An integral theory and its method for the diagnosis and management of female urinary incontinence.

Abstract

The Integral Theory on Female Urinary Incontinence states: stress symptoms, urge symptoms, and symptoms of defective flow may all derive , for different reasons, from laxity in the suburethral vagina or its supporting ligaments. This theory proposes that the pre-tensioned anterior vaginal wall transmits specific pelvic muscle contractions which open or close the bladder neck and urethra. The vagina is tensioned like the membrane of a drum against the ligaments which support it from above. In its tensioned state, the vagina can be pulled by the pelvic floor muscles to mechanically open or close bladder neck. The tensioned vagina also indirectly supports the nerve terminals at bladder base. Vaginal laxity may predispose to premature activation of the micturition reflex. If this reflex cannot be suppressed, then the subsequent uninhibited detrusor contraction may cause urinary urge incontinence ( bladder instability). Therefore, laxity* in the vaginal tissue or its supporting ligaments may, for different reasons cause symptoms of stress incontinence, urge incontinence, or of defective opening. Based on the evidence presented here and in previous studies (1), a new anatomical classification of female urinary incontinence can be made, consisting of six specific anatomical defects. Characteristic clinical, morphological and urodynamic changes which help to diagnose a particular defect are identified, as is the modifying effect of age, hormones, and iatrogenically induced scar tissue. Three separate closure mechanisms are described, urethral, bladder neck, and a separate voluntary mechanism. * excessive tightness of these structures may also cause dysfunction of the opening/closure mechanisms in the patient who has been already subjected to surgical interference.