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Scientific Basis of Midwifery > Pelvic Floor > Flashcards

Flashcards in Pelvic Floor Deck (25)
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What are some long-term problems that women may suffer from an NVD?

- Pain
- Dyspareunia (pain during sex)
- Urinary, flatal and faecal incontinence


Why is it not good to have a face presentation?

The facial bones cannot slide over each other like the skull bones


What is used to treat chronic pelvic pain?

Peripheral nerve block


Describe the pelvic floor

- Funnel shaped
- Formed mostly of deep levator ani muscle and coccygeus muscle
- Made up of ligaments, fascia, muscles and blood vessels


Describe the muscles of the pelvic floor

Packed into the diamond shape of the pelvic outlet bordered by the SP, ischial tuberosities and the coccyx


Where is the perineum located?

- Between the thighs and buttocks
- The vagina, uretha and anal canal are enclosed within the perineum
- Urethra sits 1cm below clitoris


Name the superficial muscles of the pelvic floor

1. Ischiocavernosus
2. Urethral sphincter
3. Bulbocavernosus
4. Transverse Perinei
5. Eternal anal sphincter


Name the deep muscles of the pelvic floor

1. Pubococcygeus
2. Iliococcygeus
3. Ischiococcygeus
4. Puborectalis


What is vaginismus sometimes caused by?

Spastic contraction of the Levator muscle


What are the functions of the pelvic floor?

- Supports bladder, vagina, uterus and rectum
- Maintains optimal mechanical orientation of the urethra and anorectal angle for continence
- Puborectalis important to faecal continence
- Counteracts intra-abdominal pressure


What does the pelvic floor help with?

- Process of childbirth and rotation of presenting part
- Defacation
- Sexual functioning and arousal


Describe the structure of the perineal muscle

- Perineal tissue is made up of elongated skeletal muscle made up of actin and myosin
- Attached to pelvis at SP, tuberosities, sacrum and across joints, allowing movement


Explain how the perineal muscles work

- Excitability --> Contractibility --> Extensibility --> Elasticity
- Protein collagen provides firmness and strength
- Elastin works with collagen to provide flexibility


What are the functions of the internal anal sphincter muscles?

- Involuntary smooth muscle attaches to puborectalis
- Contributes to 50-70% of resting closing pressure
- Provides an involuntary barrier to faecal leakage and is relatively inhibited during rectal distension, allowing dilation and passage of faecal mass during defacation


Describe the external anal sphincter muscle

- Constricts the anal canal and keeps the anus closed
- Primary muscle for maintaining faecal continence


Describe the blood supply to the pelvic floor

- Supplied by 2 internal iliac arteries
- Drainage by corresponding veins


Which muscles make up the perineal body

- Bulbocarvernosus
- Transverse perineal muscle
- Pubococcygeus
- Anal sphincter muscle
- Deep and superficial muscles
- All but anal sphincter are cut in an episiotomy


Why is an episiotomy never done straight down?

It would hit the anal sphincter


Describe the changes in the pelvic floor during pregnancy

- Ligaments relax due to hormones relaxin and progesterone; alters composition of connective tissue
- Smooth muscle relaxation
- As presenting part engages, uterine ligaments are displaces towards the pelvic floor, pushing the bladder towards the SP


Describe the intrapartum changes to the pelvic floor

- Resistance of the pelvic floor through muscle contraction is essential for presenting part to rotate within pelvic cavity
- Neurological feedback alters pelvic floor as labour progresses
- Stretching and thinning of perineal muscles facilitated by some muscle relaxation and contraction


How can perineal damage and morbidity be minimised in pregnancy?

Antenatal perineal massage


How can perineal damage and morbidity be minimised in labour?

- Perineal support (hands on delivery)
- Medio-lateral episiotomy at 60degree angle - less risk of tears extending to anal sphincter
- Avoid instrumental delivery
- Bi-digital and sphincter assessment post-delivery
- Use continuous non-locking subcuticular repair technique


How can perineal damage and morbidity be minimised in the puerperium?

- Audit of perineal wound healing
- Sensitivity towards sexuality and resumption of sexual intercourse


Give some techniques to help women find their pelvic floor muscles

- When emptying bladder, try to stop stream
- Imagine you are trying to avoid passing wind
- Use mirror to watch and squeeze muscles down below


How are pelvic floor exercises performed?

- Squeeze pelvic floor muscles intermittently for 10 seconds each time up to 12 times
- Complete 3 sets of exercises per day
- Tight pelvic floor prevents faecal incontinence