The musculature of the pelvic floor functions as more than a bowl for carrying the pelvic organs, Ms.
Hartzell Leggin said. The collective muscles and fascia form a sling that fills in the pelvic ring and functions as an integrated system with constant resting tone. But the musculature is also active and interactive. Looking at risk factors for pelvic organ prolapse alone, Ms.
Hartzell Leggin said these can include age, body mass index, a history of occupational or recreational heavy lifting, chronic cough, and even genetics. However, one of the most significant risk factors for prolapse of pelvic organs is simply having had a vaginal delivery. And even if a patient progresses to surgery, PT may be a useful adjunct. Pelvic floor dysfunction may also be considered if a diastasis recti is discovered on physical exam, or if the patient reports a linear abdominal bulge.
Hartzell Leggin, so a PT referral for pelvic floor therapy and, in some cases, some behavioral retraining can help with issues of urinary frequency and urgency. These are options that may be considered before prescribing anticholinergic medication, she said.
Medications are also reviewed. An external and internal examination of the pelvic floor will look for muscle tone at rest and with strain, and for any defects or prolapse.
Pelvic Organ Prolapse (POP) - Women's Health Issues - MSD Manual Consumer Version
Slow-twitch fibres maintain muscle tone at rest. Highly resistant to fatigue because they can contract over a long period of time, they give muscles endurance. They tire quickly but can produce a strong and effective contraction; they also cope well with increases in intra-abdominal pressure. Tightening the levator ani muscles enhances the effectiveness of the sphincter muscles, thereby, helping to prevent leakage and incontinence.
This is especially the case when intra-abdominal pressure is raised, for example, on exertion, sneezing, coughing, laughing, lifting and straining. The superficial muscles are made up of the bulbocavernosus and ischiocavernosus sphincter. The main function of the superficial pelvic floor muscles is to support and anchor the deep muscles to the pelvic girdle, but they also are active during sexual activity Dorey, The superficial pelvic floor muscles and sphincter muscles are innervated by the pudendal nerve, while the levator ani is innervated directly by the pelvic nerves.
Any deficit in these nerves can be identified on examination of the dermatomes Fig 2. The pelvic floor muscles support the female pelvic organs bladder, uterus and rectum , protecting them against the effects of gravity.
The pelvic floor
These muscles are an integral part of a wider muscle system that responds to increases in intra-abdominal pressure. The muscles of the pelvic floor control the opening of the bladder and rectum, and maintain sphincter pressure and colorectal angle. They respond to an increase in intra-abdominal pressure caused, for example, by coughing, sneezing, laughing or straining , which will cause them to contract around the urethra and anus to prevent leakage. They can also have an inhibitory effect on bladder activity.
Just as importantly, they relax and lengthen to allow the passing of urine or faeces without straining. In women, the voluntary contraction squeezing of the pelvic floor muscles contributes to sexual arousal and sensation. The pelvic floor muscles support the unborn child in the uterus during pregnancy, and help it navigate through the pelvic girdle during birth. There are several factors that increase the risk of, or directly cause, damage to the pelvic floor muscles, leading to pelvic floor weakness or dysfunction. As explained by Marques et al , many are a consequence of human evolution, childbirth and ageing.
Others are lifestyle factors or illnesses. Causes of, and risk factors for, pelvic floor weakness are summarised in Box 1; the most prevalent causes and risk factors are also discussed below. Pregnancy and childbirth are probably the biggest risk factors for pelvic floor damage. This is because, during pregnancy and childbirth, muscular, connective and nervous pelvic floor tissues are subjected to numerous anatomical, functional and hormonal modifications Abrams et al, The pelvic floor goes through extensive change: initial hormonal changes prepare it for birth and it is stretched during vaginal delivery.
There are specific factors linked to pregnancy and childbirth that further increase the risk of damage to the pelvic floor:. The risk of pelvic floor damage is estimated to be 2. During vaginal delivery, interventions such as episiotomy or use of forceps may be used and can cause tears Abrams et al, These may, in turn, damage both internal and external anal sphincters, thereby, increasing the risk of faecal incontinence. Chronic constipation and regularly having to strain to empty the bowels can overstretch and weaken the pelvic floor muscles.
Difficulties emptying the bowels can sometimes be due to poor relaxation of the pelvic floor muscles. International Journal of Fertility and Women's Medicine. Anatomy of the peritoneum and mesentery.
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Peritoneum cavity Mesentery. Lesser omentum Hepatoduodenal ligament Hepatogastric ligament Liver Coronary ligament Left triangular ligament Right triangular ligament Hepatorenal ligament Falciform ligament Round ligament of liver Ligamentum venosum. Greater omentum Gastrophrenic ligament Gastrocolic ligament Gastrosplenic ligament Mesentery Splenorenal ligament Phrenicocolic ligament Folds Umbilical folds Supravesical fossa Medial inguinal fossa Lateral umbilical fold Lateral inguinal fossa Ileocecal fold.
Greater sac Lesser sac Omental foramen. Cystohepatic triangle Hepatorenal recess of subhepatic space Abdominal wall Inguinal triangle Peritoneal recesses Paracolic gutters Paramesenteric gutters. Broad ligament of the uterus Mesovarium Mesosalpinx Mesometrium Ovarian ligament Suspensory ligament of ovary. Extraperitoneal space Retroperitoneal space Retropubic space.
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Muscles and ligaments of abdomen and pelvis. Abdominal external oblique Transverse abdominal Conjoint tendon Rectus sheath rectus abdominis pyramidalis Arcuate line Tendinous intersection Cremaster Abdominal internal oblique. Inguinal triangle Inguinal canal Deep inguinal ring Superficial inguinal ring Intercrural fibers Crura of superficial inguinal ring Inguinal ligament Pectineal ligament Lacunar ligament Reflected ligament. Iliac fascia Iliopectineal arch.
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- The Oxford Handbook of the History of Medicine;
- BBC - Future - The mystery of the pelvic floor!
- The book of Jubilees, or The little Genesis.
- Chemical Reactions and Processes under Flow Conditions (RSC Green Chemistry Series)!
Sacral nerves . Anatomical terminology [ edit on Wikidata ]. From ventral mesentery Lesser omentum Hepatoduodenal ligament Hepatogastric ligament Liver Coronary ligament Left triangular ligament Right triangular ligament Hepatorenal ligament Falciform ligament Round ligament of liver Ligamentum venosum. Muscle quadratus lumborum Iliopsoas psoas major psoas minor iliacus.