Pelvic Foor

Question 1

Function of the pelvic floor

Answer 1

• support pelvic organs
• maintain intrabdominal pressure during coughing, vomiting, sneezing etc.
• facilities defaecation + micturition
• maintain continence
• facilities childbirth

Question 2

Outline the 3 mechanism of how pelvic floor provides support

Answer 2

• Suspension: provides sling like support inferiorly in pelvis against gravity
• Attachment: vagina is support by attachments to endopelvic fascia, levator ani muscles + perineal body
• Fusion: of urogenital diaphragm + perineal body

Question 3

What are the levator ani muscles?

Answer 3

Puborectalis
Pubococcygeus
Iliococcygeus

Question 4

List the deep pelvic floor muscles

Answer 4

puborectalis
pubococcygeus
iliococcygeus
coccygeus

Question 5

What maintains the anteverted position of the uterus?

Answer 5

Round ligament

Question 6

List the superficial pelvic floor muscles

Answer 6

Bulbospongiosus
Ischiocavernosus
Superficial + deep transverse perineal

Question 7

Ligaments of the pelvic floor

Answer 7

• cardinal/transverse ligaments
• pubocervical ligaments
• uterosacral/rectouterine ligaments

Question 8

Nervous supply to the pelvic floor

Answer 8

Pudendal nerve S2-4

Question 9

Blood supply to pelvic floor

Answer 9

Pudendal arteries

Question 10

What do the levator ani muscles take part in forming?

Answer 10

Perineal body

Question 11

What is the urogenital diaphragm?

Answer 11

• triangular sheet of dense fibrous tissue
• spans anterior half of pelvic floor
• attaches to urethra, vagina + perineal body
• supports pelvic floor

Question 12

Lymphatic drainage of pelvic floor

Answer 12

Inguinal lymph nodes

Question 13

Types of pelvic floor dysfunction

Answer 13

Pelvic organ prolapse
Vaginismus
Stress urinary incontinence
Female genital mutilation

Question 14

Risk factors of pelvic organ prolapse

Answer 14

• increase age
• given birth
• number of vaginal deliveries
• oestrogen deficiency (menopause)
• obesity (raised intra abdominal pressure)

Question 15

Management of pelvic organ prolapse

Answer 15

Depends on severity + how patient is coping
- surgical: mesh supports, hysterectomy if central
- non-surgical: pessaries to provide support +/- topical oestrogen + pelvic floor exercises

Question 16

Symptoms of pelvic organ prolapse

Answer 16

• dragging/bugling sensation in vagina
• lump
• feeling of incomplete emptying of bladder
• double voiding

Question 17

How can a pelvic organ prolapse be classified?

Answer 17

• anteior: bladder or urethra
• central: uterus
• posterior: rectum or colon

Question 18

Types of anterior pelvic organ prolapse

Answer 18

• cystocele: bladder prolapses into vaginal space
• urethrocele: urethral collapse
• cytourethrocele: bladder + urethra

Question 19

Types of posterior pelvic organ prolapse

Answer 19

• rectocele: rectum prolapses into vaginal space
• enterocele: loops of colon pressing across Rectouterine space

Question 20

What is a vault prolapse?

Answer 20

Central pelvic organ prolapse when the superior portion of vagina collapses downwards after a hysterectomy

Question 21

Risk factors for stress urinary incontinence

Answer 21

Increased age
Oestrogen deficiency (menopause)

Question 22

Managment of stress urinary incontience

Answer 22

Pelvic floor exercises
Surgical sling to support urethral sphincter

Question 23

How are vaginal tears graded?

Answer 23

• grade 1: extends into vaginal mucosa
• grade 2: extends into perineal muscles
• grade 3: extended into anal sphincter
• grade 4: extends into rectum

Question 24

What is a central pelvic organ prolapse called post hysterectomy?

Answer 24

Vault prolapse

Question 25

What is an episiotomy?

Answer 25

A surgical incision made to perineum during child birth if there is risk of tearing, distressed baby or instrumental delivery

Question 26

What is involved in a episiotomy?

Answer 26

Cutting of bulbospongiosus + transverse perineal muscles at oblique angle to relieve pressure + allow for more space

Question 27

Define female genital multination

Answer 27

All procedures involving partial or total removal of external female genitalia or other injury

Question 28

Types of FGM

Answer 28

1- partial/total removal of clitoris 2- partial/total removal of clitoris + labia minora 3- removal of labia minora + sewing labia majora together only leaving a small hole for urine + menstrual blood 4- any other harmful procedure *e.g. piercing, cutting*

Question 29

Consequence of FGM

Answer 29

- haemorrhage > sepsis or death - blood born infections - chronic pain - sexual + fertility issues - urinary outflow obstruction - flashbacks/PTSD - self esteem issues

Question 30

How does the perineal body function to maintain pelvic organ support?

Answer 30

Central point of attachment for perineal muscles

Question 31

Why can vaginal childbirth delivery cause pelvic floor dysfunction?

Answer 31

- damage to pelvic floor muscles - stretch of ligament support - stretch of pudenal nerve - perineal body injury

Question 32

What are pessaries? What are they used for?

Answer 32

- removable devices that go inside your vagina > provide support to your pelvic organs - used for non surgical treatment of pelvic organ prolapse or stress UI

Question 33

What is vaginismus?

Answer 33

The body's automatic reaction to the fear of vaginal penetration > contraction of vaginal muscles