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Reproduction and Sexual Health > Anatomy 5 - Urinary Incontinence and Prolapse > Flashcards

Anatomy 5 - Urinary Incontinence and Prolapse Flashcards

1
Q

What does the pelvic floor separate?

A

Pelvic cavity from perineum

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2
Q

What are the functions of the pelvic floor?

A

Support for pelvic organs

Urinary and faecal continence

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3
Q

What makes up the pelvic floor?

A

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane (fibrous sheet)

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4
Q

What is the deepest layer of the pelvic floor?

A

Pelvic diaphragm

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5
Q

What 2 muscle groups make up the pelvic diaphragm?

A

Coccygeus

Levator ani

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6
Q

What is the urogenital hiatus?

A

Passage through pelvic diaphragm for urethra and vagina (anterior gap between medial borders)

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7
Q

What muscle group forms the majority of the pelvic diaphragm?

A

Levator ani

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8
Q

What are the 3 parts of the pelvic diaphragm?

A

Puborectalis
Pubococcygeus
Iliococcygeus

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9
Q

What state is the levator ani in for majority of time?

A

Tonically contracted

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10
Q

When does the levator ani relax?

A

To allow urination and defacation

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11
Q

What are the attachments and insertions of the levator ani?

A

Attach via pubic bone, ischial spines and tendonous arch of levator ani
To perineal body, occygeus and walls of organs in the midline

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12
Q

What muscle creates a sling around the rectum?

A

Puborectalis

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13
Q

What is the endopelvic fascia made up of?

A

Connective tissue
Loose areolar tissue
Fibrous tissue

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14
Q

What does the fibrous tissue of endopelvic fascia form?

A

The pelvic ligaments

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15
Q

What are the major ligaments of uterus ? 3

A

Utero-sacral ligament
Tansverse cervical (cardinal) ligament
pubocervical ligament

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16
Q

What is the function of the utero-sacral ligament?

A

Stops the uterus sinking down

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17
Q

Where does the deep perineal pouch lie?

A

Below the fascia

Above the perineal membrane (slide 7 says below - check this out)

18
Q

What does the deep perineal pouch cover?

A

Inferior aspect of pelvic diaphragm

19
Q

What does the deep perineal pouch contain?

A

Part of urethra (and vagina), bulbourethral glands (males), neurovascular bundle for penis/ clitoris, extensions of ischioanal fat pads and muscles

20
Q

What is the perineal membrane?

A

Thin sheet of tough deep fascia

21
Q

What is the urogenital triangle?

A

Opening for urethra and vagina

Where the perineal membrane attaches laterally to the pubic arch

22
Q

Where does the superficial perineal pouch lie?

A

Below perineal membrane

23
Q

What does the male superficial perineal pouch contain?

A

Root of penis i.e. bulb - corpus spongiosum and crura - corpus cavernosum
Proximal spongy penile urethra
Superficial transverse perineal muscle
Branches of internal pudendal vessels
Pudendal nerve
Bulbospongiosus and ischiocavernosus muscles

24
Q

What muscles are involved in ejaculation and erection?

A

Bulbospongiosus

Ischiocavernosus

25
Q

What does the female superficial perineal pouch contain?

A 
Clitoris and crura - corpus cavernosum
Paired bulbs of vestibule
Bulbospongiosus and ischiocavernosus muscles 
Greater vestibule glands
Superficial transverse perineal muscle
Branches of internal pudendal vessels
Pudendal nerve
26
Q

What are the greater vestibular glands also called?

A

Bartholin’s glands

27
Q

What are the functions of the pelvic floor?

A

Support to pelvic organs
Urinary continence
Faecal continence

28
Q

How does the pelvic floor give support to pelvic organs?

A

Usually tonically contracted

Actively contracts when coughing, sneezing, vomiting

29
Q

What parts of the pelvic floor help maintain urinary continence?

A

External urethral sphincter
Compressor urethrae
Levator ani

30
Q

How is faecal continence maintained?

A

Tonic contraction of the pubo-rectalis bends anorectum anteriorly
Active contaction maintains continence after rectal filling
Acute angle when contracted
Relaxes to allow matter through

31
Q

What can cause injury to pelvic floor?

A 
Pregnancy/ Childbirth
Chronic constipation
Obesity
Heavy lifting
Chronic cough or sneeze
Previous pelvic injury
Menopause (degeneration of the fibrous ligaments)
32
Q

What contributes towards urinary continence?

A

Urinary bladder neck support
External urethral sphincter
Smooth muscle in urethral wall

33
Q

What organs can prolapse?

A

Uterus
Vagina
Bladder
Rectum

34
Q

What happens in a pelvic organ prolapse?

A 
Herniation through supporting fascia of:
Urethra (urethrocele)
Vagina 
Rectum (rectocele)
Bladder (cystocele)
Bowel (enterocele)
Rectouterine pouch

Into the vagina

35
Q

What happens in a uterine prolapse?

A

Pelvic floor muscles and ligaments stretch and weaken

Uterus slips down into or protrudes out of the vagina

36
Q

What are the degrees of uterine prolapse?

A

1st
2nd
3rd

37
Q

What are the treatment options for prolapse?

A

Sacrospinous fixation

Incontinence surgery

38
Q

What is sacrospinous fixation?

A

Suture sacrospinous ligament (medial to ischial spine)

39
Q

How is the sacrospinous fixation performed?

A

Vaginally

40
Q

What structures are at risk during a sacrospinous fixation?

A

Pudendal NVB

Sciatic nerve

41
Q

What is incontinence surgery?

A

Mesh through obturator canal (transobturator approach) to create a sling around the urethra

42
Q

Where are the incisions made via for incontinence surgery?

A

Through vagina and groin

Reproduction and Sexual Health (18 decks)

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