Presentation on theme: "Pelvic Floor Anatomy and Female Lower Urinary Tract Dysfunction"— Presentation transcript:
1 Pelvic Floor Anatomy and Female Lower Urinary Tract Dysfunction Hann-Chorng KuoDepartment of UrologyBuddhist Tzu Chi General Hospital
2 Abdomino-pelvic cavity Respiratory diaphragmVertebral columnAbdominal musclesPelvic floorIntra-abdominal pressureVisceral weight & Gravity in erect bodyMaintain visceral function
3 Genital SupportPelvic floor- Pelvic visceral attachment to pelvic walls through endopelvic fasciaLevator ani muscles- a pelvic diaphragm with a cleft in anterior portionUrogenital diaphragm connects perineal body to ischiopubic ramiBulocavernous, ischiocavernous, sup.transverse perineal, anal sphincter m.
5 Levator ani musclesPelvic diaphragm composed of levator ani, coccygeus, obturator internus, and piriformis musclesLevator ani consists of medial pubococcygeus and lateral iliococcygeus musclesPelvic diaphragm composed of levator ani, coccygeus, obturator
13 The Function of Pelvic Floor Support pelvic and abdominal organs during stress of increased abdominal pressureAllow for opening of the pelvic floor to accommodate excretory functions and parturitionEndopelvic fascia and visceral ligaments contains smooth muscles
14 The Pelvic Floor Attachments Pelvic floor support depends on its connection to the pelvic bonesAn evolutionary solution for support of visceral organsPelvic floor muscles oppose gravity and increased abdominal pressures
15 Prevention of Prolapse Constriction – levator ani muscles constrict lumen of vaginaSuspension –cardinal ligaments & uterosacral ligaments, pubocervical fascia act to suspend cervix and vaginaFlap valve mechanism- anterior traction of levator ani m. and suspension of vagina in posterior pelvis
19 Pelvic Floor Dysfunction A variety of fascial and anatomic defectsCystocele, rectocele, uterine prolapse, enterocele, vault prolapseAdequate diagnosis and staging of pelvic floor dysfunction is essential
20 Diagnosis of Pelvic Floor Dysfunction Detailed physical examinationPelvic ultrasoundFluoroscopy of rectum & bladderMagnetic resonance imaging (MRI)
24 Cystocele Most Gr 1 and 2 cystoceles are asymptomatic High grade cystoceles are associated with vaginal buldging, vaginal pressure, dyspareunia, UTI, obstructive voiding, urinary retentionA high grade cystocele may mask urethral hypermobility and stress incontinence
40 Pelvic Floor Relaxation Associated with damage to pubococcygeus muscleThe muscle is lax, atrophied, poor toneUrinary stress incontinenceGenital prolapseSexual ProblemRectal stasis
41 Muscular Component of Pubococcygeus muscle Large diameter slow twitch type I fibers predominant- provide static visceral supportFast twitch type II fibers- assists in active closure of pelvic visceral organs40% of women have lost function or coordination of this muscle
42 The Structures supporting Bladder and Urethra Arcus tendineus fascia pelvisLevator ani (pubococcygeus muscles)Pubovesical muscles or ligamentsVaginal muscle attachments to fascia and levator ani
52 Physical examination of Pelvic Floor Dysfunction General examination- cancer screen, stool OB, urinalysis, physical examinationNeurological examination- paresthesia of dermatome, bulbocavernous reflex, voluntary contraction of anal sphincterPelvic examination- cystocele, rectocele,uterine prolapse, vault prolapseUrinary incontinence by Valsalva maneuver or coughing
53 Staging of Pelvic Organ Prolapse Stage 0 - no prolapseStage I - the most distal portion is >1cm above level of hymenStage II - The most distal portion is <1cm proximal or distal to plane of hymenStage III - The most distal portion is >1cm below plane of hymen, but < total vaginal length - 2 cmStage IV - complete eversion of total length of lower genital tract, the distal portion is > TVL-2 cm, i.e. cervix or vaginal cuff
54 Evaluation of Pelvic Floor Muscle Function Assessing patient’s ability to contract and relax pelvic muscles separatelyMeasuring the force of contractionPalpation of thickness of pelvic floor musculaturesElectromyographyPressure recording
55 Measurement of Bladder Base Descent (The Q-tip Test)
56 Lower Urinary Tract Symptoms caused by Pelvic Organ Prolapse Stress incontinenceFrequency, urgency, urge incontinenceHesitancy, weak stream, incomplete emptyManual reduction of prolapse for voidingPositional change to start or complete voiding
57 Bowel Symptoms caused by Pelvic Organ Prolapse Difficulty with defecationIncontinence of flatusIncontinence of liquid stoolIncontinence of solid stoolFecal staining of underwearDigital manipulation to complete defecationFeeling of incomplete evacuationRectal protrusion during or after defecation
58 Sexual symptoms caused by Pelvic Organ Prolapse Vaginal coitus?Frequency of vaginal coitus?Painful coitus?Satisfaction with sexual activity?Change in orgasm?Incontinence experienced during sexual activity?
59 Local symptoms caused by Pelvic Organ Prolapse Vaginal pressure or heavinessVaginal or perineal painSensation or awareness of tissue protrusion from vaginaLow back painAbdominal pressure or painObservation or palpation of a mass
Your consent to our cookies if you continue to use this website.