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Body excreta (Urine and Feces) continence, how to gain, and how does it fail?

Author: 
Abdel Karim M. El Hemaly, Laila A.E.S. Mousa, Ibrahim M. Kandil and Khulood Samy Husssein
Subject Area: 
Health Sciences
Abstract: 

Introduction: We believe that every organ in the body has a strong collagen chassis. Injury and lacerations of the chassis will distort the shape of the organ, lead to its dysfunction, abnormal position and chronic pain. The strong pelvic diaphragm keeps the pelvic organs and tracts in their normal position. Pelvic floor dysfunction is widely present in women particularly around menopause. The internal urethral sphincter (IUS) is a collagen-muscle tissue cylinder that extends from the bladder neck down to the perineal membrane. Its nerve supply is from the thoraco-lumbar alpha sympathetic nerves T10-L2. After toilet training, a gained high alpha sympathetic tone keeps the IUS contracted and the urethra closed and empty all the time. The vagina is a collagen-muscle-elastic tissue cylinder that extends up-wards and backwards from the vulva. Childbirth trauma causes redundancy of its walls with subsequent prolapse. When the injury and lacerations affect the pelvic ligaments, vault and uterine prolapse ensue. The internal anal sphincter (IAS) is a collagen-muscle tissue cylinder that surrounds the anal canal, with the external anal sphincter surrounding its lower part. Its nerve supply is thoraco-lumbar alpha-sympathetic nerves. Toilet training creates high alpha-sympathetic tone at the IAS that keeps it contracted and the anal canal closed and empty all the time. Pathology: Injury and lacerations of the collagen chassis of the pelvic tracts, lead to voiding troubles, urinary incontinence, genital prolapse and fecal incontinence. Aim of the study: Is medical imaging, show the difference between normal pelvic organs and lacerated collagen chassis? In addition, does mending the torn collagen chassis of the pelvic organs restore the normal continence and functions? Surgery: We introduced an operation “Urethro-Ano-Vaginoplasy” to correct those troubles, by mending the torn chassis. We mend the torn IUS, and then do overlapping of the bisected anterior vaginal wall. Thus, we restore the integrity and strength of the IUS, and add to it extra support and narrow the vagina. We mend the torn IAS, then do overlapping of the bisected posterior vaginal wall, approximate the levator ani muscles, and repair the perineum with excellent results of gaining continence and narrowing the patulous vagina.

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