Archive for May, 2013

Post-Void Dribbling

May 25, 2013

Post-Void Dribbling (PVD)

Andrew Siegel, MD  Blog #108

Introduction:  Probably the two most common and annoying complaints from my male patients are sleep-disruptive nighttime urination and post-void dribbling. The following is a tiny “taste” of the content of my new book, forthcoming this summer, entitled Male Pelvic Fitness: Optimizing Sexual and Urinary Health.

The Problem: Post-void dribbling is the leakage of urine immediately or shortly after completing the act of urinating. This “after-dribble” is more annoying than serious and can be one of the first manifestations of prostate enlargement.  Although it rarely occurs before age forty, it can happen on occasion to men of any age.

Dorey et al published an article in the British Journal of Urology that demonstrated the effectiveness of pelvic floor muscle (PFM) exercises for erectile dysfunction, but also suggested an association between the occurrence of erectile dysfunction (ED) and post-void dribbling.  How fascinating—ED and PVD are linked and parallel problems, one sexual and the other urinary—both being manifestations of pelvic floor muscle weakness, and both treatable by increasing pelvic floor muscle fitness.

The Science: The urethra has an external portion within the penis, an internal portion that travels in the perineum (the area of the body between the scrotum and the anus), and an innermost portion, which traverses the prostate and enters the bladder.  After urinating, there is always some urine that remains and pools in the internal urethra.  When it drips out of the urethra aided by gravity and movement, it is referred to as PVD.

The Premise: Pelvic floor muscle contractions are the body’s natural mechanism for draining the urethra.  Improving the strength and tone of the PFM will help eject the contents of the inner, deeper portion of the urethra.  When contracted, the bulbocavernosus (BC) muscle compresses this deep portion of the urethra, displacing the urine within further downstream.  A powerful BC muscle will substantially help this process, in much the same way that it facilitates ejaculation. The BC is the body’s natural urethral “stripper”; however, the BC does not surround the entire urethra, so it is likely that a strong BC will improve the PVD, although it is possible to still have some drops remaining in the penile urethra.

The Solution: Try not to rush the act of urination.  The adage “haste makes waste” is absolutely relevant with respect to PVD. When finished urinating, vigorously contract the PFM several times to displace the inner urethra’s contents. If necessary, the urethra of the penis can be further evacuated of urine by manually compressing and stripping it.  To do so, starting where the penis meets the scrotum, compress the urethra between your thumb on top and index and middle fingers on the undersurface and draw them forth towards the penile tip, “milking” out any remaining urine.  To further improve the PVD, gently shake the penis until no more urine drips from the urethra. It is not a bad idea to apply tissue to the tip of the penis to soak up any residual urine—women have the right idea here.


Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.


Dr. Siegel’s Interview on “Best In Health Radio”

May 18, 2013

Audio podcast of Shira Litwack of Toronto’s “Best In Health Radio) and Dr. Andrew Siegel’s illuminating discussion of “promiscuous eating” behaviors, delving into cravings; addictive foods; mindfulness; our relationship with what we eat; Freud; neuroplasticity; food stress; why we eat; processed foods; exercise; and setting a good example for children.

Beach Body Season

May 11, 2013

Beach Body Season 

Andrew Siegel, M.D.   Blog #106

Michelangelo’s “David” was at one time a mere solid block of marble.  The master artist crafted this magnificent sculpture by knowing exactly what to carve away.  Antoine de Saint-Exupery (author of Le Petit Prince) wrote: “Perfection is not when there is no more to add, but when there is no more to take away.”

We all have “beach bodies” obscured beneath our perhaps winter-weighted physiques.  We may be a bit flabbier and less toned than desirable, but somewhere hidden within is a sinewy, tight, and lean figure. What can we do to bring out this inner beach body—to allow us to feel confident, svelte and shapely—since swimsuit season is right around the corner?

A great body (and more importantly, a healthy body) mandates a lifestyle encompassing a healthy diet and plentiful physical activity—this is a process incorporated into the daily existence of those who respect themselves and are committed to being stewards of their own wellness.  Realistically, this is a lifetime pursuit—major changes are not going to occur in 6 weeks of “cramming” to achieve a respectable appearance at the beach. However, all journeys start with small steps and with diligence, some real and measurable progress towards that beach body can be made even after a few weeks of effort.  Within a month or so of consistent healthy eating and exercise, we should note the pounds peeling off, better muscle tone, and increased energy levels.

Nutrition to Maximize Our Beach Body Appearance

To help sculpt our bodies to reveal the “David” or “Venus de Milo” within, we are going to need healthy fuel to serve as energy and provide the basic building blocks for the reconstructive and regenerative processes that are ongoing in our bodies.  For weight loss, we will need reduced caloric consumption—3500 calories fewer per week will result in a one-pound loss, a very realistic and reasonable goal.  As weight gain is gradual, so should weight loss be.  No fads, no gimmicks, no nonsensical, unbalanced, ridiculous diets—just a sensible reduction in calories and an effort to eat healthy, nutrient-dense, natural and unprocessed foods.

Since portion control is fundamental to the process, a really easy diet is simply to reduce portions to one-half to three-quarters of our normal size helpings.  When it comes to snacking, we should make every effort to eat wholesome fresh vegetables and fruits instead of processed junk that often contain a load of unhealthy fats, salt and carbohydrates. It is important to make smart choices and often our intuition will suffice to guide us.

Lean sources of protein such as egg whites, wild salmon (or any other wild fish that is grilled or broiled), skinless chicken, turkey breast, fat-free yogurt and soy products such as tofu and edamame are healthy and desirable.  We should be judicious with meat and dairy intake because they are rich in saturated fats and high in calories.  Vegetables are a much healthier source of fat—think nuts, avocados and olives.  High fiber foods—vegetables, fruits and legumes including lentils, peas and beans—are very filling and the fiber regulates the rate of carbohydrate absorption. Intake of a variety of brightly colored fruits and veggies will ensure getting ample doses of phyto-nutrients and anti-oxidants.   We need to attempt to minimize the rich sauces and fattening dressings put on otherwise healthy foods…if we cannot avoid them, then we need to use them in moderation.   It is important to be careful with our sodium intake as it causes fluid retention, bloating, weight gain and a number of potential medical issues.

And now a brief discussion of the science of fat: Our hormone insulin has much to do with the way our bodies store or burn fat—when insulin levels are elevated, we accumulate fat; when levels are low, we burn fat as fuel.  Our insulin levels are more-or-less determined by the carbohydrates we eat: the more carbs we eat, the sweeter they are, the easier they are to digest, the greater the insulin levels and the more that fat accumulation is driven. Insulin secretion caused by eating carb-rich foods—flour and cereal grains, starchy vegetables like potatoes, sugars and high-fructose corn syrup—makes us fat.  The sweeter the food, and the easier it is to digest, the fatter it will make us, and liquid carbs such as sodas, fruit juices and beer are probably the biggest culprits.

So, we need to try to steer clear of refined carbohydrates, substituting whole grain products for white bread, refined pasta, white rice, etc.   It is very important to minimize sugar intake since sucrose is fructose/glucose and fructose gets metabolized much differently from glucose, pushing our bodies towards fat deposition…the same thing goes for high fructose corn syrup (HFCS), which should be avoided like the plague.  Let fruits be the source of fructose for our bodies, not refined sugars and HFCS.  It is imperative that we carefully read food labels to know what we are consuming.

To repeat a very important principle: if we want a beach body we do NOT want to drink our calories—actively avoid liquid calories such as soda, juices, processed iced tea, etc.  The best drink is water or seltzer—we can spritz them up with a lemon or lime.  Lots of water will serve to keep us well hydrated, dampen our appetites, and will quell our thirsts, which are sometimes confused for hunger.  Remember that liquid calories include alcohol—a beer belly is the opposite of a beach belly.  It is best to be moderate with alcohol consumption during the beach body training period—reducing alcohol will also help us maintain our discipline, which can easily be thrown by the wayside due to the uninhibiting effects of alcohol.  Sobriety will go a long way towards molding that beach body.

Exercise to Maximize Our Beach Body Appearance

Our bodies are remarkably engineered to adapt to the stresses placed upon them with compensation, adapting to exercise with increased muscle strength and fitness.  The general rule of thumb is to think “athletics” and the “aesthetics” will follow.   The key to exercise is diligence—carving out the time—and variety—strength  (resistance) training, cardiovascular (aerobic) training and core (abdominal and torso) conditioning.  A core synergistic exercise regimen, which is a combination of the aforementioned three types of exercise, provides a great overall workout.

Muscles play a key role in our metabolism: they are extremely metabolically active.  With a sedentary existence and aging, there is a gradual loss of muscle mass and a resultant slowing in our resting metabolic rate.  By building and maintaining our muscle mass with strength training, we will raise our resting metabolic rate and burn more calories.  Additionally, exercise serves to increase the “insulin sensitivity” of muscle, which means that our muscles become more efficient at burning off carbs as fuel, before they have a chance to become stored as fat.

We can measure our maximal heart rates by doing an aerobic activity, such as swimming, running or cycling full throttle until we can’t go on, and then taking our pulses.  In our workouts, if we can achieve a heart rate of 75% of our maximum rate and sustain that for 30-60 minutes daily, it is easily conceivable to burn 600 or more calories per day.   High intensity interval training—alternating between extremely intense exertion and regular “normal” exertion—can rapidly help propel us towards the beach body within.

“Integrational” exercise—incorporating non-gym physical activities into our daily lives—is an alternative form of exercising that burns calories and gets us moving just the same.  These include gardening, house chores, vacuuming, walking the dog, chopping down trees, etc.  It has even been shown that fidgeting will do the trick.  The key is to get off the couch and get moving.

In order to feel and look your best it will take the combined efforts of diet and exercise.  A healthy diet is fundamental and will help you look great in clothes, but it is the exercise component that will help you look and feel great in a bathing suit. Maintaining good posture like a ballet dancer will help with the beach body mode—David and Venus certainly do not slouch forward with rounded shoulders.  To this end, yoga and Pilates are wonderful forms of exercise. Getting enough rest and sleep is also imperative.  Insufficient sleep makes it difficult to exercise and the fatigue eating that often ensues can often be detrimental to our goals.

Minimizing stress and negativity in our lives will help many causes, including the beach body one.  Our stress hormone—cortisol—functions to stimulate our appetites and cravings and promotes fat deposition and weight gain. Stress can be managed in a healthy fashion through exercise as opposed to the unhealthy habit of stress eating.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Healthy, Free and Natural Drugs

May 4, 2013

Blog # 105   Andrew Siegel, M.D.

Each and every one of us has the capacity to draw upon a powerful pharmacy housed within our bodies.  We are capable of producing and using to our benefit a powerful ‘cocktail’ of natural chemicals and hormones that can dramatically influence and affect our mood, energy, focus, drive, etc.

I am capable of tapping into my supply of  ‘happy drugs’ through the means of vigorous exercise. On my part it demands exertion, sweating, my heart pounding and heavy breathing—walking on the treadmill will not suffice for this purpose, even though any form of movement is certainly of benefit.   The ‘fix’ I get through physical exertion probably accounts for my ‘addiction’ to exercise and my suffering from ‘withdrawal’ if I miss my ‘dose’ for a day or two. It is not just the physical high that I get from this ‘drug’, but more importantly the emotional high that really keeps me coming back for more. Exercise is certainly not the means for everyone—we all need to try to figure out how to exploit our internal pharmacy that does not call for a doctor visit, prescription, co-pay or a medicine cabinet

Most days, I do not get the opportunity to exercise until after work, at 5PM or so.  On rare occasions, I will have a gap between early morning procedures and afternoon office hours, an interlude that affords me the opportunity to go home, exercise, shower and have lunch before returning to the office.  This past Wednesday, I had one such lovely day.  I began the day with a 7:30AM surgery at the hospital and because of the fact that I was finished by 10AM and did not have to return to the office until 12:30PM, I went home, changed, headed to the basement and pulled out one of my P90x plus DVDs, specifically the total body workout.  I exercised for an hour or so, and even though this particular workout was primarily resistance, I still worked up a great sweat and had my heart pumping and lungs heaving.  After a shower and a healthy lunch, I headed to the office, refreshed, renewed, restored and invigorated, feeling like the day was just beginning.

My office is hectic and stressful—especially since we started electronic medical records last summer.  That stated, on days in which I get to exercise midday, stress is banished.  I find myself super-alert, focused, energetic and immune from the many frustrations and irritations that typically chip away at my good spirits.  I am convinced that vigorous exercise releases a host of ‘happy drugs’ including dopamine, endogenous opiates and a cocktail of other natural chemicals that are responsible for my heightened state of mind, vigor, stamina, serenity and resistance to the usual stressors that typically leave me fatigued, depleted and emotionally and physically spent.

Because exercise makes me feel so physically and emotionally robust, I can better resist the urge to consume some of the junk foods that I am bombarded with at work. To wit, I had absolutely no urge to indulge in that piece of Dairy Queen chocolate ice cream cake that we had in the office. After my workout, shower and lunch, I truly had enough of a ‘high’ such that I did not need to get a sugar/fat/chocolate ‘high.’  Additionally, the thought process of ‘why blow the benefits of a great workout on an unnecessary indulgence?’ is very helpful in maintaining eating discipline.

I always vow that I must schedule exercise into my midday routine—for the benefit of myself as well as my patients— but I never do—the rare occasion it occurs is due to happenstance…and is a welcomed gift.

“Exercise is medicine, and every man needs a daily dose.”

Jordan Metzl, M.D.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.