The Pelvic Floor Flashcards
What is the pelvic floor made up of and where is it located?
- made up of thick bands of tissue, mostly muscle.
- extends from the symphysis pubis to the sacrum and between the lateral walls of the pelvis and across the pelvis outlet
What are the functions of the pelvic floor?
Support- organs that are above the pelvic floor
Micturition
Defecation
Sexual intercourse
Pregnancy: vital in supporting the increase in weight of the uterus.
Labour and delivery: rotation and descent of the fetus.
What does the pelvic floor consist of?
- Pelvic peritoneum
- Supporting ligaments of the uterus
- Two layers of muscle:
- Deep layer of muscle
- The superficial layer of muscle
What is the deep layer of muscle of the pelvic floor?
Deep layer of muscle directly supporting the vagina and indirectly supports the uterus.
Known as the levator ani muscles.
There are three main muscles:
Pubococcygeus muscles → extends from the inner pubic bone to the coccyx. Three main bands (first: surrounds the urethra, second: surrounds the vagina and third: loops around the anus) most vital of the deep muscle layer as they support important structures.
Iliococcygeus muscles → extends from the inner aspect of the iliac bone to the midline of the perineum.
Ischiococcygeus muscles → arise from ischial spine and pass to the lower sacrum.
What is the superficial layer of muscle of the pelvic floor?
Superficial muscle layer supports the urethral, vaginal and anal sphincter → vitally important in maintaining the overall strength of the pelvic floor.
Ischiocavernosus muscles
Bulbocavernosus muscles
Transverse perineal muscles
Where is the blood, lymph and nerves supplied from?
→ supplied from the pudendal arteries and veins
→ nerve supply is provided by the third and fourth sacral nerves
→ lymph drains into the inguinal and external iliac glands
What are the other muscles that support the pelvic floor?
External anal and urethral sphincter
Play a role in defecation and micronutrition.
What does the perineal body consist of?
It consists of : The layer of skin at the base The bulbocavernosus and transverse perinei of the superficial muscles The puboccygeus of the deep muscles
What are the changes to the pelvic floor during pregnancy?
Muscles become relaxed due to the effect of hormones → relaxin produced by the placenta
Pelvic floor exercise- fast and slow fibres → should be done hourly
Perineal massage → massaging the posterior vaginal wall
Stress incontinence
Prolapse
What are the changes to the pelvic floor during labour?
The muscles of the pelvic floor will aid the expulsion action which pushes the fetus
Maternal position if the woman lies on her left side can reduce perineal trauma
What are the different degrees of tears?
1st injury to the skin → involves both the forchette and the perineal skin.
no sutures needed
2nd injury to the perineal muscles not involving the anal sphincter. Can involve both the forchette and both muscles of the pelvic floor.
3 classification of the 3rd > due to the different ways of sutures → very serious because it involves the external anal sphincter as well as the structures of a 2nd degree tear
4th degree not only external and internal but also the bowel
Labial and clitoral tears can be left spontaneously to heal is the vulva hygiene is good. It may have to be sutured as they associated with high blood loss.
What is an episotomy?
Surgical incisions into the perineum before delivery intending to aid the birth of the fetus.
An incision will heal better than a tear.
Episiotomy is carried out during instrumental delivery or fetal distress.
A small incision of the fourchette, the skin of the perineum, the posterior vaginal wall and the superficial muscles of the pelvic floor.
Two types of incision:
Mediolateral
Midline
Informed consent is needed
