Integral Theory Paradigm: Common Pelvic Ligament Pathogenesis Guides Management for Urology, Gynecology, Coloproctology.

Background: This work had its origins in the 1990s, when women having collagen-creating midurethral slings for stress urinary incontinence (SUI) and uterosacral slings for uterine prolapse began reporting cure or improvement in co-occurring fecal incontinence, obstructive defecation, and chronic pelvic pain.

Summary: We briefly describe anatomical etiopathogenesis to explain how the same collagen-creating ligament repair system using a common ligament-based diagnostic system, can treat pelvic symptoms from 3 disciplines: Urology, Gynecology, Coloproctology. Collagen-induced laxity in ligaments and vagina diminishes contractile forces required by pelvic muscles to close urethra and anus for continence, open them for evacuation, and stretch the bladder base and rectum like a trampoline to prevent stretch receptors prematurely activating micturition and defecation reflexes. These are perceived cortically as bladder or fecal "urge to go." The pictorial algorithm summarizes common ligament pathogeneses for prolapse/bladder/bowel/pain dysfunctions which can be confirmed by mechanical support of PUL for relief of urine loss on coughing, and uterosacral ligaments (USL) for relief of urge and chronic pelvic pain. The same minimally invasive ligament repairs used for SUI, prolapse, pain/bladder dysfunctions were demonstrated by X-ray defecography controlled studies to cure fecal incontinence, obstructive defecation, anterior rectal wall intussusception and descending perineal syndrome (as shown in 16 case managements in 3 disciplines; video: https://youtu.be/a6jJQXDx71U?si=MLdo3Yq9kAZ82RVb).

Key messages: Symptom relief can be achieved using standard operations which repair PUL or USL even with minimal prolapse. Whether the surgery is done laparoscopically or vaginally is of little consequence, as the same structure is repaired.