PF

Question 1

What are the four layers of the pelvic floor?

What are their main functions?

Answer 1

1. Anal sphincter (with puborectalis, provides fecal continence - Sphincteric)
2. Superficial Genital muscles (Sexual function)
3. Perineal Membrane (urinary continence - Sphincteric)
4. Pelvic Diaphragm – also called Levator Ani (support)

Question 2

What muscles makes up the Anal sphincter?

Answer 2

Internal Anal Sphincter (smooth muscle)

External Anal Sphincter (skeletal muscle)

Question 3

What are considered the superficial layers of the pelvic floor? (in order of most superficial to least superficial if you want)

Answer 3

1. Anal sphincters (with puborectalis, provides fecal continence - Sphincteric)
2. Superficial Genital muscles (Sexual function)
3. Perineal Membrane (urinary continence - Sphincteric)

Question 4

What are considered the deep layers of the pelvic floor?

Answer 4

1. Pelvic Diaphragm – also called Levator Ani (support)

Question 5

In which pelvic floor layer does dysfunction mainly occur in?

Answer 5

1. Pelvic Diaphragm – also called Levator Ani (support)

Question 6

What are the names of the two anal sphincters? What type of muscle are they?

Answer 6

Internal Anal Sphincter (smooth muscle)

External Anal Sphincter (skeletal muscle)

Question 7

What are the three muscles of the Superficial Genital Muscles?

Answer 7

1. ischiocavernosus
2. Bulbocavernosus
3. Superficial transvers perineal

Question 8

What are the three muscles of the Perineal Membrane?

Answer 8

1. Urethrovaginal sphincter
2. Compressor urethrae
3. Sphincter Urethra

Question 9

What are the four muscles of the Pelvic Diaphragm?

Answer 9

1. Coccygeus
2. Illiococcygeus
3. Pubococcygeus (also called pubovaginalis)
4. Puborectalis

Question 10

Which muscle is considered the “tail wagger”?

Answer 10

Coccygeus (part of pelvic diaphragm)

*may stabilize the sacrum

Question 11

Which muscle slings around the vagina?

Answer 11

Pubococcygeus (also called pubovaginalis) (part of the pelvic diaphragm)

Question 12

Which muscle slings around the rectum?

Answer 12

Puborectalis (part of the pelvic diaphragm)

Question 13

What 2-3 muscles provide fecal continence?

Answer 13

Anal Sphincters (internal and external) with the puborectalis from the pelvic diaphragm (it slings around the rectum)

Question 14

What are 4 sort-of phases of micturition? What is a fourth thing we talked about that is not really a phase?

Answer 14

1. Storage
2. Transition-phase
3. Emptying
4. (Post-Void) – nota true phase

Question 15

Describe sensations during the bladder storage stage:

(include volumes)

Answer 15

• When bladder is 150 mlfull, the person gets the “first sensation” to urinate
• When bladder is 200-300 ml full, it increases activation of bladder stretch receptors which increases urge to urinate
• When bladder is 400-550 ml full, the urge to urinate is severe

Question 16

What is the detrusor doing during the bladder storage stage?

Answer 16

Quiet/relaxed

Question 17

What is the Pelvic floor doing during the bladder storage stage?

Answer 17

Contracts minimally to maintain resting tone

Question 18

What happens during the bladder transition phase?

Answer 18

Person decides it is time to take action.

Transport to toilet, remove clothes.

Question 19

What happens to the detrusor muscle and pelvic floor muscles during the emptying bladder phase?

Answer 19

Detrusor contracts (no increase in intra-abdominal pressure!)

Pelvic Floor Relaxes

Question 20

Is it normal to have some urine in the bladder post-void? If so, how much?

Answer 20

A bit of urine is okay. Dr. Mincer’s chart listed 0-50 ml. I think Dr. T said up to 30 ml

Question 21

Normal Micturition: What sensation is present post-void?

Answer 21

No urge

Question 22

What does the detrusor muscle and pelvic floor muscles do post void?

Answer 22

Go back to

• Relaxed Detrusor
• Pelvic floor has normal resting tone.

Question 23

What is one way your body can delay voiding if you have a strong urge but are not close to a toilet?

Answer 23

The pelvic floor may contract harder to delay voiding. This also inhibits the detrusor from contraction by activating a reflex.

You can do this on purpose or teach a pt to do this on purpose.

Question 24

Explain what the detrusor does during the stages of normal micturition:

Answer 24

Detrusor is relaxed except during emptying

Question 25

Explain what the pelvic floor does during the stages of normal micturition:

Answer 25

Pelvic floor maintains a normal resting tone except for during emptying when it relaxes. It may contract harder if the bladder is very full (strong urge), but the person has not reached a toilet yet.

Question 26

What is max bladder capacity?

Answer 26

400-500ml (?)

Question 27

What do the anal sphincters fuse with superiorly?

Answer 27

* Puborectalis component of pelvic diaphragm muscle.

Question 28

What three muscles function together to provide fecal continence?

Answer 28

1. Internal anal sphincter (smooth M) 2. External anal sphincter (skeletal M) 3. Puborectalis from pelvic diaphragm

Question 29

What 3 muscles aid in sexual functioning (and part of the continent mechanism)?

Answer 29

The muscles of the superficial Genital membrane 1. Superficial transverse perineal 2. Ischiocavernosus 3. Bulbocavernosus

Question 30

What three muscles are specifically for urinary continence?

Answer 30

1. Compressor Urethra 2. Urethrovaginal sphincter 3. Sphincter Urethra

Question 31

**How are the pelvic floor layers organized from superficial to deep?**

Answer 31

1. Anal Sphincter (continence) 2. Superficial genital muscles (sexual functioning) 3. Perineal membrane (continence) 4. Pelvic Diaphragm (continence and pelvic support)

Question 32

**What are the “3 S’s” of pelvic floor function, and briefly describe what they mean?**

Answer 32

1. Supportive function (prevents pelvic organs from prolapsing) 2. Sphincteric Function (prevents involuntary loss of feces, urine, and gas from the urethra and rectum 3. Sexual function (increases sexual appreciation and maintains erection)

Question 33

Categorize each layer of the pelvic floor as mostly Supportive, Sphincteric, or Sexual in function:

Answer 33

1. Anal Sphincter (Sphincteric) 2. Superficial genital muscles (sexual functioning) 3. Perineal membrane (Sphincteric) 4. Pelvic Diaphragm (Support and contributes to Sphincteric) * For example: Puborectalis is involved in sphincteric function of anal sphincter.

Question 34

What percentage of the pelvic floor muscle fibers are slow twitch? fast twitch?

Answer 34

70% slow twitch 30% fast twitch

Question 35

What function do fast twitch fibers in the pelvic floor mainly contribute to?

Answer 35

Sphincteric (continence) by contracting quickly when there is short bursts of higher IAP (intra-abdominal pressure), such as during coughing, jumping, laughing, vomiting, etc.

Question 36

What function do slow twitch fibers in the pelvic floor mainly contribute to?

Answer 36

More to support – holding up the pelvic organs from below

Question 37

**What is the interaction between the PFM’s and pelvic ligaments for providing support?**

Answer 37

The normal pelvic organ support is achieved by ligamentous support from above, PFMs from below, and the structural geometry achieved normal function of both.

Question 38

How do you get recovery of organ support if the normal supports are not working?

Answer 38

Recovery of organ support requires attention to restoring PFM function (PFM rehabilitation) firstly and in some cases restoring ligamentous support (surgery).

Question 39

Summarize the innervation and muscle fiber type of the PFM’s

Answer 39

Basically S2-S4, dual innervation is common Pudendal nerve is involed in most?