Pelvic Floor Symptoms

The Integral Theory - A New Perspective

For some practitioners, the scientific framework and contemporary practical applications of the Integral Theory approach to improving female pelvic floor problems will be a new way of looking at anatomy and incontinence problems. The aim of this website is to present explanations for the specialist, general practitioner, and even the general public who may have a specific interest in understanding the origins and curative options for these pelvic floor disorders. More recently, the theory has been expanded to include nocturia, some types of faecal incontinence and pelvic pain.

The consequences of the Integral Theory approach are that such conditions, many previously considered incurable, are potentially curable by reinforcing the damaged ligaments with plastic tapes

The ideas are more fully expounded in Prof Peter Petros Book: 'The Female Pelvic Floor' available from Springer Publishers.
“Symptoms of stress, urge and abnormal emptying mainly derive, for different reasons, from laxity in the vagina or its supporting ligaments, a result of altered connective tissue.”

The Problem

Female pelvic floor dysfunctions form an extensive, if well hidden problem. Urinary incontinence is perhaps the best known of these dysfunctions but prolapses, faecal incontinence and pelvic pain affect a significant number of women. Even with urinary incontinence, the conventional approaches leave many bladder conditions deemed as ‘incurable’.

The problem of ‘conventional’ surgical correction is a case in point. When performed in the usual manner, bladder neck elevation (BNE) surgery for stress incontinence is characterized by long hospital stays, post-operative pain, urinary retention, neourgency, increasing surgical failure with time, and an incidence of enterocoele of up to 20%. BNE surgery is not generally advised for situations where there is mixed incontinence. Moreover, it cannot cure other pelvic floor dysfunctions.

It is the contention of this book that pelvic floor dysfunctions are largely caused (for different reasons) by damaged connective tissue in the suspensory ligaments of the pelvic floor. Treatment according to the Integral Theory is based on the principle that ‘restoration of form (structure) leads to restoration of function’. Hence, repair of damaged ligaments makes it possible to cure many conditions currently deemed ‘incurable’ by conventional approaches to incontinence. These are listed below.

Urinary Incontinence

In simple terms, urinary incontinence can be defined as involuntary urine loss. The prevalence in women as reported varies between 10 and 60%. It has two main components, stress (SI) and urge (UI) incontinence. UI increases with age. Only SI is said to be surgically curable. UI or mixed SI and UI are treated with drugs or bladder training. Drugs are rarely tolerated in the longer term because of side effects.

Frequency of Urination

Frequency of urination is defined as a problem when it occurs more than eight times per day. Causation is mostly unknown and it is treated with drugs or bladder training, both of which are not effective in the longer term.

Nocturia

Nocturia is defined as a problem when it occurs more than two times per night. Causation is mostly unknown and it is treated with drugs or bladder training, both of which are not effective in the longer term.

Bowel Dysfunction

Bowel dysfunction has two elements, difficulty with evacuation (‘constipation’) and incontinence, involuntary loss of wind or faeces (FI). FI causation is unknown, but is thought to be due to anal sphincter or pelvic muscle damage. The prevalence of all bowel dysfunctions in women varies between 10 and 20%. Treatment usually consists of drugs to slow down the bowel action, diet and operations such as levatorplasty. None of these treatments are particularly effective.

Abnormal Bladder Emptying

Abnormal bladder emptying can be defined as difficulty in bladder evacuation. It has specific symptoms and can present as chronic urinary infection due to a high residual urine. Conventionally it is treated with urethral dilatation, even though there is no obstruction and the treatment is not very effective.

Chronic Pelvic Pain

Chronic pelvic pain is characterized by a one-sided ‘dragging ‘ pain, of varying severity. The incidence can be as high as 20% of women. The cause is unknown but is thought to be psychological.

Other Problems

‘Interstitial Cystitis’ is a debilitating condition. The cause is unknown and no long term effective treatment is known. ‘Vulvodynia’ may occur in 10% of women. Symptoms can be severe in affected women. Causation is unknown. Treatment is empirical, and not always effective.