Urologie médicale et chirurgicale
Libre accès

Abstrait

Body Excreta Control and Incontinence

Abdel Karim El Hemaly M, Laila Mousa A, Mervat Ibrahim, Ibrahim Kandil M, Muhammad Reda Morad and Fatma El Sokary

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.