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Continence is self-control on temperance, sex acts, and bodily excreta. It is how you can manage your autonomic nervous system, (the non-conscious part of the central nervous system), which has two subtypes, the cranio-sacral para-sympathetic, and the thoraco-lumbar sympathetic system. The para-sympathetic system is responsible for the basic vegetative processes in the body. The sympathetic system is responsible for the reactions and response actions. It is the system of holding back, fight or flight . Urinary and fecal continence depends on inherent factors and on acquired behavior. The inherent factors are normal anatomy with intact sphincters. The acquired factor is keeping high alpha-sympathetic tone at the IUS, and the IAS. Failure to gain high alpha-sympathetic tone at the IUS causes nocturnal enuresis. Childbirth trauma lacerates the collagen chassis of the vagina, the IUS, and the IAS. This leads to vaginal prolapse, stress urinary incontinence (SUI), and fecal incontinence (FI). We introduced a simple vaginal operation to expose and mend the torn chassis of the vagina, the IUS, and the IAS to control the troubles.

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Abdel Karim M. El Hemaly is a professor in Ob/Gyn and Uro-gynecology at faculty of medicine, Al Azhar University, Cairo, Egypt. He holds MB, BCh , DGO, DS, MRCOG (London) & FRCS (Glasgo) certificates. Through his scientific research journey, extended up to 50 years, he focused on the female pelvic floor anatomy, physiology and dysfunction.

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