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Pelvic Floor Flashcards

1
Q

What are the posterior and anterior fornices of the vagina?

A

Portion anterior/posterior to the cervix within the vaginal canal

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2
Q

Where does the ureter sit in relation to the uterus?

A

Very close to the lateral aspect

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3
Q

What are the three muscles that comprise the levator ani from anterior to posterior?

A
  • Coccygeus
  • Pubococcygeus
  • Iliococcygeus
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4
Q

What are the s/sx of pelvic floor prolapse? (4)

A
  • Pelvic pressure/pain
  • Bulging from the vagina
  • Dyspareunia
  • Difficulties voiding
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5
Q

What is level I vaginal support?

A

Connective tissue support to the upper vagina

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6
Q

What is level II vaginal support?

A

Fascial crucus in mid vagina

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7
Q

What is level III vaginal support (anterior and posterior)?

A

Anterior = Fusion of anterior vagina and urethra muscles involved in urethral support

Posterior = Fusion of posterior vagina and perineal body

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8
Q

What is rectal splinting?

A

Applying pressure to the perineum in order to have a BM

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9
Q

What are anterior compartment prolapse?

A

Cystoceles or bladder herniation through the vaginal wall

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10
Q

What are are posterior compartment prolapse?

A

Rectocele, or posterior compartment prolapse

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11
Q

What is apical vaginal prolapse?

A

Vaginal vault prolapse (head of the uterus prolapse in)

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12
Q

What is uterine prolapse?

A

Prolapse of uterus through the vagina

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13
Q

What is the dove sign on pelvic examination?

A

Flattening of the anterior surface of the anus–indicative of perineal injuries

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14
Q

What happens if there is loss of level 1 vaginal support?

A

Connective tissue support to the upper vagina is lost, resulting in uterine or vaginal vault prolapse

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15
Q

What are the ligaments that are fused when a hysterectomy has been performed, in order to form the vaginal cuff? What happens if these are weakened from chronic coughing/straining?

A
  • Uterosacral ligament

- Wear down, and may cause loss of the vaginal vault support

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16
Q

What, generally speaking, is vaginal vault prolapse?

A

Vaginal walls (not uterus) prolapsing out of the vagina

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17
Q

What is an enterocele?

A

Prolapse of the intestines that can occur with uterine prolapse

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18
Q

What does failure of the level 2 vaginal support cause?

A

Mid level loss of support from CT between bladder/vagina and vagina/rectum (cystoceles, rectoceles)

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19
Q

Loss of the level 3 vaginal support results in what (anterior/posterior)?

A

Hypermobile urethra in anterior part lost

Loss of posterior causes perineocele

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20
Q

Bulging of the perineum with coughing indicates what pathology of the aginal?

A

Loss of the posterior vagina and perineal body

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21
Q

What is a hypermobile urethra?

A

A urethra that is greater than 30 degrees from the horizontal by Q-tip test

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22
Q

Why are pelvic support issues more common among women of advancing age?

A

Tissues become less resilient and accumulated stresses have an additive effect

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23
Q

There is an (__)x increase in prolapse 2 vaginal deliveries.

A

8x

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24
Q

What percent of women have anal incontinence after one delivery? Two?

A

35%

45%

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25
A birth weight of more than (__)kg is a risk factor for the development of fecal incontinence
4 kg
26
What is the risk associated with episiotomies?
Increased risk of anal incontinence
27
What stage of labor that, if prolonged, will increase the risk of fecal incontinence?
2nd stage
28
What fetal position will increase the risk for fecal incontinence?
Occiput posterior (OP)
29
True or false: delivery with forceps decreases the risk for fecal incontinence
False--increases
30
True or false: the first delivery has the greatest risk for the development of fecal incontinence
True
31
Does induction of labor have an effect on the incidence of fecal incontinence?
Yes, increases
32
Do epidurals increase the risk of fecal incontinence?
Yes
33
What is the effect of early pushing, and active restraining of the head on the incidence of fecal incontinence?
Both increase
34
What happens to the urethra when the bladder loses it support?
The mobility of the urethra increases as it pulls away from its attachment to the pubic symphysis
35
True or false: the degree of incontinence is often NOT commensurate with the degree of pelvic relaxation
True
36
What happens to the severity of urinary incontinence with later stages of uterine prolapse?
Improves, since now have functional obstruction in the outflow tract that can simulate continence
37
What type of incontinence is more common in women? Men?
``` Women = Stress Men = Urge ```
38
What happens to the lining of the urethra as women lose estrogen? What is the significance of this?
Thins--meaning urinary incontinence is much more likely later in life
39
How does the loss of the angle of the urethra affect urinary incontinence?
Loss will mean that there is a straight shot out of the bladder
40
What are the etiologies urge incontinence? (3)
- Urinary tract or vaginal infections - Bladder tumors/stones - Neuro causes
41
What is the physiological cause of urge incontinence?
Detrusor overactivity presents with the feeling that she must run to the bathroom frequently and urgently
42
What is the muscarinic receptor on the bladder?
M3
43
What is overflow incontinence?
Over-distention of the bladder leads to urine dribbling out
44
What are the etiologies of overflow incontinence? (2)
- Obstructive (fecal impaction) | - Non-obstructive (MS, other neuro issues)
45
Why is it that the bladder does not empty completely during voiding with overflow incontinence?
Inability of the detrusor muscle to contract
46
What is functional incontinence?
Urine loss caused by factors outside the urinary tract
47
What are the etiologies of functional incontinence?
- Dementia - Injury (fistula) - Decreased mobility
48
How common is pelvic organ prolapse?
- 11% of women will have prolapse in the life | - Half of women over age 50
49
What are the clinical tests to assess for pelvic organ prolapse?
-measuring post void residual
50
What should you always screen for when seeing pelvic organ prolapse?
UTIs
51
What is grade I uterine prolapse?
Prolapsed tissue descends halfway to the hymen
52
What is grade II uterine prolapse?
Prolapsed tissue extends to the levels of the hymen
53
What is grade III uterine prolapse?
Prolapsed tissue extends outside the hymen with straining
54
What is grade IV uterine prolapse?
Prolapsed tissue extends outside the hymen without straining
55
What is the major non-surgical option for pelvic organ prolapse?
Referral to PT for pelvic floor exercises
56
What is the success rate for PT for pelvic floor exercises?
85%
57
What are pessaries?
Objects inserted into the vagina to improve pressure on the bladder
58
What are the objectives for vaginal vault surgery, besides the obvious?
-Preserve normal vaginal axis
59
What is the ligament that is often used as an anchor to attach the uterus to in case of POP?
Sacrospinous ligament
60
What is the inferior rectal nerve a branch of?
Pudendal nerve
61
What is the perineal nerve a branch of?
Pudendal nerve
62
What provides the primary support to the pelvis?
Pelvic diaphragm (levator ani muscles)
63
What are the three mechanisms that the vagina relies on for support?
- Closure of the vagina at its introitus - Vertical suspension of the vagina by the uterosacral ligament - The flap effect created by the near horizontal position of the vagina
64
What are the three major anatomical landmarks that are used to anchor the uterus?
- Iliococcygeus - Sacrospinous fixation - Uterosacral ligament suspension
65
What other repair often accompanies Rectocele repairs?
Perineoplasties
66
What test should be done postop for cystoscopy?
Voiding trial bladder scan for cystoscopy

OB/GYN (33 decks)

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