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Basic Neurological Evaluation and Referral
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
David B. Vodušek, Jalesh N. Panicker
L: 200 V/division (b) Figure 36.5 KinesiologicAl eMG recordings from the pubococcygeus muscles (recording with intrAmusculAr wires: right, upper trAces; left, lower trAces). (A) recordings from A 33-yeAr-old nullipArous womAn. Continuous firing of motor unit potentiAls is seen on the right with A grAduAl recruitment on voluntAry contrAction. on the left, no ongoing Activity is present. symmetricAl recruitment on voluntAry contrAction is present. (b) recordings from A 52-yeAr-old stress Urinary incontinent womAn. some ongoing muscle Activity cAn be seen in both pubococcygeAl muscles. on voluntAry contrAction, recruitment cAn only be seen on the left. on the right, there is ActuAlly A decreAse in firing of motor units on "voluntAry contrAction."
Urinary Incontinence
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Dudley Robinson, Linda Cardozo
More recently the ‘integral theory’ has been described by Petros and Ulmsten.15 This hypothesises that the distal and mid urethra have an important role in the continence mech-anism16 and that maximal urethral closure pressure is controlled at the mid-urethral point.17 The theory also proposes that damage to the pubo-urethral ligaments, which support the urethra, impaired support of the anterior vaginal wall to the mid urethra, and weakened function of part of the pubococcygeal muscles, which insert adjacent to the urethra, are responsible for causing stress incontinence.
Libido, Loss Of
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Management of this condition may prove difficult unless there is an underlying cause (Table 1) that can be treated or medication changed. Lifestyle changes may be helpful, especially reviewing alcohol consumption, smoking, and weight and stress management. Pharmacological agents may include vaginal lubricants and the use of androgenic progestogens (levonorgestrel, norgestrel, or desogestrel). Pubococcygeal exercises can increase blood flow to the perineum and can improve the sensation of arousal. However, if these measures are ineffective, then the help of a psychosexual counsellor should be recommended.
Investigation of pelvic floor disorders
Published in Climacteric, 2019
Dynamic MRI has enhanced the understanding of pelvic floor anatomy and dysfunction, allowing the visualization of all three compartments both at rest and during Valsalva maneuver51. Establishment of appropriate landmarks on sagittal images is critical for functional evaluation of the pelvic compartments and the extent of POP. The pubococcygeal line (PCL) is a straight line between the inferior border of the pubic symphysis and the last coccygeal joint and is thought to correspond to the plane of the pelvic floor61. The distance from the PCL to the bladder neck, cervix, and anorectal junction should be measured on images obtained at rest and during maximal Valsalva maneuver. In healthy individuals, there is minimal movement of the pelvic organs with respect to the PCL, even during maximal strain62. The ‘HMO’ system63 has been proposed to grade POP and includes evaluation of the ‘H-line’, the ‘M-line’, and the ‘O-line’. The ‘H-line’ is a measure of the width of the pelvic floor hiatus in the anteroposterior dimension, the ‘M-line’ represents the degree of pelvic floor descent, and the ‘O-line’ allows grading of POP relative to the PCL.
Female genito-pelvic reflexes: an overview
Published in Sexual and Relationship Therapy, 2019
Symen K. Spoelstra, Esther R. Nijhuis, Willibrord C. M. Weijmar Schultz, Janniko R. Georgiadis
The main somatic nerve of the perineum is the pudendal nerve, which has somatosensory and somatomotor tributaries, and which divides into three main branches (inferior rectal, perineal, dorsal penile/clitoral) at the level of the levator ani muscle. The muscles that embryonically derive from the cloacal sphincter (external anal and urethral sphincter, superficial transverse perineal muscle, bulbocavernosus muscle and ischiocavernosus muscle) are all innervated by pudendal nerve fibres originating in a specialized sacral motor neuronal pool called Onuf's nucleus (Iwata, Inoue, & Mannen, 1993; Onuf, 1899). As Onuf motoneurons innervate striated muscles but also are known to be relatively unaffected by somatic motoneuron diseases like amyotrophic lateral sclerosis (Mannen, Iwata, Toyokura, & Nagashima, 1977), they have been proposed to be of a mixed somatic/autonomic type (Kihira, Yoshida, Yoshimasu, Wakayama, & Yase, 1997). Interestingly, the pudendal nerve seems less involved in the innervation of the levator ani muscle. A separate nerve, the “levator ani nerve” (Wallner, Maas, Dabhoiwala, Lamers, & De Ruiter, 2010), arising from the ventral ramus of the third and fourth sacral nerves, is held to innervate the pelvic diaphragm. In at least 50% of cadavers studied, the pudendal nerve also contributed to innervation of the levator ani muscle, especially in regards to the medial portions (puborectal and pubococcygeal muscles) (Rock JA, 2003).
Perineal hernia mesh repair: a fixation with glue, sutures and tacks. How to do it
Published in Acta Chirurgica Belgica, 2019
L. Hassan, A. Beunis, M. Ruppert, V. Dhooghe, S. Van den Broeck, G. Hubens, N. Komen
A 68-year-old female patient underwent an APR after neoadjuvant concomitant chemoradiotherapy for an adenocarcinoma of the lower rectum with moderate differentiation. About 11 years later, she presented complaining of pressure in the lower abdomen. A magnetic resonance imaging (MRI) (Figure 2) showed a herniation of intra-abdominal fat via the posterior perineal lodge, 12 cm underneath the pubococcygeal line.