Repro5 - The Pelvic Floor Flashcards
4 functions of the pelvic floor
- ) Support - of the pelvic organs, mainly the vagina, uterus, ovaries, bladder, and rectum
- ) Pressure Maintenance - intra-abdominal pressure during coughing, vomiting, sneezing and laughing
- ) Continence - urinary and faecal continence
- ) Childbirth
What are the 3 mechanisms for support of the pelvic organs?
Suspension (3 ligaments)
Attachment
Fusion
- ) Suspension - vertical support against gravity and intra-abdominal pressure
- cardinal ligaments holds the cervix and vagina in place
- uterosacral ligaments holds the cervix and vagina laterally
- round ligament - keeps anteverted position of uterus - ) Attachment - provided by the:
- arcus tendinosus fascia pelvis (ATFP)
- endopelvic fascia stretches like a hammock from the ATFP laterally to the vaginal wall medially - ) Fusion - of the vaginal endopelvic fascia to other structures supports the lower half of the vagina
- posteriorly = perineal body, laterally = levator ani, anteriorly - urethra
What 4 structures is the pelvic floor composed of?
- ) Deep Levator Ani Muscles
- ) Superfical Perineal Muscles - superficial and deep transverse, bulbospongiosus, ischiocavernous
- ) Perineal Body - central between vagina and rectum
- site of attachment for pelvic floor muscles and other structures supporting the pelvic floor - ) Urogenital Diaphragm/Perineal Membrane - sheet of dense fibrous tissue spanning the anterior half of the pelvic floor
- attaches to the urethra, vagina, and perineal body
What are the 3 levator ani muscles
- ) Puborectalis - encircles the rectum
- ) Pubococcygeus - encircles the vagina
- ) Iliococcygeus - ishcium –> coccyx
Neurovasculature of the Pelvic Floor
- ) Blood Vessels - internal and external pudendal arteries and veins
- ) Nerve Supply - pudendal nerve (S2-S4)
- ) Lymphatic Drainage - inguinal lymph nodes
5 features of a pelvic organ prolapse (POP)
Definition Causes and Risk Factors x7 Consequences Assessment Management
1.) Definition - loss of support of pelvic organs leading to their prolapse into the vagina
- ) Causes and Risk Factors - main ones are:
- age, parity (being pregnant), and vaginal delivery,
- others: oestrogen deficiency, chronic increased abdominal pressure (obesity), neurological or CT disorders e.g. Marfan’s
3.) Consequences - not life threatening but has impact on QoL, body image and cause depressive symptoms
- ) Assessment - POP-Q system, examination
- patients present with dragging sensation or lump - ) Management - non-surgical or surgical
- non-surgical is use of pessaries
- surgical includes anterior/posterior repair, vaginal hysterectomy + others
3 compartments of pelvic organ prolapse
- ) Anterior Compartment - bladder and/or urethra
- Cystoceole - bladder prolapse into vagina
- Urethrocoele - urethra prolapse into vagina
- Cystourethrocoele - bladder and urethra prolapse - ) Middle Compartment - uterus prolapse into the vagina
- the vaginal apex (vault) can prolapse when the supportive ligaments are cut after a hysterectomy - ) Posterior Compartment - bowel or rectum
- Rectocoele - rectum prolapse,a small hook can be created which can trap faeces in rectum
- Enterocele - loops of bowel prolapse into the rectouterine pouch
What are obstetric anal sphincter injuries (OASIS) and how can they be prevented?
1.) Definition - perineal tears involving the anal sphincter complex. - occur mainly during pregnancy
- ) Prevention - episiotomy (widening vagina wall)
- this can lead to damage of the bulbospongiosus and transverse perineal muscles
- encouraging the mother not to push when the head is crowning
5 features of female genital mutilation (FGM)
Definition Types Acute Consequences x3 Late Consequences x3 Other Consequences x2
1.) Definition - partial or total removal of the external female genitalia or other injury to the female genital organs for non-therapeutic reasons
- ) Types - 4 types of FGM, Type 1: clitoridectomy
- Type 2: excision of clitoris and labia minora
- Type 3: infibulation (stiching edges of vulva together)
- Type 4: other harmful procedures to female genitalia - ) Acute Consequences - haemorrhage, sepsis, death
- ) Late Consequences - infertility, chronic pain, urinary outflow obstruction
- ) Other Consequences - psychological impacts and obstetric issues
4 other conditions caused by dysfunction of the pelvic floor
- ) Urinary (stress) Incontinence - increased abdominal pressure causes leaks of urine due to weak pelvic floor muscles
- same risk factors as POP
- 1st line management is pelvic floor exercises,
- surgical (colposuspension) fixation if symptoms persist - ) Anal (faecal) Incontinence - impairment of QoL
- in women, caused mainly by OASIS - ) Vulval Problems - vestibulodynia (painful vulva),
- vaginismus (tight vaginal opening) causing pain on vaginal penetration - ) Posterior Compartment (anorectal) Dysfunction
- caused by structural defects e.g. rectocele, drugs, dehydration, immobility, pregnancy, post-op
- presents as vaginal or rectal lump, constipation, incomplete evacuation, anal incontinence