Anatomy of Urinary Incontinence and Prolapse

Question 1

What is the role of the pelvic floor?

Answer 1

Separates pelvic cavity from perineum

Plays important role in providing support to pelvic organs

Plays an important role in maintaining continence

• Urinary
• Faecal

Question 2

Name the 3 layers that make up pelvic flor

Answer 2

1. Pelvic diaphragm
2. Muscles of perineal pouches
3. Perineal membrane

Question 3

Which is the deepest/most internal layer of the pelvic floor?

Answer 3

Pelvic diaphragm

Question 4

Which two muscle groups make up the pelvic diaphragm?

Answer 4

Levator ani: more anteromedial part

Coccygeus: Posterolateral

Question 5

What is the significance of the anterior gap between medial borders of pelvic diaphragm?

Answer 5

Urogenital hiatus

Passage for urethra and vagina

Question 6

Which muscle forms most of pelvic diaphragm?

Answer 6

Levator ani

Question 7

Name the origin of puborectalis and pubococcygeus

Answer 7

Posterior aspect of coccygeus

Question 8

What are the 3 parts of the levator ani?

Answer 8

Puborectalis
Pubococcygeus
Iliococcygeus - comes mainly from ischial spine, main attachment point is towards the coccyx

Question 9

What is the function of levator ani?

Answer 9

Tonically contracted most of time

Must relax to allow urination and defecation

Question 10

What is perineal body?

Answer 10

Fibro-muscular skeleton of pelvic floor

SUPER important for support to the pelvic floor (incontinence)

Question 11

Name the innervations of levator ani

Answer 11

Pudendal nerve - S2 to S4

Nerve to levator ani

Question 12

What are the additional layers of support apart from pelvic diaphragm?

Answer 12

Endo pelvic fascia

Pelvic ligaments

Question 13

What is endopelvic fascia?

Answer 13

connective tissue ‘packing’

some loose areolar tissue

some fibrous
- collagen and elastic fibres

Question 14

What are the pelvic ligaments?

Answer 14

Fibrous endo-pelvic fascia
Provide support to pelvic organs
Uterosacral
Transverse cervical (cardinal)
Lateral ligament of bladder
Lateral rectal ligaments

Question 15

What is the tendinous arch of pelvic fascia?

Answer 15

Thickened area of fascia that covers the obturator internus

Question 16

Where is deep perineal pouch located?

Answer 16

Underneath pelvic diaphragm and above perineal membrane

Question 17

What does deep perineal pouch contain?

Answer 17

Urethra
Vagina
Bulbourethral gland/Cowper’s glands (homologus for bartholin glands in females)
Neurovascular bundle for penis/clitoris
Extensions of the ischioanal fat pads and muscles

Question 18

Which urethral muscles work together to maintain continence

Answer 18

External urethral sphincter

Compressor urethrae

Question 19

What is the perineal membrane?

Answer 19

Thin sheath of tough membrane

Question 20

Where does the perineal membrane attach?

Answer 20

Laterally to the side of the pubic arch, closing the urogenital triangle

Question 21

What are the perineal membrane openings?

Answer 21

For urethra in males and vagina in females

Question 22

Which is the last layer of passive support for pelvic organs?

Answer 22

Perineal body together with perineal membrane

Question 23

Where is the superficial perineal pouch in males?

Answer 23

below perineal membrane

Question 24

Contents of the superficial perineal pouch in males

Answer 24

Contains root of penis:
Bulb – corpus spongiosum, crura – corpus cavernosum
Associated muscles – bulbospongiosus and ischiocavernosus

Also contains proximal spongy (penile) urethra, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve

Question 25

Which erectile tissue contains 90% of blood flow in an erection?

Answer 25

Corpus cavernosum

Question 26

Which muscle covers the bulb of penis?

Answer 26

Bulbospongiosus

Question 27

Which muscle covers the crura of penis?

Answer 27

Ischiocavernosus

Question 28

Ischiocavernosus muscles contributes to perineal body - T or F

Answer 28

F

Question 29

Where is superficial perineal pouch located in females?

Answer 29

Below perineal membrane

Question 30

What is the contents of the superficial perineal pouch in females?

Answer 30

Contains female erectile tissue and associated muscle:
Clitoris and crura – corpus cavernosum
Bulbs of vestibule – paired
Associated muscles – bulbospongiosus and ischiocavernosus

Also contains greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve

Question 31

Which structures of pelvic floor maintains urinary continence?

Answer 31

External urethral sphincter, Compressor urethrae,

Levator ani

Question 32

Which features of pelvic floor maintains fecal continence?

Answer 32

Tonic contraction of puborectalis bends the anorectum anteriorly

Active contraction maintains continence after rectal filling

Question 33

Which events cause injury to pelvic floor?

Answer 33

Pregnancy

Childbirth

• stretching or tearing
• pudendal nerve damage

Chronic constipation

Obesity

Heavy lifting

Chronic cough or sneeze

Previous injury to pelvis/pelvic floor

Menopause