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Introduction: Continence is self-restraint and self-control of the following items:-Temperance and re-action, -Sexual behavior, -Body's excreta, the urine and the stool, -Poor's due and Charity donation, -Justice and honesty. Pathophysiology:Continence is an acquired behavior gained by learning and training. An intact sound brain and central nervous system (CNS) control and master coordination between the sympathetic, parasympathetic, somatic nervous systems and the body's skeleto-muscular system and various body organ's response. The primary target of the sympathetic nervous system is to stimulate the body to "fight-or flight" response. Most people are born with the parasympathetic nervous system dominating the functions of the autonomic nervous system. We gain, progressively, rising up sympathetic tone from everyday life stress, annoyance, teaching, training and experience. A provoking stimulus will lead to one of four possibilities; 1-fight, 2, flight, 3, holding back (continence) and 4-if the offense is overwhelming it will lead to sympathetic failure and incontinence. Mechanism of action:Continence is a nerve-muscle action, where the nerve secretes neurotransmitter, which acts on receptors on the target tissues. The neurotransmitter of the post-ganglion sympathetic system is norepinephrine (NE). Body excreta control:Toilet training in early childhood leads to gaining high alpha-sympathetic tone at the internal urethral sphincter (IUS) and the internal anal sphincter (IAS) keeping the sphincters contracted and the urethra and the anal canal closed all the time. Conclusion:The way to gain continence is how to control the sympathetic nervous system harmonized and mastered by healthy intact CNS, and it is how to control different responses according to social circumstances.

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.

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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.