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The maintenance of fecal and/or urinary continence becomes a significant medical issue particularly with
aging. The mechanisms responsible for continence in the lower gastrointestinal and urinary tract are closely
related to the integrity of the pelvic floor muscles and their neuromuscular response to stresses. The guarding
reflex constitutes an important involuntary physiologic mechanism whose activity involvement assists to
maintain continence. In this presentation, the physiological mechanism involving the recruitment of the guarding
reflex of rectal, anal, vaginal and urethral structures are considered. Physiological measurements are made to
show the interrelationship of these structures to incontinence generating stimuli that rapidly increase intra-
abdominal pressures. Such stimuli were generated by eliciting a cough while simultaneously measuring pressures
in the bladder/urethra vagina rectum and anus. Correlative anatomical visualizations using a combination of
consecutive axial, saggital and coronal MRI will be presented demonstrating the 3D configuration of support as
well the changes occurring during the aging process. MRI imaging is used to identify the voluntary aspects control
as would be elicited to contain incontinence. In addition using dynamic perineal ultrasound the reflex activity to
generated reflex contraction will be presented. These visualizations are segmented to show in slow motion and to
identify the speed and direction of pelvic floor contractility that supports the ano-rectal structures and urethra.
Such activity is considered critical in containing abdominal organs and contributes to the maintenance of both
urinary and fecal continence.
Christos E Constantinou completed his Ph.D. at Stanford University and continued as faculty in the Department of Urology where
he was responsible in organizing its first urodynamics laboratory. He worked as principal investigator of a number NIH projects
involving the evaluation of pelvic floor function, using ultrasound imaging and novel vaginal and urethral probes. He has published
more than 145 papers and chapters in peer reviewed journals, are currently editor in chief of the Open Journal of Obstetrics and
Gynecology and is serving on the editorial board member of many other journals.
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