Medical & Surgical Urology
Open Access

Voiding Troubles, Fecal Incontinence and Anal Intercourse

Abdel Karim M El Hemaly^* and Laila AS Mousa ^*Correspondence: Abdel Karim M El Hemaly, Department of Ob/Gyn and Uro-Gynecology, faculty of Medicine, Al Azhar University, Cairo, Egypt, Tel: +201001577969, Email:

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Homosexuality and Voiding Troubles

Body excreta (urine and stools) are stored in the urinary bladder (UB) and the rectum. The channels for their expulsion are the urethra in front and the anal canal behind. Both the urethra and the anal canal have the same embryology (from the cloaca), the same vascular and nerve supply and the same function (conduit) for expulsion of body excreta. Both channels (the urethra and the anal canal after toilet training) remain empty and closed all the time until there is a need &/or a desire to void.

The anal canal is surrounded by two sphincters: an internal involuntary anal sphincter (IAS) and an external voluntary anal sphincter (EAS). The IAS consists mainly of a strong collagen sheet cylinder with smooth muscle tissue fibers lying on and intermingle with the stout collagen bundles that surrounds the entire length of the anal canal. The tough collagen of the IAS has collagen strands that extend down to the peri-anal skin wedging it to the buttock skin giving it extra support and strength. While the EAS is a voluntary striated muscle. It consists of three parts deep, superficial and the subcutaneous parts. It surrounds the lower part of the IAS and the anal canal. It has its nerve supply from the peripheral systemic voluntary nervous system though the pudendal nerve [1-4] (Figures 1& 2).

Figure 1: The anatomy of the internal anal sphincter (IAS). The IAS, according to the new description is a collagen-smooth muscle tissue cylinder that surrounds the anal canal and is surrounded in its lower part by the voluntary external anal sphincter (EAS) with its three sections.

Figure 2: Coronal section of three-dimension ultrasound (3DUS) picture. It shows an intact internal anal sphincter (IAS) that surrounds the anal canal and is surrounded in its lower part with the external anal sphincter (EAS) with its three parts. The anal canal is closed and empty because of the persistent contraction of the IAS.

Defecation passes through two main sequential physiological stages. Toilet training switches defecation from the involuntary pelvic para-sympathetic act in the first stage to the second physiological step of voluntary thoraco-lumbar sympathetic second stage. This depends on a healthy intact nervous system and on an alert healthy CNS. The IAS after toilet training is always contracted keeping the anal canal empty and closed all the time until there is a desire &/ a need to void.

The presence of feces &/or flatus in the anal canal induces the sensation of voiding (feces &/or urine). Depending on the social circumstances available the person can postpone voiding by increasing the alpha sympathetic tone and inhibiting the para-sympathetic activity. The urinary bladder-the internal urethral sphincter (IUS), the rectum-the IAS get the same sensory, motor and autonomic nerve supply [1-4] (Figures 3-5).

Figure 3: Sagittal sections of two MRI pictures of women, picture (A) of a patient who suffer from FI, the picture shows an open anal canal with torn IAS. Picture (B) shows healthy intact both internal urethral sphincter (IUS) with full urinary bladder and an intact IAS with full rectum and a closed and empty anal canal.

Figure 4: Coronal section by three-dimension ultrasound (3DUS) two pictures that show lacerated IAS with open anal canal in patients with FI.

Figure 5: MRI, sagittal section of two women suffering from voiding troubles. Picture (A) suffers severe degree of voiding troubles both urinary and fecal, both the IUS, and the IAS are severely lacerated. Picture (B) show mild laceration of the IUS and marked lacerations of the IAS with passage of flatus.

The IAS in women is intimately lying on the posterior vaginal wall. Childbirth trauma (CBT), distension of the vagina causes unseen lacerations in the strong collagen chassis of the posterior vaginal wall causing its weakness, redundancy and its prolapse. It also lacerate the stout collagen chassis of the IAS leading to FI. The lacerations that affect the IAS from CBT affect its anterior segment of the entire circle leading to a horse-shoe appearance on medical imaging with MRI and 3DUS (Figures 6-8).

Figure 6: Cross section picture of the IAS by 3DUS, it demonstrates the defect in the collagen chassis of the IAS. Notice that there are two horse-shoe appearances one for the torn IAS and one for the torn EAS.

Figure 7: Two MRI images which demonstrate torn IAS with FI and passage of feces and flatus.

Figure 8: Two MRI pictures sagittal section in women, picture (A) is in a continent woman with intact IUS and IAS. Both the urethra and the anal canal are closed and empty. Picture (B) is in a patient with voiding incontinence with torn the collagen chassis of both the IUS and the IAS with anal canal open and passage of flatus.

Homosexuality, anal intercourse affect and lacerate the whole circumference of the IAS leaving the anal canal open for uncontrolled passage of rectal contents feces &/or flatus [1-5].

The urethra and the anal canal develop embryologic ally from the cloaca, both have the same vascular supply and the same innervation. Both have internal sphincters (collagen-muscle tissue cylinder) and striated muscle external sphincters). Thoraco-lumbar (T10-L2) sympathetic nerve supply keep both internal sphincters contracted and the urethra and the anal canal empty and closed. The IUS is a collagen-smooth muscle tissue cylinder that extends from the bladder neck down to the perineal membrane.

Torn IAS allowing passage of rectal contents (feces &/or flatus) to an open anal canal can, sometimes, can be interpreted as urine in the urethra and give sensations of urgent desire to void (OAB) [6-13].

Anal intercourse in men (homosexuals) leads to FI & OAB, and it may also cause infections: sexually transmitted diseases (STDs) and bacterial infections. It may also lead to major psychological troubles and problems. Since the vagina and the anal canal have the same embryologic origin from the cloaca and get the same nerve endings (sensors) satisfaction from anal intercourse can be similarly satisfying as vaginal intercourse, The IAS is torn, all around, from anal intercourse in women and homosexuals and lead to FI.

Homosexuality in addition to cause physical damage proved by voiding troubles, it leads to variable degree of psychiatric damage.

Fecal incontinence is the result of lacerations of the IAS and not lacerations of the external anal sphincter (EAS) only. This explains the poor results after repair of complete perineal tear, repair of the EAS whether by end-to – end or overlapping techniques [14-17].

Conflict of Interest

We hereby confirm that no conflict of interest has been observed or shall be resulting in future.

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