A Novel Concept on the Patho-Physiology of Defecation and Fecal Incontinence (FI) in Women – Moreover, Its Reconstructive Surgery

Hemaly, Abdel Karim M. El; Mousa, Laila A.E.S.; Kandil, Magdy S. Al Sayed Ibrahim M.; Zaher, Mohammad Abdel; Soliman, Magdi S.A.; Serour, A.

doi:10.5772/57383

Cited by 3 publications

(8 citation statements)

References 14 publications

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“…A healthy intact IUS forms the muscular arc of the good control. Sometimes the terminal sympathetic nerves do not produce nor-epinephrine so the IUS does not contract and there will be involuntary leak of urine (enuresis) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. The lack of norepinephrine is either partial or total deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Before toilet training the first stage of micturition is controlled by the pelvic parasympathetic nervous system (S. [2][3][4] (Figures 1-3) [1][2][3][4][5][6].…”

Section: Micturitionmentioning

confidence: 99%

“…The rectum is the reservoir for feces (stool and gases) and the anal canal is the tap that controls the passage of the feces (Figures 8 and 9) [4][5][6][7][8][9]. Sensations of full rectum travel to the spinal cord and higher CNS centers through sensory nerves sacral 2, 3 & 4.…”

Section: Defecationmentioning

confidence: 99%

“…Then, overlapping of the two vaginal flaps is done, image (5). Image (6), at the end of the anterior repair with the direction of the urethra directly forward and clear urine is coming out.…”

Section: Reconstructive Surgerymentioning

confidence: 99%

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Urinary and Fecal Control and Incontinence: Pathogenesis and Management

Hemaly¹,

Mousa²,

Ibrahim³

et al. 2018

Med Surg Urol

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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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Section: Discussionmentioning

confidence: 99%

“…Before toilet training the first stage of micturition is controlled by the pelvic parasympathetic nervous system (S. [2][3][4] (Figures 1-3) [1][2][3][4][5][6].…”

Section: Micturitionmentioning

confidence: 99%

Section: Defecationmentioning

confidence: 99%

Section: Reconstructive Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Urinary and Fecal Control and Incontinence: Pathogenesis and Management

Hemaly¹,

Mousa²,

Ibrahim³

et al. 2018

Med Surg Urol

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“…It is better called pelvic organs dysfunction, there are anatomical derangement of the pelvic organs and physiological changes [1][2][3][4][5][6][7][8][9]. Trauma especially child birth trauma (CBT) disturbs the anatomy and physiology of the pelvic organs.…”

Section: Pelvic Floor Dysfunctionmentioning

confidence: 99%

Body Excreta Control and Incontinence

M¹,

A²,

Ibrahim³

et al. 2018

Med Surg Urol

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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.

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

Hemaly¹,

Kandil²,

Mousa³

et al. 2018

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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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.

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A Novel Concept on the Patho-Physiology of Defecation and Fecal Incontinence (FI) in Women – Moreover, Its Reconstructive Surgery

Cited by 3 publications

References 14 publications

Urinary and Fecal Control and Incontinence: Pathogenesis and Management

Urinary and Fecal Control and Incontinence: Pathogenesis and Management

Body Excreta Control and Incontinence

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

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