Module 7

Question 1

What are the 4 primary layers of pelvic floor?

Answer 1

1. Anal sphincter
2. Superficial genital muscles
3. Perineal membrane
4. Pelvic diaphragm

Question 2

Components of the anal sphincter layer

Answer 2

• internal anal sphincter (smooth)

- external anal sphincter (skeletal)

Question 3

What are the superficial genital muscles?

Answer 3

• bulbocavernosus
• ischiocavernosus
• superficial transverse perineal

Question 4

What are the component muscles of the perineal membrane?

Answer 4

• urethrovaginal sphincter
• compressor urethrae
• sphincter urethrae

Question 5

What are the component muscles of the pelvic diaphragm?

Answer 5

Levator ani

• coccygeus
• iliococcygeus
• puborectalis
• pubococcygeus

Question 6

What are the 3 s’s of pelvic floor dysfunction?

Answer 6

1. Trunk support
2. Sphincteric function
3. Sexual function

Question 7

How do the layers of the pelvic floor contribute to trunk support?

Answer 7

• PFM and TrA co-contract = enhanced trunk stability
• extensive fascia, ligamentous support
• increased tone with increased IAP

Question 8

How do the layers of the pelvic floor contribute to sphincteric function?

Answer 8

Closure of urethra and rectum for continence

Question 9

How do the layers of the pelvic floor contribute to sexual function?

Answer 9

• proprioceptive sensation
• PFM hypertrophy » smaller vagina » more friction » increased stimulation of nerve fibers
• achieve and maintain erection

Question 10

These fibers provide quick closure of sphincter muscles

Answer 10

Phasic fast twitch

Question 11

These fibers provide closure of sphincter muscles during rest

Answer 11

Slow twitch fibers

Question 12

Normal pelvic organ support is achieved by this from above

Answer 12

Ligamentous stability

Question 13

Normal pelvic organ support is achieved by this from below

Answer 13

PFM function

Question 14

Preservation of continence: innervation of bladder/sphincters

Answer 14

Sympathetic innervation

Question 15

Preservation of continence: storage

Answer 15

Bladder stores urine by expanding

Question 16

Preservation of continence: organ position

Answer 16

Organs aren’t directly in line with the hole

Question 17

Preservation of continence: colorectal angle

Answer 17

Angle between rectum and anus

Question 18

Preservation of continence: IAP

Answer 18

Proximal urethra is within the IAP zone and gets closed off when IAP increases

Question 19

Preservation of continence: control of sphincters

Answer 19

Have both autonomic and voluntary control

Question 20

Preservation of continence: reflex inhibition

Answer 20

Reflex inhibition of detrusor in response to PFM contraction

For normal people, detrusor and PFM don’t contract together

Question 21

Preservation of continence: detrusor

Answer 21

Relaxation to allow filling

Question 22

Preservation of continence: urethral walls

Answer 22

• spongy urethral walls

- closed by default, but opens when necessary

Question 23

Why is the urethra spongy and how does this change over time?

Answer 23

• related to estrogen levels

- when there’s less estrogen, it becomes less spongy

Question 24

Common causes of underactive PFMs

Answer 24

• injury (i.e. Childbirth)
• prolonged IAP (i.e. Lifting, prolonged coughing/vomiting)
• hormonal changes during pregnancy

Question 25

Underactive PFM: common impairments

Answer 25

- weakness - adaptive lengthening of mm and connective tissue - atrophy - endurance impairment - impaired abd activation

Question 26

Underactive PFM: common medical dx associated with this

Answer 26

- stress incontinence - mixed incontinence - pelvic organ prolapse

Question 27

What might cause overactive PFMs?

Answer 27

- pelvic joint dysfunction - hip muscle imbalance - abdominopelvic adhesions and scars

Question 28

Common causes of overactive PFM

Answer 28

- fall (i.e. On coccyx or pubic ramus) - impairments of joint, mobility, pain, performance - adhesions/scars

Question 29

overactive PFM: common impairments

Answer 29

- altered tone - impaired coordination » increased tone - mobility impairments

Question 30

overactive PFM: common medical dx associated with these

Answer 30

- levator ani syndrome - vulvodynia - vestibulitis - vaginisimus - anisimus - chronic pelvic pain - dyspareunia - coccygodynia