Urinary incontinence and prolapse

Question 1

Functions of pelvic floor?

Answer 1

• Separates pelvic cavity (above) from perineum (below)
• Plays important role in providing support to pelvic organs
• Plays an important role in maintaining continence (urinary & faecal)

Question 2

3 layers of pelvic floor?

Answer 2

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane

Question 3

Pelvic diaphragm?

Answer 3

Deepest later of pelvic floor
Levator ani and coccygeus

Question 4

Appearance of pelvic diaphragm?

Answer 4

Sling

Question 5

Name areas

Answer 5

Question 6

What forms most of pelvic diaphragm?

Answer 6

Levator ani

Question 7

What are the attachments of the levator ani?

Question 8

Is levator ani contracted or relaxed?

Answer 8

Tonically contracted most of the time

Question 9

Innervation of levator ani?

Answer 9

Pudendal nerve and nerve to levator ani

Question 10

Most medial part of levator ani?

Answer 10

Puborectalis

Question 11

3 parts of levator ani?

Answer 11

Puborectalis

Pubococcygeus

Iliococcygeus

Question 12

What must relax to allow urination and defeceation?

Answer 12

Levator ani

Question 13

Name muscles of levator ani

Answer 13

Question 14

Additional support to pelvic floor?

Answer 14

Endopelvic fascia

Pelvic ligaments

Question 15

Where does the deep perineal pouch lie

Answer 15

Below the fascia covering the inferior aspect of pelvic diaphragm

Above perineal membrane

Question 16

What does the deep perineal pouch contain?

Answer 16

Part of urethra (and vag in females)

Bulbourethral glands (male)

Neurovascular bundle for penis/ clitoris

Extensions of ischiocanal fat pads and muscles

Question 17

Name the areas

Answer 17

Question 18

Do male or females have deep transverse perineal muscle?

Answer 18

Males

Question 19

What is perineal membrane?

Answer 19

Thin sheet of tough, deep fascia

Lies superficial to deep perineal pouch

Question 20

Where does the perineal membrane attach

Answer 20

Laterally to the sides of the pubic arch, closing urogenital triangle

Question 21

Openings in perineal membrane?

Answer 21

Urethra

Vagina in females

Question 22

Name this membrane

Answer 22

Question 23

Where does the female superficial peroneal pouch lie?

Answer 23

Below perineal membrane

Question 24

Where is the female erectile tissue contained?

Answer 24

Superficial perineal pouch

Question 25

What does the superficial perineal pouch contain?

Answer 25

Clitoris and crura Bulbs of vestibule Associated muscles - bulbospingiosus (covers bulb) and ischiocavernous (covers crura) Greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and nerve

Question 26

Name the areas

Answer 26

Question 27

Where does male perineal pouch lie?

Answer 27

Below the perineal membrane

Question 28

What does male superficial perineal pouch contain?

Answer 28

Root of penis (bulb, crura and associated muscles) Associated muscles - bulbospingiosus and ischiocavernosus Proximal; spongy urethra, superficial transverse perineal muscle & branches of internal pudendal vessels and nerve

Question 29

What is male bulb made from?

Answer 29

Corpus spongiosum

Question 30

What is male crura made from?

Answer 30

Corpus cavernosum

Question 31

Name areas of male superficial perineal pouch

Answer 31

Question 32

Perineal body?

Answer 32

Ball of tissue Contains fibrous tissue and skeletal and smooth muscle Important in support of pelvic floor

Question 33

where is perineal body in females?

Answer 33

In between rectum and most posterior part of vagina

Question 34

Where is perineal body in males?

Answer 34

Slightly anterior to rectum, behind urethra

Question 35

Which muscles converge at perineal body?

Answer 35

Bulbospongiosis, external anal sphincter, perineal muscles (superficial and deep), slips of muscle from levator ani, external urethral sphincter and muscular coating of rectum

Question 36

When does pelvic floor actively contract?

Answer 36

Coughing, sneezing and vomiting

Question 37

What structures help maintain urinary continence?

Answer 37

External urethral spincter Compressor urethrae Levator ani

Question 38

What structures help maintain faecal continence?

Answer 38

Tonic contraction of puborectalis bends anorectum anteriorly Active contraction maintains continence after rectal filling

Question 39

1st degree uterine prolapse?

Answer 39

Just cervix dropped into vagina

Question 40

2nd degree uterine prolapse?

Answer 40

Cervix drops just inside opening of vagina

Question 41

3rd degree uterine prolapse?

Answer 41

Cervix just outisde of vagina

Question 42

4th degree uterine tear?

Answer 42

Entire uterus outside of vagina