Limits...
The integral system.

Petros P - Cent European J Urol (2011)

Bottom Line: With more severe cases, polypropylene tapes applied through "keyhole" incision using special instruments reinforce the damaged ligaments, restoring structure and function.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.

View Article: PubMed Central - PubMed

Affiliation: Honorary Professor, Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia.

ABSTRACT

Unlabelled: The Integral System 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 connective tissue'.

Normal function: The organs are suspended by ligaments against which muscles contract to open or close the their outlet tubes, urethra and anus. These ligaments fall naturally into a three-zone 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 that can be potentially addressed by application of the Integral SystemUrinary stress incontinenceUrinary urge incontinenceAbnormal bladder emptyingFacal incontinence and "obstructed evacuation" ("constipation")Pelvic pain, and some types of vulvodynia and interstitial cystitisOrgan 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.

No MeSH data available.


Related in: MedlinePlus

Pictorial Diagnostic Algorithm relates prolapse (cystocoele “2”, rectocele “4” and uterus ”3”), to symptoms. Both prolapse and symptoms are caused by looseness in the suspensory ligaments and their associated tissues. The anterior (pubourethral) and posterior (uterosacral) ligaments are in purple. The middle ligaments (ATFP& cardinal) are not shown in this diagram. There are three columns, one for each ligament group and the symptoms and prolapses (lumps) associated with damage to these ligaments. In patients who have urgency, grouping of symptoms is the key to diagnosing the zone of damage, as any zone may cause urgency. In this patient, the symptoms (ticked) indicate damaged posterior ligaments (uterosacral).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3921723&req=5

Figure 0009: Pictorial Diagnostic Algorithm relates prolapse (cystocoele “2”, rectocele “4” and uterus ”3”), to symptoms. Both prolapse and symptoms are caused by looseness in the suspensory ligaments and their associated tissues. The anterior (pubourethral) and posterior (uterosacral) ligaments are in purple. The middle ligaments (ATFP& cardinal) are not shown in this diagram. There are three columns, one for each ligament group and the symptoms and prolapses (lumps) associated with damage to these ligaments. In patients who have urgency, grouping of symptoms is the key to diagnosing the zone of damage, as any zone may cause urgency. In this patient, the symptoms (ticked) indicate damaged posterior ligaments (uterosacral).

Mentions: Both collagen and elastin deteriorate markedly after menopause, which explains the vast increase in prolapse and incontinence that occurs after this event [25]. A partially damaged ligament which is only just functioning before the menopause, may lose enough collagen after it, to “give way”. This looseness may result in organ prolapse, abnormal symptoms, or both. The estrogen hormone replacement therapy (“HRT”) helps to slow down the degeneration of collagen, though it cannot reverse damage (for example incontinence) once it has occurred, as the suspensory ligament(s) have already been stretched to the point where the muscle contractility is diminished due to the lax insertion point [27, 28]. According to Gordon's Law, a muscle contracts efficiently only over a finite distance [29]. If the muscle insertion points, the pelvic ligaments, are loose, part of the muscle contraction is wasted in stretching the loose ligament. Therefore neither opening nor closure, Fig. 5, can be adequately accomplished by the relevant muscles. Such dysfunction is perceived as symptoms, Fig. 9: inadequate closure = incontinence (urinary and fecal); inadequate evacuation = constipation and urinary retention/emptying difficulties; or inadequate stretching of the vaginal membrane causes “S” Fig. 7 to fire off prematurely = urgency, frequency nocturia.


The integral system.

Petros P - Cent European J Urol (2011)

Pictorial Diagnostic Algorithm relates prolapse (cystocoele “2”, rectocele “4” and uterus ”3”), to symptoms. Both prolapse and symptoms are caused by looseness in the suspensory ligaments and their associated tissues. The anterior (pubourethral) and posterior (uterosacral) ligaments are in purple. The middle ligaments (ATFP& cardinal) are not shown in this diagram. There are three columns, one for each ligament group and the symptoms and prolapses (lumps) associated with damage to these ligaments. In patients who have urgency, grouping of symptoms is the key to diagnosing the zone of damage, as any zone may cause urgency. In this patient, the symptoms (ticked) indicate damaged posterior ligaments (uterosacral).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921723&req=5

Figure 0009: Pictorial Diagnostic Algorithm relates prolapse (cystocoele “2”, rectocele “4” and uterus ”3”), to symptoms. Both prolapse and symptoms are caused by looseness in the suspensory ligaments and their associated tissues. The anterior (pubourethral) and posterior (uterosacral) ligaments are in purple. The middle ligaments (ATFP& cardinal) are not shown in this diagram. There are three columns, one for each ligament group and the symptoms and prolapses (lumps) associated with damage to these ligaments. In patients who have urgency, grouping of symptoms is the key to diagnosing the zone of damage, as any zone may cause urgency. In this patient, the symptoms (ticked) indicate damaged posterior ligaments (uterosacral).
Mentions: Both collagen and elastin deteriorate markedly after menopause, which explains the vast increase in prolapse and incontinence that occurs after this event [25]. A partially damaged ligament which is only just functioning before the menopause, may lose enough collagen after it, to “give way”. This looseness may result in organ prolapse, abnormal symptoms, or both. The estrogen hormone replacement therapy (“HRT”) helps to slow down the degeneration of collagen, though it cannot reverse damage (for example incontinence) once it has occurred, as the suspensory ligament(s) have already been stretched to the point where the muscle contractility is diminished due to the lax insertion point [27, 28]. According to Gordon's Law, a muscle contracts efficiently only over a finite distance [29]. If the muscle insertion points, the pelvic ligaments, are loose, part of the muscle contraction is wasted in stretching the loose ligament. Therefore neither opening nor closure, Fig. 5, can be adequately accomplished by the relevant muscles. Such dysfunction is perceived as symptoms, Fig. 9: inadequate closure = incontinence (urinary and fecal); inadequate evacuation = constipation and urinary retention/emptying difficulties; or inadequate stretching of the vaginal membrane causes “S” Fig. 7 to fire off prematurely = urgency, frequency nocturia.

Bottom Line: With more severe cases, polypropylene tapes applied through "keyhole" incision using special instruments reinforce the damaged ligaments, restoring structure and function.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.

View Article: PubMed Central - PubMed

Affiliation: Honorary Professor, Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia.

ABSTRACT

Unlabelled: The Integral System 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 connective tissue'.

Normal function: The organs are suspended by ligaments against which muscles contract to open or close the their outlet tubes, urethra and anus. These ligaments fall naturally into a three-zone 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 that can be potentially addressed by application of the Integral SystemUrinary stress incontinenceUrinary urge incontinenceAbnormal bladder emptyingFacal incontinence and "obstructed evacuation" ("constipation")Pelvic pain, and some types of vulvodynia and interstitial cystitisOrgan 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.

No MeSH data available.


Related in: MedlinePlus