Introduction: Urinary and Fecal Control depends on two factors, the first is an inherent, and the second is an acquired. The inherent factor is the presence of an intact sound IUS and IAS. The acquired factor is, through toilet training, having and maintaining high sympathetic tone at the IUS and the IAS. This keeps the sphincters contracted and the urethra and the anal canal empty and closed all the time.

Laceration of the collagen chassis of the IUS leads to its weakness and subsequent stress urinary incontinence (SUI) and/or over active bladder (OAB).

Similarly, lacerations of the collagen chassis of the IAS lead to its weakness and subsequent fecal incontinence (FI).

The lacerations in one/or both sphincters are mainly caused by childbirth trauma (CBT). The pelvic collagen is hormone dependent and drop in the estrogen level causes further weakness of the sphincters.

In men senile prostatic enlargement compress the upper part of the urethra leading to irregular dilatation of the bladder neck allowing some urine to enter the urethra on increases of abdominal pressure causing frequent desire to void. The start of voiding may take some time (hesitancy) because of the effort to open the urethra which is compressed by the enlarged prostate.

Reconstructive surgery: In women the commonest cause of incontinence is traumatic lacerations of the collagen chassis of the IUS and/or the IAS from CBT. Reconstructive surgery is to restore the normal anatomy and it will restore the function. A new operation “urethra-ano-vaginoplasty” is introduced where mending the torn collagen chassis of the IUS and overlapping the anterior vaginal wall flaps over the mended IUS; and mending the torn chassis of the IAS, overlapping the posterior vaginal wall flaps over the mended sphincter, approximate the two levator ani muscles and repair of the perineum is done.

https://www.longdom.org/open-access/urinary-and-fecal-control-and-incontinence-pathogenesis-and-management-2168-9857-1000203.pdf

Urinary and Fecal Control and Incontinence: Pathogenesis and Management

The urinary bladder and the urethra; the rectum and the anal canal have the same embryologic anatomical source, from the cloaca. They share the same nerve supply and have systemic sensory and proprioceptors (mechanoreceptors) in the muscle responsive to mechanical changes. Toilet training switches the toilet control, supervised by the CNS, from para-sympathetic to mainly sympathetic control. Acquired high sympathetic tone at the Internal Urethral Sphincter (IUS) and the Internal Anal Sphincter (IAS) keeps both sphincters contacted and the urethra and anal canal empty and closed all the time. Voluntarily or in need with proper social circumstances, controlled by intact healthy CNS, the IUS and/or the IAS relax and the urethra and the anal canal will open to allow pass of urine, flatus and/or feces. The neurotransmitter at the sympathetic nerve endings is nor-epinephrine, which can be deficient in cases of nocturnal enuresis. The IUS and the IAS are collagen-muscle tissue cylinders. In women both sphincters are closely related to the vagina, and are subject to lacerations from vaginal delivery. Lacerated sphincters as a result of Child-Birth Trauma (CBT) become weak and cannot stand against sudden rise of abdominal pressure resulting in Urinary Incontinence (UI) and/or Fecal Incontince (FI).

https://www.longdom.org/open-access/micturition-and-defecation-neurochemical-control.pdf

Micturition and Defecation, Neuro-Chemical Control

Voiding (urine &/or feces) depends on:
Toilet training early in life switch voiding from uncontrolled CNS-pelvic parasympathetic action to voluntary CNSthoracolumbar sympathetic act.
The IAS is a collagen-muscle tissue cylinder that surround the anal canal. The IAS consists mainly of strong collagen tissue cylinder mixed with smooth plain muscle fibers with its nerve supply from the autonomic nervous system. It is surrounded in its lower part with the voluntary striated muscle, the external anal sphincter (EAS).
The IUS is a collagen-plain muscle tissue cylinder that extends from the bladder neck to the perineal membrane in both sex. The external urethral sphincter is a striated voluntary muscle lying in the deep perineal pouch. Voiding training induces and keeps high alpha-sympathetic tone at both the IUS & the IAS to maintain both contracted all the time, thus keeping the urethra & the anal canal empty and closed. On desire &/or need the person lowers the high alpha sympathetic tone at the IUS &/or the IAS to open the urethra &/ or the anal canal to void.
Injury of the IAS leads to fecal incontinence (FI). The injury is mostly traumatic from childbirth trauma (CBT) but it can be the result of anal intercourse. Subsequently the presence of excreta in the open anal canal will induce sense of desire to void; it may give false impression of desire to void urine (OAB).
Homosexuality &/or voiding incontinence are an important cause of psychological ailment.

https://www.longdom.org/open-access/voiding-troubles-fecal-incontinence-and-anal-intercourse.pdf

Voiding Troubles, Fecal Incontinence and Anal Intercourse

Introduction: Body excreta (urine, feces and flatus) are expelled through the urethra in front and the anal canal posterior. Both the urethra and the anal canal are derived embryological from the cloaca and have the same neurovascular bundle, thoraco-lumbar sympathetic nerves (T10-L2) through the inferior hypogastric nerve plexus as exciter, and sacral sensory nerves (S 2, 3 &4). Everybody organ has a strong collagen chassis, this include the internal urethral sphincter (IUS) and the internal anal sphincter (IAS). Toilet training in early childhood leads to acquiring and keeping high sympathetic tone at the IUS and the IAS causing their contraction and the urethra and the anal canal are kept empty and closed all the time until there is a need/or a desire to expel at proper social circumstances.
Clinical Study: Function of the IUS is proved by urodynamic studies, while structural damage of both the IUS and the IAS is demonstrated by medical imaging.
Results: We proved that there is high sympathetic tone at the IUS, recording the UPP at rest, and then we gave alpha-sympathetic drug, the UPP dropped markedly. We gave sympathomimetic drug the UPP raised immediately. Medical imaging proved lacerated IUS in cases of stress urinary incontinence (SUI) and lacerated IAS in cases of fecal incontinence (FI).
Conclusion: Urinary continence depends on a closed and empty urethra. Fecal continence depends on a closed and empty anal canal. Healthy reactive CNS, intact sensory nerves, intact sympathetic nerves producing normal neuro-transmitter are essential for continence.

https://www.longdom.org/open-access/body-excreta-control-and-incontinence-2168-9857-1000198.pdf

Body Excreta Control and Incontinence

Introduction: Outlet control means continence, which is how to control body excreta (urine, flatus, and feces), control of temperance, body reaction, and control of sexual behavior and premature ejaculation. It is a nerve–muscle action, controlled by the central nervous system (CNS). Outlet control is an acquired behavior gained by learning and training to control the sympathetic nervous system. Although the sympathetic nervous system is part of the involuntary autonomic nervous system control, its function may be controlled. Evidence of this is seen in the control of body excreta control after toilet training and in how domestic animals can be trained to control body excreta as well. Micturition and urinary continence: Urinary continence depends on a closed and empty urethra created by two factors: one is the presence of a strong intact internal urethral sphincter (IUS), which is a collagen–muscle tissue cylinder that extends from the bladder neck down to the perineal membrane. The other factor is an acquired behavior which is keeping high sympathetic tone at the IUS gained in early childhood from toilet training. Failure of either factors leads to urinary incontinence (UI). Defecation and fecal continence: Fecal continence depends on a closed and empty anal canal created by two factors, one is inherent and one is acquired. The acquired factor is keeping high sympathetic tone at the internal anal sphincter (IAS) gained in early childhood from toilet training. The inherent factor is the presence of an intact strong IAS, which is a collagen–muscle tissue cylinder surrounding the anal canal. Pathology: Childbirth trauma (CBT) causes laceration in the collagen chassis of the vagina leading to vaginal prolapse, and the intimately related IUS in front and/or the IAS posterior, causing UI and/or fecal incontinence (FI). Pathophysiology: Outlet control is how to control the sympathetic nervous system and to manage different responses according to social circumstances. OriGinal article 1-8Professor, 9Lecturer, 10Consultant 1,4-8Department of Obstetrics and Gynecology, Al Azhar University, Cairo, Egypt 2Department of Pathology, Al Azhar University, Cairo, Egypt 3Department of Obstetrics and Gynecology, University of Zagreb Zagreb, Croatia 9Department of Radiology, Ain Shams University, Cairo, Egypt 10Department of Obstetrics and Gynecology, Al-Galaa Maternity Hospital, Cairo, Egypt Corresponding Author: Abdel KM El Hemaly, Professor Department of Obstetrics and Gynecology, Faculty of Medicine Al Azhar University, Cairo, Egypt, Phone: +201001577969 e-mail: profakhemaly@hotmail.com 10.5005/jp-journals-10009-1546 Diagnosis: Structural damage is diagnosed clinically and by medical imaging: ultrasound (US), magnetic resonance imaging (MRI) and/or computed tomography (CT) scan. Structural damage will cause functional disturbance which is assessed clinically and by urodynamics. Conclusion: Ultrasound scanning of the urethra to see if it is closed or open and the state of the IUS and visualizing the lacerations are easy and cheap methods of assessment of UI. Also US assessment of the anal canal, open or closed, and the IAS, and the extent of its laceration will help very much in its diagnosis and management.

/pdf/outlet-control-pathogenesis-and-treatment-the-role-of-2gs5qwcg7a.pdf

Muhammad R. Morad

Papers

Body Excreta Control and Incontinence

Outlet Control, Pathogenesis, and Treatment: The Role of Ultrasound in Its Management

Urinary and Fecal Control and Incontinence: Pathogenesis and Management

Micturition and Defecation, Neuro-Chemical Control