Pelvic floor muscles

Question 1

What are the functions of the pelvic floor?

Answer 1

• control of defeacation and micturition
• maintain intra-abdominal pressure during sneezing, coughing, laughing etc
• maintan continence
• facilitate childbirth

Question 2

A main function of pelvic floor is support of pelvic organs. What are the 3 mechanisms of support?

Answer 2

1. suspension
2. attachment
3. fusion

Question 3

What is suspension?

Answer 3

“holding up the muscles” - maintains an anti-gravity position by providing strong vertical support

Question 4

What structures allow suspension?

Answer 4

cardinal and uterosacral and round ligaments

Question 5

What does the cardinal ligament do?

Answer 5

holds the cervix and upper vagina in place

Question 6

What does the uterosacral ligament do?

Answer 6

holds the back of the verve and upper vagina laterally

Question 7

What does the round ligament do?

Answer 7

maintains the anteverted position of the uterus

Question 8

What is the attachment mechanism?

Answer 8

the support that comes from attachments on the pelvic organs

Question 9

What is significant about the endopelivc fascia?

Answer 9

it stretch like a hammock and the urethra lies anterior and above it so when intra abdominal pressure increases., urethra is compressed - important for urinary continence

Question 10

What is the fusion mechanism?

Answer 10

support that arises from fusion of different tissues e.g. urogenital diaphragm and perineal body

Question 11

What are the deep muscles of the pelvic floor?

Answer 11

the levator ani muscles -they encircle the urethra, vagina and rectum

Question 12

What are the muscles of elevator ani?

Answer 12

iliococcygeus
puborectali
pubococcygeus

Question 13

What is the midpoint of these attachments?

Answer 13

perineal body (central point between the vagina and the rectum)

Question 14

What are the superficial muscles?

Answer 14

bulbospongiosus
ischiocavernosus
superficial transverse perineal

Question 15

Which muscles are most commonly involved in injury and what is the mechanism of injury?

Answer 15

the superficial muscles - perineal trauma - accidental, sexual or obstetric (during childbirth)

Question 16

What is the urogenital diaphragm?

Answer 16

triangular sheet of dense fibrous tissue that spans half of the pelvic outlet and support the pelvic floor

Question 17

What is the blood supply to the pelvic floor muscles?

Answer 17

pudendal arteries and drainage through pudendal veins

Question 18

What is the lymph drainage of the pelvic floor muscles?

Answer 18

inguinal lymph nodes

Question 19

What is the nerve supply to the pelvic floor muscles?

Answer 19

the pudendal nerve (S234)

Question 20

What is pelvic floor dysfunction?

Answer 20

refers to a wide range of symptoms and conditions that can arise as a result of problems to do with the pelvic floor

Question 21

What type of pelvic floor dysfunctions can you get?

Answer 21

• pelvic organ prolapse
• urinary incontinence
• posterior compartment pelvic floor dysfunction
• obstetric trauma including episiotomy
• FGM
• vulval pain syndromes

Question 22

What is pelvic organ prolapse?

Answer 22

loss of support for the uterus, bladder, rectum, colon - prolapses into vagina

Question 23

What disturbances can POP cause?

Answer 23

anorectal, urinary and sexual function issues

Question 24

How are POP classified?

Answer 24

by the compartment that the prolapse has occurred

Question 25

What is an anterior compartment prolapse related to?

Answer 25

bladder (cystoceole) urethra (urethrocoele) Both - cystourethrocoele

Question 26

What is a middle compartment prolapse related to?

Answer 26

``` the uterus prolapsing into the vagina -uterine prolapse entire uterus (procidential) ```

Question 27

Can the uterus prolapse after a hysterectomy? WHY?

Answer 27

the apex may still prolapse - the supportive ligament have to be cut when removing the uterus

Question 28

What is a posterior prolapse related to?

Answer 28

the rectum prolapsing into the posterior part of the vagina (rectocele) - loops of bowel may prolapse into the rectovaginal space (pouch of douglas) (enterocoele)

Question 29

What are the causes and risk factors of POP?

Answer 29

AGE! - weight and mode of delivery (these 3 are most common) - connective tissue disorders - lack of oestrogen - neurological - chronic cough (increased intra abdominal pressure)

Question 30

What mode of delivery is more commonly associated with POP?

Answer 30

vaginal delivery

Question 31

What is the typical symptoms associated with POP?

Answer 31

feeling a lump down below and feeling "something coming down" -constipation

Question 32

What is the management for POP?

Answer 32

- need to consider nature of symptoms/severity/how is it impacting the patient - sexual activity - future pregnancies - fitness for surgery - work/physical activity

Question 33

What are the non-surgical options?

Answer 33

pessaries (hold up pelvis and organs)

Question 34

What is the surgical management?

Answer 34

- removal of uterus | - mesh suppor in a vault prolapse

Question 35

What is stress urinary incontinence?

Answer 35

incontinence affect by the dysfunction of the pelvic floor causing the urethral sphincter to allow leakage

Question 36

What is urge incontinence?

Answer 36

problems with the bladder not the pelvic floor

Question 37

What are the risk factors for stress incontinence?

Answer 37

-age and oestrogen deficiency

Question 38

What are typical symptoms of stress incontinence?

Answer 38

-passing urine on coughing/laughing/vomiting

Question 39

What is the management for stress incontinence?

Answer 39

pelvic floor muscle training | surgical intervention to create slings to support urethral sphincter

Question 40

What vulval problems can you get?

Answer 40

patients can experience pain with no obvious finding on examination - often related to tension of the levator ani

Question 41

What is vaginismus?

Answer 41

taut pelvic floor and muscle spasms that won't let anything in or out - have painful sex

Question 42

What is FGM?

Answer 42

All procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or non-therapeutic reasons

Question 43

What is type 1 FGM?

Answer 43

-partial or total removal of the clitoris

Question 44

What is type 2 FGM?

Answer 44

- partial or total removal of the clitoris and labia majora

Question 45

What is type 3 FGM?

Answer 45

Narrowig of the vaginal orifice with creation of a covering seal by sewing together the labia minor and majora

Question 46

What is type 4 FGM?

Answer 46

all other harmful procedures to the female genitalia for non-medical purposes

Question 47

What are the consequences and complications of FGM?

Answer 47

Haemorrhage -septic shock and infection Sexual difficulties/fertility issues/urinary outflow obstruction Obstetric - fear of childbirth, PPH Psychological - PTSD, flashbacks

Question 48

What is posterior compartment pelvic floor dysfunction?

Answer 48

presents as - constipation, incomplete evacuation, anal incontinence, vaginal or rectal lump

Question 49

What are the causes of posterior compartment pelvic floor dysfunction?

Answer 49

structural, drugs (opiates), dehydration, pregnancy, immobility

Question 50

What is the commonest cause of faecal incontinence in women?

Answer 50

obstetric anal sphincter injury