title: The integral system.
abstract: 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'.
  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.
  Damaged ligaments weaken the force of muscle contraction, causing prolapse and abnormal bladder and bowel symptoms.
  
  
  METHODS
  A pictorial diagnostic algorithm relates specific symptoms to damaged ligaments in each zone.
  
  
  METHODS
  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.
authors.affiliation: Honorary Professor, Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Petros
keywords: Integral System; Integral Theory; connective tissue; diagnosis; ligaments; minisling; pictorial algorithm