A critical analysis of integral theory statements concerning pathogenesis of LUTS and chronic pelvic pain

ABSTRACT Lower urinary tract symptoms (LUTS) and pelvic pain are highly prevalent in women and often poorly understood. The aim was to critically analyse the integral theory paradigm’s (ITP) statements concerning anatomical pathogenesis of LUTS, in particular, chronic primary pelvic pain syndrome (CPPPS) and LUTS as defined by the 2002 ICS report. The ITP explains pelvic floor function is determined by three directional muscle forces: forward, backwards and downward-acting muscle vector forces supported by ligaments which result in an anterior and posterior resultant keeping the balance needed for optimal sphincter closing and voiding. Muscular weakness caused by loose ligaments may result in LUTS and pain in some patients. Loose uterosacral and pubourethral ligaments provoke dysfunctional bladder filling and evacuation. Weakened uterosacral ligaments (USL), often accompanied by pelvic organ prolapse, weaken the posterior resultant, as seen in the posterior fornix syndrome and may explain chronic pelvic pain, LUTS, and dysfunctional defecation in some. Further studies are needed to investigate the importance of the ITP when treating CPPPSs and LUTS, in particular, possible non-surgical options to support USLs, considering the possible complications of reconstructive surgery.