Integral Theory

The Integral Theory System. A simplified clinical approach with illustrative case histories

  • PETER E. PAPA PETROS

Pelviperineology 2010;29(2):37-51

The integral theory: States that prolapse and pelvic floor symptoms such as urinary stress, urge, abnormal bowel and 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 connective tissue. Normal Function: The organs are suspended by ligaments against which muscles contract to open or close the outlet tubes, urethra and anus. These ligaments fail naturally into a 3 zone classification, anterior, middle, and posterior. Dysfunction: Damaged ligaments weaken the force of muscle contraction, causing prolapse and abnormal bladder and bowel symptoms Diagnosis: A pictorial diagnostic algorithm relates specific symptoms to damaged ligaments in each zone. 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 which 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.

Keywords: Integral Theory; diagnosis; minisling; ligaments; connective tissue; pictorial algorithm.