Imaging of the Pelvic Floor

Hemaly, Abdel Karim M. El; Mousa, Laila A.E.S.; Kandil, Ibrahim M.; Shehata, Khaled

doi:10.2174/1573405609666131113203427

Cited by 4 publications

(11 citation statements)

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“…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%

“…Patients with nocturnal enuresis suffer from either total absence or partial defiance of the neuro-transmitter norepinephrine. About 10-15% of patients with nocturnal enuresis suffer as well from diurnal enuresis [3]. Giving patients with nocturnal enuresis ephedrine tablets will cure them.…”

Section: Micturitionmentioning

confidence: 99%

“…Giving patients with nocturnal enuresis ephedrine tablets will cure them. Ephedrine acts on the nervereceptors on the IUS as sympathomimetic and it also acts on the sympathetic nerve endings stimulating them to produce norepinephrine [3]. The IUS in women lies intimately on the anterior vaginal wall.…”

Section: Micturitionmentioning

confidence: 99%

“…Voiding and defecation have two stages. The first stage for both excreta is controlled by the pelvic parasympathetic system (S. [2][3][4]. The second stage after toilet training which induces and keeps high sympathetic tone (T.10-L.2) at the internal urethral sphincter (IUS) and the internal anal sphincter (IAS) keeping them contracted and the urethra and the anal canal empty and closed all the time until there is a need/or a desire to evacuate.…”

Section: Introductionmentioning

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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“…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: Micturitionmentioning

confidence: 99%

Section: Micturitionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…The commonest cause of lacerations of the IUS is vaginal deliveries [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22](Defecation: Figures 1, 3, 4 and 6). …”

mentioning

confidence: 99%

Continence

Hemaly¹,

Mousa²

2016

Reprod Syst Sex Disord

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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.

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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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Imaging of the Pelvic Floor

Cited by 4 publications

References 0 publications

Urinary and Fecal Control and Incontinence: Pathogenesis and Management

Urinary and Fecal Control and Incontinence: Pathogenesis and Management

Continence

Body Excreta Control and Incontinence

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