What is the integral theory of urinary incontinence in women?

Updated: Sep 23, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

A unifying theory of the etiology of stress incontinence, urge incontinence, voiding dysfunction, and fecal incontinence in women has been proposed. [25] The basis of the theory is that these disorders are the result of overstretching of the vaginal connective tissue and supporting ligaments, which usually occurs during childbirth.

Laxity of the pubourethral ligaments (ie, anterior zone of damage), mid vagina (ie, middle zone), and uterosacral ligaments (ie, posterior zone) make the usual tridirectional support of the vagina ineffective. With the vagina no longer properly tethered to the pelvic girdle, the usual neuromuscular actions that occur during increases in intra-abdominal pressure or pelvic floor relaxation during voiding are not translated as effectively into urethral closure and opening, respectively.

Detrusor overactivity, according to this theory, occurs because of the premature firing of stretch receptors in the bladder base secondary to poor endopelvic connective tissue support to the filling bladder.

The integral theory is attractive from the standpoint of parsimony but is complex. The theory is best appreciated and understood with the help of illustrations and diagrams showing directional force vectors.


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