Juniper Publishers : Outlet Control
JUNIPER PUBLISHERS- JOURNAL OF GYNECOLOGY AND WOMEN’S
HEALTH
Journal of Gynecology and Women’s Health-Juniper
Publishers
Authored by Abdel Karim M El Hemaly*
Introduction
Outlet control means continence, which is how to
control body excreta (urine and feces) control of temperance, body
reaction and control of sexual behavior and premature ejaculation.
Anybody action is a nerve-muscle action, controlled by an alert healthy
central nervous system (CNS).
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 to the perineal membrane.
The other factor is an acquired factor which is keeping high sympathetic
tone at the IUS gained in early childhood from toilet training. Failure
of either one factor lead to urinary incontinence.
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 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 FI.
Pathophysiology
Outlet control is how to control the sympathetic
nervous system and to control different responses according to social
circumstances.
Diagnosis
Structural damage is diagnosed clinically and by
medical imaging. Functional disturbance, which is the result of the
chassis damage, can be assessed clinically and by urodynamic.
Outlet Control
Outlet control means continence, which means good
control of body excreta (urine and feces) control of temperance, body
reaction and control of sexual behavior and premature ejaculation.
Anybody action is a nerve-muscle action, controlled by an alert healthy
central nervous system (CNS). Continence is self-restraint and
self-control, it is an acquired behavior of how to control the
sympathetic nervous system [1-8].
Body excreta
Micturition: Control of micturition
depends on a closed and empty urethra. This is gained by having healthy
intact internal urethral sphincter (IUS) an inherent factor; and high
sympathetic tone gained from toilet training in early childhood, an
acquired factor. Childbirth trauma (CBT) is the main cause of
lacerations of the collagen chassis of the IUS which lies in close
contact with the anterior vaginal wall. The IUS is a collagen- muscle
tissue cylinder that extends from the bladder neck to the perineal
membrane in both sexes. The chassis is healthy strong collagen with the
muscle fibers lying on and intermingle with the collagen fibers in its
mid thickness. Toilet training will induce high sympathetic tone
(T10-L2), so the individual will maintain high sympathetic tone, and
keep the urethra empty and closed all the time, until there is a need or
a desire to void. In enuretic children the sympathetic nerves do not
secrete nor-epinephrine, so the IUS is not contracted all the time and
micturition is back to a sacral spinal reflex. Treatment of those
children is by giving them alpha sympathomimetic drugs e.g. ephedrine.
CBT causes lacerations in the collagen chassis leading to weakness of
the IUS, which cannot stand against sudden rise of abdominal pressure
and urine will leak, stress urinary incontinence (SUI). As soon as the
woman feels wet, embarrassment will induce reflex sympathetic activity
which will augment contractions of the IUS, closing the urethra
preventing further leak of urine. Reconstructive surgery, expose the
lacerations and mend the torn wall will restore the IUS strength [1-8].
Defecation: Toilet training will provoke acquiring high sympathetic tone (T10-L2) at the internal anal sphincter (IAS) and
the individual will keep this high tone all the time, thus keeping the
anal canal empty and closed all the time, until there is a need and/or a
desire to pass flatus and/or feces in favorable circumstances. The IAS
has a strong collagen chassis with muscle fibers lying on and inter
mingle with the collagen fibers in its mid thickness. It surrounds the
anal canal, and is surrounded in its lower part with the external anal
sphincter (EAS). The IAS is in close contact with the posterior vaginal
wall. CBT is a major cause of lacerations of the IAS and subsequent
fecal incontinence (FI), anal intercourse is another frequent factor [4-8].
Diagnosis
Structural damage can be diagnosed clinically and by
medical imaging e.g. ultrasound, 2DUS, 3-4DUS, X-ray (CT scan) and /or
MRI. Functional disturbance, which is the result of the chassis damage,
can be assessed clinically and by urodynamic studies in cases of urinary
incontinence.
Prevention and prophylaxis
It is how to control of temperance, body reaction and
control of sexual behavior and premature ejaculation through
controlling the sympathetic nervous system harmonized and supervised by
the CNS.
Treatment
Correction of the pathology is either: medical, or reconstructive surgery. Medical treatment is giving ephedrine, a non-catechol amine sympathomimetic in case of nocturnal enuresis. In addition, giving alpha-blocker drugs, in cases of retention of urine. Surgical reconstructive surgery as doing “Urethro-Ano-Vaginoplasty” which is a reconstructive surgery for SUI, FI and vaginal prolapsed [2,7,8].
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