Original Article

A critical review of TFS ligament repair. Part 3: The role of ligaments in the control of bladder, bowel and pain symptoms

  • DARREN M GOLD
  • DAVID ENDE

Pelviperineology 2018;37(3):90-92

Background

Fundamental to the understanding of abnormal bladder, bowel and pain symptoms is the understanding of normal control mechanisms. Essentially, pelvic symptoms can mainly be attributed to dysfunctions of organ closure (incontinence), evacuation (emptying), control of the micturition and defecation reflexes, and pelvic pain.

Aim

To explain the role of intact ligaments and vagina in the control of these normal functions.

Methods

Seven key anatomical points are identified by the Integral Theory for normal pelvic function. Each of these is critically analysed with reference to Parts 1& 2. The urethra and anus function as emptying tubes for evacuation of the bladder and rectum. They are opened and closed by 3 directional muscle forces contracting or relaxing in concert against anterior (PUL, pubourethral) and posterior (CL/USL cardinal/uterosacral) suspensory ligaments.

Conclusions

These 7 basic anatomical points prepare the groundwork for Part 4, how two main ligament groups are associated with the generation of pain and major symptoms of bladder and bowel dysfunction, pubourethral ligaments anteriorly and cardinal/uterosacral ligaments posteriorly.

Keywords: TFS,Urge incontinence,nocturia,chronic pelvic pain,fecal incontinence,obstructive defecation,abnormal emptying