When can the pelvic floor be damaged?
When is the anal sphincter endangered in childbirth?
If there is a midline tear or episiotomy
When is the anal sphincter protected in childbirth?
If there is a mediolateral tear or episiotomy
When are episiotomies performed?
If there is a clinical need, such as intrumental birth, or a suspected fetal compromise
What are perineal tears classified into?
What is a first degree perineal tear?
Where the fourchette and vaginal mucosa are damaged, and the underlying muscles are exposed, but not torn
What is a second-degree perineal tear?
Tears to posterior vaginal walls and perennial muscles, but the anal sphincter is intact
What is a third-degree perineal tear?
Extends to the anal sphincter that is torn, but the rectal mucosa is intact
What is a fourth-degree perineal tear?
When the anal canal is opened, and the tear may spread to the rectum
How is a episiotomy performed?
Use a mediolateral technique; 45-60 degrees to the right side, originating from the vaginal fourchette, and use tested, effective analgesia
Other than tears, what other damage can childbirth cause?
- Stretch of the pudendal nerve
- Stretch and damage of the pelvic floor and perineal muscles
- Stretch/rupture of ligaments supporting muscles
What does a stretch of the pudendal nerve cause?
- Muscle weakness
What does stretching and damage to the pelvic floor and perineal muscles cause?
What does stretching/rupture of ligaments supporting muscles cause?
Ineffective muscle action
What happens if ligaments supporting muscles in the perineal area get stretched overtime?
They remodel and get longer
Does a caeserean avoid the damage caused by childbirth?
No, appears that the damage can occur due to just having the child in the pelvis area
What factors contribute to pelvic floor dysfunction?
- Chronic cough
- Intrinsic connective tissue laxity
Why does menopause predispose to pelvic floor dysfunction?
Atrophy of tissues after oestrogen withdrawal
What can cause intrinsic connective tissue laxity leading to prolapse?
Defined conditions or constitutional
What are the types of prolapse?
- 1st degree
- 2nd degree
- 3rd degree
What is a first degree prolapse?
Uterus falls into vagina, but doesn't fall out of the body
What happens in a 2nd degree prolapse?
Uterus reaches vaginal opening (cervix peeks out near the labia)
What happens in a 3rd degree prolapse?
Uterus partially or completely falls externally, and the vagina is turned inside out
When does a 3rd degree prolapse most commonly occur?
What % of women over 50 will have urinary incontience problems?
What % of prolapses reoccur after corrective surgery in women?
How can prolapse and urinary incontinence be treated?
- Pelvic floor muscle
What is the advantage of pelvic floor muscle exercise in treatment of prolapse and urinary incontinence?
How effective are pelvic floor muscle exercises in treating incontinence?
Cure of incontinence occurs in 50-75% of patients
What is the effect of pelvic floor muscle exercises in prolapse management?
Will prevent or delay worsening of prolapse
What do surgical continence procedures do?
Increase support to the sphincter mechanism and prevent descent of the bladder neck
Give two examples of surgical continence procedures
- Tension-free vaginal tape
How effective are surgical continence procedures?
Cure rate 85-90%
What are the disadvantages of surgical continence procedures?
- Voiding difficulty/retention
- Overactive bladder disease (obstruction)
Give 3 surgical prolapse procedures
- Removed prolapsed organs
- Restoring connective tissue supports
- Maintaing functions
What are the side effects of surgical prolapse procedures?
- New incontinence
- Dyspareunia (painful intercourse)