone body and tendinous arch.
Around urogenital hiatus to cocyx via anococcygeal liigament

Elevates pelvic floor

Question 15

Describe iliococcygeus

Answer 15

Ischial spines and posterior tendinous arch to coccyx via anococcygeal ligament

Elevates pelvic floor

Question 16

What is coccygeus? Innervation?

Answer 16

Smaller, most posterior pelvic floor component.
Coccygeus lies to the posterior, overlying the sacrospinous ligament.
Anterior rami of S4 and S5

Elevates pelvic floor

Question 17

What is the perineal body? What does it consist of?

Answer 17

Fibromsucular mass at junction between urogenital and anal triangles in the perineum.
Consists of skeletal muscle, smooth muscle, collagenous and elastic fibres.

Question 18

What is the function of the perineal body in women?

Answer 18

Anchoring perineal muscles and rectum

Supports the lower posterior part of the vaginal wall against prolapse and forms a dense attachment for the two halves of the levator muscles in the midline.

Acts as a tear-resistant body between the vagina and external anal sphincter muscle tube during childbirth (now stressed by evolution of large fetal head size).

Question 19

What attaches to the perineal body?

Answer 19

• External anal sphincter
• External urethral sphincter
• Bulbospongiosus
• Superficial and deep transverse perineal muscles
• Fibres of levator ani

Question 20

What happens if the perineal body ruptures in childbirth?

Answer 20

Prolapse of structures such as vagina and uterus.

Question 21

Describe the damage childbirth can cause to the pelvic floor muscles

Answer 21

Fibres of pubococcygeus can be damaged during childbirth –> Prolapse or herniation of the bladder/urethra with incontinence.

Medial fibres of puborectalis (insert into perineal body) torn
Herniation of rectum
–> Faecal incontinence.

Question 22

What may pelvic floor damage lead to?

Answer 22

Stretch of the pudendal nerve
- Neuropraxia and muscle weakness

Stretch and damage of pelvic floor and perineal muscles

Stretch/rupture of ligament supports of muscles
- Ineffective muscle action

Prolapse of organs
- Loss of tone in muscles/ damage to perineal body

stress incontinence

Question 23

What is the function of legator ahi in childbirth? Which muscles are most prone to injury? Why?

Answer 23

Supporting fetal head

Pubococcygeus and puborectalis as they are most medial.

Question 24

Why does prolapse of pelvic organs occur?

Answer 24

Damage to perineal body

Loss of tone in pelvic muscles

Question 25

Give risk factors for pelvic floor dysfunction

Answer 25

Age
Number of vaginal deliveries
Menopause (atrophy of tissueS)
Family history of pelvic floor dysfunction
Obesity
Chronic cough
Intrinsic CT laxity

Question 26

What are the treatments for pelvic floor dysfunction?

Answer 26

Pelvic floor muscle exercises
- safe, effective

Continence surgeries

• Increase support to sphincter mechanisms and prevent descent of bladder neck
• Colposuspension
• Tenison free vaginal tape

Prolapse procedures:
Replace organs
Restore CT support
Maintain function

Question 27

What are the side effects of continence sugeries?

Answer 27

Voiding difficulty, urinary retention

Overactive bladder disease

Question 28

What are the side effects of prolapse procedures?

Answer 28

Recurrence
New incontinence
Dyspareunia (painful sex)