Review

A practical update on functional and dysfunctional anatomy of the female pelvic floor - Part 2 Dysfunction

10.34057/PPj.2019.38.01.005

  • YUKI SEKIGUCHI
  • HIROMI INOUE
  • RYOKO NAKAMURA

Pelviperineology 2019;38(1):21-26

Background

The Integral Theory System considers pelvic organ prolapse (POP), pain, bladder & bowel dysfunctions to be mainly caused by laxity in up to 5 suspensory ligaments and their vaginal attachments.

Aim

To define the role of ligaments in normal function (Part1), then dysfunction and principles of surgical cure (Part 2).

Methods

The role of pelvic ligaments and muscles in normal bladder & bowel closure, evacuation, central and peripheral neurological control is analysed.

Results

Normal function Ligaments stretch minimally, vagina stretches extensively during coughing, straining, squeezing, micturition, defeca-tion. Competent ligaments suspend organs and act as insertion points for 3 striated muscle forces. These act in opposite directions to close and open urethra & anorectum, stretch organs to prevent inappropriate activation of micturition and defecation reflexes. Dysfunction Ligaments must be competent, otherwise the muscles which contract against them lengthen and weaken. A cascade of dysfunctions follow from elongated ligaments: prolapse; muscles cannot close urethral and anal tubes (incontinence) open them (emptying problems) or stretch organs sufficiently to support stretch receptors which may fire off prematurely to activate the micturition reflex (urge incontinence, frequency, nocturia) or defeca-tion reflex (fecal incontinence).

Conclusions

Part 1 demonstrated that competent ligament insertion points are required for the 3 directional for-ces which control mechanical closure and evacuation and the neurological feedback mechanisms for defecation and micturition reflexes. Len-gthening of the sarcomere due to ligament laxity was considered the ultimate link between loose ligaments and dysfunctions in these organs.

Keywords: Loose ligaments,Integral Theory,Stress incontinence,TFS,Chronic pelvic pain,OAB,Nocturia,Fecal incontinence