The integral theory: A musculo-elastic theory of pelvic floor function and dysfunction

Abstract

The Integral Theory (1993) stated: Stress, urge, and abnormal emptying are mainly caused by connective tissue laxity in the suspensory ligaments of vagina, a result of altered connective tissue. More recently, the theory has been amended to include pelvic pain, fecal incontinence, and defecation difficulties. According to the theory, therefore, accurate diagnosis and reconstruction of the suspensory ligaments will cure such symptoms. Essential to understanding the theory are the following concepts: the organs are suspended by ligaments; the organs are opened or closed by neurologically coordinated muscle forces contracting against these ligaments; lax ligaments may invalidate the muscle forces causing organ prolapse, and dysfunctions in closure (incontinence) or opening (evacuation symptoms); a symptom-based diagnostic algorithm helps to locate ligament laxity; these are confirmed by a three-zone structured examination system; and organ prolapse and abnormal symptoms are both addressed by using tapes to reinforce damaged suspensory ligaments. © 2010 Springer-Verlag Milan.