Function and Dysfunction of the Female Pelvic Floor According to the Integral System

Özet

The Integral System (ITS) is a total care management system based on the Integral Theory which states 'prolapse and symptoms of urinary stress, urge, abnormal bowel & bladder emptying, and some forms of pelvic pain, mainly arise, for different reasons, from laxity in the vagina or its supporting ligaments, a result of altered collagen/elastin. The ITS addresses

• Function – the role of competent suspensory ligaments in organ support and function. • Dysfunction – how damaged ligaments upset the musculoelastic control mechanism to cause prolapse and abnormal bowel and bladder symptoms. •Diagnosis – how to diagnose which damaged ligaments are causing which prolapse and which symptoms.

Treatment

In mild cases, new pelvic floor muscle exercises based on a squatting principle strengthen the natural closure muscles and their ligamentous insertions, thereby improving the symptoms predicted by the Theory. With more severe cases, polypropylene tapes applied through "keyhole" incision using special instruments reinforce the damaged ligaments, restoring structure and function.

Problems that can be potentially addressed by application of the Integral System

• Urinary stress incontinence • Urinary urge incontinence • Abnormal bladder emptying • Faecal incontinence and "obstructed evacuation" ("constipation") • Pelvic pain, and some types of vulvodynia and interstitial cystitis • Organ prolapse

Conclusions. Organ prolapse and symptoms are related, and both are mainly caused by laxity in the four main suspensory ligaments and perineal body. Restoration of ligament/fascial length and tension is required to restore anatomy and function.