ISSN: 2161-038X
Abdel Karim M. El Hemaly, Laila A. Mousa, Ibrahim M. Kandil and Khulood Sami Husssein
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.