Lecture 4 - Pelvic Floor Flashcards
What are the functions of the pelvic floor?
- Support the pelvic organs (3 ways)
- Maintain intra-abdominal pressure during coughing, vomiting, sneezing, laughing etc.
- Facilitate defaecation and micturition (urinating)
- Maintain urinary and faecal continence
- Facilitate childbirth
What the the three levels of support maintained by the pelvic floor?
1) Suspension
* Maintains anti-gravity position of reproductive organs by strong vertical support by cardinal and uterosacral ligaments
2) Attachment
* Support from attachmentd on pelvic organs. Eg. Vagina attached to endopelvic fascia, levator ani muscles and perineal body
3) Fusion
* Fusion of tissues eg. Urogenital Diaphragm and Perineal Body
What are the 3 Levator Ani Muscles? What is their shared midpoint of attachment?
Pubococcygeus
Iliococcygeus
Puborectalis
Midpoint: Perineal Body
What are the three superficial muscles of the pelvic floor?
Bulbospongiosus
Ischiocavernosus
Superficial transverse perineal
What is the clinical relevance of the superficial muscles during an episiotomy in childbirth?
Bulbospongiousus and Transverse Perineal muscles can undergo iatrogenic damage during mediolateral episiotomy (cutting posterior vagina at 45 degree angle for larger baby deliverance).
Can cause infection, haemorrhage and damage to anal sphincter
But purpose of operation is to prevent further perineal damage (prevents Obstetric Anal Sphincter Injuries OASIS)
What is the function of the cardinal ligament?
Attaches and holds the lateral side of the vagina and cervix to the lateral pelvic wall
What is the function of the Uterosacral Ligaments?
Holds the posterior cervix and upper vagina laterally from the back
What is the function of the Round Ligament?
Helps to maintain the anteflexed position of the uterus
What is the Perineal Body?
Central point between vagina and rectum
Site of attachment for pelvic floor muscles (insertion for levator ani muscles)
Attaches posteriorly to external anal sphincter (so any damage affects sphincter)
What is the urogenital diaphragm?
Fibrous tissue that spans anterior half of pelvic floor
Blood supply, innervation and lymphatic drainage of the pelvic floor?
Pudendal Arteries and Veins
Pudendal Nerve (S2, S3 and S4)
Drain via inguinal lymph nodes
What is Pelvic Organ Prolapse and what complications occur as a result?
Loss of support of uterus, bladder, colon, rectum leading to prolapse of organs into vagina
Impacts on sexual life, anorectal and urinary function
Can also alter body image = depressive symptoms
What are the 3 classifications of Pelvic Organ Prolapse?
1) Anterior Compartment
- Cystocele (bladder), Urethrocele (urehtra) or Cystourethrocele
- Bladder/urethra collapses into the vagina (from anterior)
2) Middle Compartment
- Uterine prolapse
- Whole uterus = Procidentia
- Can still occur with hysterectomy bc. supportive ligaments get cut (apex collapses instead) = Post-hysterectomy vault prolapse
3) Posterior Compartment
- Rectocele - Rectum into vagina from posterior
- Enterocele - Loops of bowel into Pouch of Douglas (rectouterine pouch)
What are causes and risk factors of POP?
Most common = Age, Parity (no. of pregnancies) and delivery
Others; Low Oestrogen (postmenopausal), Connective tissue disorders (Ehlers-Danlos, Marfan’s)
History/Examination and Management of POP?
Feeling of lump below
Constipation if rectum compressed
Surgical and Non-Surgical depending on affect on patients life, ability to undergo surgery, severity of prolapse etc.
Surgical: Hysterectomy or mesh placement
Non-Surgical: Pessaries (rings) for support
