pelvic floor
The pelvic floor is the connective tissue-muscular floor of the pelvic cavity in humans . It is formed, among other things, by the levator ani muscle . Due to the different postures and pelvic positions, the term pelvic floor in quadruped mammals describes the ventral surface of the bony pelvis formed by the pubic and ischium bones . The rear end of the pelvic cavity, which corresponds to the human pelvic floor, is called the retroperitoneal part of the pelvic cavity .
Classification of the anatomical structures
The pelvic floor is divided into
- Pelvis diaphragm : posterior part of the pelvic floor, coccygeus muscle and the levator ani muscle on both sides (with its three parts puborectalis muscle , pubococcygeus muscle and iliococcygeus muscle ), broken through by the rectum
- Urogenital diaphragm : anterior part of the pelvic floor, formed by the transversus perinei profundus and superficialis muscles (and their fasciae), passage of the urethra, in women also the vagina
- Cavernous and sphincter layer : muscle ischiocavernosus , muscle bulbospongiosus ; External ani sphincter muscle
function
The pelvic floor has three main functions:
- tense,
- relax,
- Counterhold reflexively (tense in response to an increase in pressure in the abdomen).
Tension is important to maintain continence in women and men. The pelvic floor muscles significantly support the lower part of the urethra , the sphincter muscles of the urinary bladder and the anus .
The pelvic floor relaxes when urinating , when defecating , in women during sexual intercourse , in men when an erection occurs . The pelvic floor pulsates during orgasm , which means tension and relaxation alternate.
The pelvic floor has to hold up reflective when coughing, sneezing, laughing, jumping, carrying heavy loads, etc., otherwise urine may leak.
Diseases in humans
In women and men, the pelvic floor is weakened by obesity, chronic physical overload, poor posture, surgeries in the small pelvis and sometimes by medication.
In women, the pelvic floor muscles can be weakened or permanently damaged by vaginal births , in extreme cases the levator ani muscle can also be partially torn off from the pelvic bone. In the case of planned caesarean sections , these injuries practically do not occur; in the case of vaginal births, the birth position and the pressing technique have an influence on the probability of injury. The injuries can lead to inadequate control of the excretory organs, constant need to urinate, bladder subsidence , vaginal prolapse and uterine subsidence. In many, but not all, cases, the problems can be resolved with appropriate training. Such exercises help develop and control the pelvic floor muscles and can also help women better control their orgasm . As part of a scientific study, gynecologists from Great Britain, Sweden and New Zealand developed a method for individual risk assessment for the development of permanent pelvic floor damage during vaginal birth. Risk factors include a high weight of the child, an elderly mother and a family history of incontinence and sagging. An evaluation of the risk of injury in Germany is not part of prenatal care , a systematic follow-up on violations that occurred not part of the follow-up.
Surgery for vaginal vaginal and pelvic floor plasty for sagging states is one of the most common gynecological operations in Germany, with around 90,000 procedures per year.
Vaginal cramp or vaginismus is the reflexive or permanent tension in the pelvic floor or vaginal muscles. Women who suffer from vaginismus are unable to relax their muscles during sexual intercourse or during gynecological examinations in such a way that the penis or speculum can penetrate painlessly.
Diseases in animals
A break (hernia) in the area of the pelvic floor with a bulging perineum is called a perineal hernia . It occurs relatively frequently, especially in uncastrated male domestic dogs .
See also
Web links
- University of Sydney - Hans-Peter Dietz: Pelvic Floor Assessment (information page on examination options for pelvic floor damage)
- Jochen Fanghänel , Uwe Preuße: Anatomical basics of the pelvic floor. Curriculum Anatomy & Pain, Greifswald 2005, accessed September 30, 2018 [1]
- Robert E. Gutman: Pelvic Anatomy Anatomy. Johns Hopkins University, accessed September 30, 2018 [2]
Individual evidence
- ↑ Martina Lenzen-Schulte: Pelvic floor damage: educate better than before about the risks of vaginal births. Dtsch Arztebl 2018; 115 (45): A-2062 / B-1716 / C-1693
- ↑ Hans-Peter Dietz: Levator trauma. In: Pelvic Floor Assessment. University of Sydney, accessed March 31, 2018 .
- ↑ What does the levator ani muscle look like shortly after birth? In: Gyn-Depesche. Accessed March 31, 2018 .
- ↑ Schumpelick, Volker; Rath, Werner; Willis, Stefan; Faridi, Andree: Anal incontinence after vaginal birth: An argument in favor of a caesarean section on request? In: Deutsches Ärzteblatt. Accessed March 31, 2018 .
- ↑ Criticism of strict instructions on forced pressing and supine position of the laboring woman. Retrieved April 1, 2018 .
- ↑ Postpartum incontinence usually remains
- ↑ UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction? PMID 24740445
- ↑ Federal Statistical Office: Flat-rate hospital statistics (DRG statistics) Operations and procedures for fully inpatients in hospitals in 2015. (PDF) Retrieved on March 30, 2018 .