Pelvic Floor Lecture 2 Flashcards by Caroline Sparks

Describe the alignment of the ASIS with the pubic bone for women and men

for men its inline and for women the pelvis is slightly tilted forward

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Lots of sacral sitting may cause what

weak pelvic floor muscles because they are not working against gravity

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What does the angle of the spine in the sacral region do to the pelvic area?

condenses/pushes it in

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Perineum

surface region in both males and females between the pubic sympyhsis and coccyx

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What 2 triangles make up the perineum?

urogential and anal

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List the *anatomical borders of the perinuem

anterior - pubic symphysis

inferior border - tip of coccyx

lateral border - ischiopubic rami and sacrotuberous ligament

Perineal body runs unbetween triangles

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List the *surface borders of the perinuem

anterior - mons pubis

inferior - intergluteal cleft

lateral - medial surface of thigh

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What structures lies directly under the lateral border of the perineum?

Ischiocavernosis lies directly under the ischiopubic ramus/ST ligament

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What 3 branches does the pudendal nerve split into?

rectal
dorsal
perineal

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Pudendal neuralgia is

pain with sitting because the nerve stretches

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What is the inguinal canal

passage way from the abdominal cavity though the anterior abdominal wall, formed by the folds of the external obliques aponeurosis

Contains the inguinal ring

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What are the contents of the inguinal canal?

MALES - spermatic cord
FEMALES - round ligament of the uterus

Inguinal nerve

blood and lymph vessels

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Inguinal ligament attachments

fibrous band from ASIS to puberic tubercle

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Sacroiliac joint type

synovial

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Pubic symphysis joint type

fibrocartilaginous disc between pubic bones

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Sacrococcygeal joint

cartilaginous
symphysis

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Know the location of the anterior longitudinal ligament, iliolumbar ligament, sacroiliac ligament, sacrospinous and sacrotuberous ligament

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What are the borders of the pelvic inlet?

anterior - pubic symphysis

posterior - sacral promontory and sacral wings/ala

lateral - arcuate line on the inner surface of the ilium and the pectineal line on the superior pubic ramus

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Borders of the pelvic outlet

Anterior - pubic arch (inferior border of ischiopubic rami)

Posterior - tip of coccyx

lateral - ischial tuberosities and margin of ST ligament

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Describe the differences between the male and female pelvis

male is more heart shaped and female more of a wider circle

males is heavier

males sacral promontory more prominent and have a more narrow pubic arch

males have ischial spines more medially

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What msucles make up the 1 layer of the pelvic floor

ishiocavernosus
bulbospongiosus
superficial transverse perineum

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What two muscles does the perineal body connect

bulbospongiosus and external anal sphincter

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Layer 2 of the pelvic floor

urogenital diaphragm - the middle muscle layer

external urethral sphincter deep

transverse perineal muscle

compressor urethrae

Whats the main function of the second layer of the pelvic floor?

stop flow of urine

What muscle makes up the walls of the bladder?

Detrusor

What feature of the male reproductive system helps with leakage?

prostate gland helps close urethra sits on top of pelvic floor

Layer 3 of pelvic floor

levator ani: puborectalis pubococcygeus iliococcygeus coccygeus (walls = obturator internus and piriformis)

Which of the leavator ani muscles does not connect to the coccyx or sacrum?

puborectalis

Coccygeus attachments (what structure does it follow?)

ischial spine to coccyx, follows sacrospinous muscle below it

Layer 3 walls

obturator internus and piriformis piriformis coming off of sacrum in the back obturator internal more on the lateral anterior side (obturator foramen)

What layer is referred to as the pelvic diaphragm?

the second layer

If your levator ani muscles are tight, what issues might you have at the hip?

Levator ani is connected via tissue to the obturator internus, so a tight levator ani would pull on your obturator internus (pull inwards), which connects to the greater trochanter of the femur and can medially rotate the femur

What muscle keeps the rectum at 90 degrees, preventing you from pooping without squating?

puborectalis - wraps around rectum and connects to pubic bone

The internal and external anal sphincter muscles are ___

connected via smooth muscle

What spinal levels does the sensory innervation of the pelvis span?

T12-S4

pudendal nerve entrapment

pudendal canal!

Who is the pudendal nerves travel buddy

pudendal artery - you can feel pulse

What artery supplies most of the pelvis? List the arterial supply

internal iliac artery anterior trunk obturator artery inferior gluteal artery internal pudendal artery (posterior trunk - superior gluteal)

Functions of the pelvic floor

support sphincter sexual stability blow and lymph pump

When you contract the pelvic floor the perineal body goes

What muscle often co-contracts with the pelvic floor?

transverse abdominis

How often should you pee a day? What about poop?

4-8x pee 1-2/day or every other day or 3 times a day - 3/week is normal range

What are common overactive urinary issues?

frequency, urgency and nocturia may not be a weakness issue always but may need coordination of the muscles sometimes tight pelvic floor causes urgency - C-section scar near bladder can contribute to this

Stress incontinence

leakage of urine with increased intra-abdominal pressure (cough, sneeze, laugh, exercise, sit to stand) pregnancy

Urge incontinence

leakage associated with a strong urge often on the way to the bathroom OAB is urgency and frequency without leakage

mixed incontinence

combo, usually one predominant

overflow incontinence

leakage from full baldder, urge to go missed or blockage to urethra

functional incontinence

patient with mobility issues preventing getting to the bathroom in time

What are some negative affects of consitpation?

pushes on bladder - urinary incontence full colon - back pain

pelvic floor prolapse

condition in which one or more of the pelvic organs (bladder, uterus, rectum, small intestine) descend or bulge into the vaginal canal due to weakness or damage to the pelvic floor muscles

What are some postural changes that occur during pregnancy?

COG shifts anteriorly increase lumbar lordosis anterior pelvic tilt posterior head position

What are some cardiovascular changes with pregnancy?

increased CO decreased blood pressure increased fluid volume

What are some respiratory changes with pregnancy?

increased tidal volume decreased total lung capacity dyspnea

What degree of perineal tears can contribute to fecal incontinence?

3rd or 4th

In a C section, muscles are not ___

sewn back together

What is diastasis recti?

separation of rectus abdominis (in middle) c-section or weak pelvic floor can cause you will see midline budging

What can endometriosis contribute to

urinary or bowel dysfunction or pain with urination and bowel movements