8a - Intro/anatomy

Question 1

WHAT ARE PELVIC ORGANS??

Answer 1

Organs that sits within the Pelvic Cavity

Question 2

Anterior compartment pelvic floor

Answer 2

Bladder

Urethra

Question 3

Central/apical compartment pelvic floor

Answer 3

Uterus

VAgina

Question 4

Posterior compartment

Answer 4

Rectum

Anal Canal

Question 5

Components of pelvic floor

Answer 5

Muscular

Fasicial

Question 6

Muscular components of the PF

Answer 6

Deep pelvic floor layer:

1. Levator Ani
2. Coccygeus

Superficial Pelvic Floor Layer

1. Urogenital Triangle
2. External Anal Sphincter

Question 7

Parts of Levator Ani

Answer 7

1. Puborectalis
2. Pubococcygeus
3. Iliococcygeus

Question 8

What does the deep pelvic floor do?

Answer 8

1. FORWARD PULL OF STRUCTURES
   Compresses Lumens
   Maintains Anorectal Angle - “angle between rectum and anal canal”
2. LIFT OF PELVIC STRUCTURES ie ‘levator”
   Lifts to support the pelvic organs, removing strain on the
   endopelvic fascia
   School of Physiotherapy
   What

Question 9

Function superficial PF muscles

Answer 9

Provides added closure to vagina and anus (rather than lift)

Question 10

Muscles of superficial PF - Anterior Half
“Urogenital
Triangle”

Answer 10

Ischiocavernosus

Bulbocavernosus /
Bulbospongiosus

Transverse Pereneii Superficialis

Question 11

Muscles of superficial PF - posterior half

Answer 11

External anal sphincter

Question 12

What is the perineal body?

Answer 12

• Pyramidal fibro-muscular mass in
the midline of the perineum
between vagina and anus
• Central insertion point for
numerous structures (muscles and
fascia) that make up the pelvic floor
• Commonly torn during childbirth

Question 13

Nerve supply deep pelvic floor

Answer 13

Levator Ani Nerve

Question 14

Nerve supply superficial pelvic floor

Answer 14

Pudental nerve

Question 15

Primary structures holding the pelvic organs in place

Answer 15

Endopelvic fascia

Question 16

Sub-components of the EndoPelvic Fascia

Answer 16

Pubocervical Fascia
Rectovaginal Fascia
Uterosacral Ligaments

Question 17

Pubocervical Fascia

Answer 17

Situated between the back of the bladder / urethra and the
front of the vagina
• Meant to holds the bladder and urethra in their normal
position away from anterior vaginal wall.

Question 18

Disruption to what can cause an anterior vaginal wall prolapse

Answer 18

Pubocervical fascia

Question 19

Rectovaginal Fascia

Answer 19

Meant to holds the rectum in it’s normal position away

from the posterior vaginal wall

Question 20

Disruption to what can cause an posterior vaginal wall prolapse

Answer 20

Break in rectovaginal fascia

Question 21

Uterosacral Ligaments

Answer 21

• Suspend lower aspect of uterus / cervix up and
attach to sacral base
• Maintains uterus high in apical section of vagina

Question 22

Disruption to what can cause uterine prolapse?

Answer 22

Uterosacral ligaments

Question 23

What is the Pelvic Floor?

Answer 23

The pelvic floor is a complex web of muscle, fascia and fibrous
tissue that helps support the pelvic organs.”

Question 24

Pelvic floor dysfunction =

Answer 24

PELVIC FLOOR MUSCLE DYSFUNCTION
OR
PELVIC FLOOR FASCIAL DYSFUNCTION
OR
BOTH!!

Question 25

How does the bladder work

Answer 25

– “The Tank” - Storage facility for urine – Receives urine from kidneys via Ureters – Muscular wall called the “Detrusor” – contracts to push urine out

Question 26

Two phases of micturition

Answer 26

``` Storage phase (>99%) Voiding phase (< 1%) ```

Question 27

What happens during bladder storage phase?

Answer 27

Storage Phase (>99%) Whilst bladder is filling • Relaxed Detrusor
expansion • Contracted Urethral Sphincters

Question 28

What happens during bladder voiding phase?

Answer 28

Voiding Phase (<1%) While bladder is emptying • Contracting Detrusor • Relaxed Urethral Sphincters

Question 29

Storage and expulsion of urine. - intra-vesical pressure and urethral pressure

Answer 29

For Storage of Urine to Occur IVP < UP For Expulsion of Urine to Occur IVP > UP

Question 30

How IVP remains low despite increase in urine volume during storage phase?

Answer 30

Tightening of urethral sphincters

Question 31

What muscle activity occurs for normal voiding?

Answer 31

Detrusor contracts and urethral sphincters relax. IVP increases and UP decreases
IVP becomes > UP
Urine Released through Urethra

Question 32

Function of stomach

Answer 32

* Minimal absorption | * Primarily break up of food

Question 33

Function of small intestine

Answer 33

* 3 Sections: Duodenum, Jejunum, Ileum * Primarily nutrient absorption * At end of small intestine consistency of ‘thick pea soup’

Question 34

Function of large intestine

Answer 34

• 4 Sections: ascending, transverse, descending, sigmoid • Primarily re-absorption of H20 – 1500mls at start of colon reduced to150mls at end • Stool consistency determined by time in colon – The longer the transit time through the colon the harder the stool • Transit time is usually 1-3 days

Question 35

Function of rectum

Answer 35

RECTUM (similar function to bladder) • Lowest part of GIT • Just before anal canal • Purpose: – Storage of feces until appropriate time to empty – ie equivalent role as bladder in urinary system

Question 36

Function of anal canal

Answer 36

ANAL CANAL (similar fx to urethra) • Starts at end of rectum, level with tip of coccyx, • Ends at anal verge • Purpose – Release of faeces from the body at an appropriate time

Question 37

Muscles that maintain faecal continence

Answer 37

Puborectalis External Anal sphincter Internal Anal Sphincter

Question 38

PUBORECTALIS action defecation

Answer 38

Pulls anorectal junction forward, maintaining anorectal angle and acting as a ‘kink’.

Question 39

EXTERNAL ANAL SPHINCTER action defecation

Answer 39

* Skeletal muscle * Voluntary Control via pudendal nerve * Responsible for 30% of anal closure pressure

Question 40

Internal anal sphincter action defecation

Answer 40

Smooth muscle Involuntary control via ANS 70% resting anal closure pressure

Question 41

Normal Defecation Sequence

Answer 41

1. Peristalsis triggered by food / fluid intake, exercise etc 2. Stool is propelled into rectum 3. Distension of rectal walls triggers relaxation of Internal Anal Sphincter……. “Recto-anal Inhibitory Reflex” 4. Stool descends into upper anal canal 5. PR and EAS increase activity until person reaches toilet 6. At appropriate time, person relaxes PR and EAS
defecation occurs