Supplementary Material for: Integral Theory Paradigm- common pelvic ligament pathogenesis guides management for Urology, Gynecology, Coloproctology

Background The pathophysiology behind this work is the same as for the midurethral sling: collagen-deficient ligaments weaken the closure muscles which contract against them; precise insertion of tapes in the anatomical position of the ligaments (PUL) create new collagen to restore function and cure symptoms.
Aims/methods To briefly describe how the same collagen-creating system applied to PUL and other ligaments such as uterosacral, can treat common symptoms from Urology, Gynecology, Coloproctology. VIDEO 1 describes 16 practical applications of this system to cure bladder/bowel/pain and tethered vagina syndrome dysfunctions.

Results 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; stretch bladder base and rectum like a trampoline to prevent stretch receptors prematurely activating micturition and defecation reflexes, 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 xray defecography controlled studies to cure fecal incontinence, obstructive defecation, anterior rectal wall intussusception and descending perineal syndrome. Pathophysiology update at: https://atm.amegroups.org/issue/view/1400