Anatomy 5 - Urinary Incontinence and Prolapse

Question 1

What does the pelvic floor separate?

Answer 1

Pelvic cavity from perineum

Question 2

What are the functions of the pelvic floor?

Answer 2

Support for pelvic organs

Urinary and faecal continence

Question 3

What makes up the pelvic floor?

Answer 3

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

Question 4

What is the deepest layer of the pelvic floor?

Answer 4

Pelvic diaphragm

Question 5

What 2 muscle groups make up the pelvic diaphragm?

Answer 5

Coccygeus

Levator ani

Question 6

What is the urogenital hiatus?

Answer 6

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

Question 7

What muscle group forms the majority of the pelvic diaphragm?

Answer 7

Levator ani

Question 8

What are the 3 parts of the pelvic diaphragm?

Answer 8

Puborectalis
Pubococcygeus
Iliococcygeus

Question 9

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

Answer 9

Tonically contracted

Question 10

When does the levator ani relax?

Answer 10

To allow urination and defacation

Question 11

What are the attachments and insertions of the levator ani?

Answer 11

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

Question 12

What muscle creates a sling around the rectum?

Answer 12

Puborectalis

Question 13

What is the endopelvic fascia made up of?

Answer 13

Connective tissue
Loose areolar tissue
Fibrous tissue

Question 14

What does the fibrous tissue of endopelvic fascia form?

Answer 14

The pelvic ligaments

Question 15

What are the major ligaments of uterus ? 3

Answer 15

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

Question 16

What is the function of the utero-sacral ligament?

Answer 16

Stops the uterus sinking down

Question 17

Where does the deep perineal pouch lie?

Answer 17

Below the fascia

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

Question 18

What does the deep perineal pouch cover?

Answer 18

Inferior aspect of pelvic diaphragm

Question 19

What does the deep perineal pouch contain?

Answer 19

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

Question 20

What is the perineal membrane?

Answer 20

Thin sheet of tough deep fascia

Question 21

What is the urogenital triangle?

Answer 21

Opening for urethra and vagina

Where the perineal membrane attaches laterally to the pubic arch

Question 22

Where does the superficial perineal pouch lie?

Answer 22

Below perineal membrane

Question 23

What does the male superficial perineal pouch contain?

Answer 23

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

Question 24

What muscles are involved in ejaculation and erection?

Answer 24

Bulbospongiosus

Ischiocavernosus

Question 25

What does the female superficial perineal pouch contain?

Answer 25

``` 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 ```

Question 26

What are the greater vestibular glands also called?

Answer 26

Bartholin's glands

Question 27

What are the functions of the pelvic floor?

Answer 27

Support to pelvic organs Urinary continence Faecal continence

Question 28

How does the pelvic floor give support to pelvic organs?

Answer 28

Usually tonically contracted | Actively contracts when coughing, sneezing, vomiting

Question 29

What parts of the pelvic floor help maintain urinary continence?

Answer 29

External urethral sphincter Compressor urethrae Levator ani

Question 30

How is faecal continence maintained?

Answer 30

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

Question 31

What can cause injury to pelvic floor?

Answer 31

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

Question 32

What contributes towards urinary continence?

Answer 32

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

Question 33

What organs can prolapse?

Answer 33

Uterus Vagina Bladder Rectum

Question 34

What happens in a pelvic organ prolapse?

Answer 34

``` Herniation through supporting fascia of: Urethra (urethrocele) Vagina Rectum (rectocele) Bladder (cystocele) Bowel (enterocele) Rectouterine pouch ``` Into the vagina

Question 35

What happens in a uterine prolapse?

Answer 35

Pelvic floor muscles and ligaments stretch and weaken | Uterus slips down into or protrudes out of the vagina

Question 36

What are the degrees of uterine prolapse?

Answer 36

1st 2nd 3rd

Question 37

What are the treatment options for prolapse?

Answer 37

Sacrospinous fixation | Incontinence surgery

Question 38

What is sacrospinous fixation?

Answer 38

Suture sacrospinous ligament (medial to ischial spine)

Question 39

How is the sacrospinous fixation performed?

Answer 39

Vaginally

Question 40

What structures are at risk during a sacrospinous fixation?

Answer 40

Pudendal NVB | Sciatic nerve

Question 41

What is incontinence surgery?

Answer 41

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

Question 42

Where are the incisions made via for incontinence surgery?

Answer 42

Through vagina and groin