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.

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.