Andrew Siegel MD 4/23/16
(photo above: Dr. Arnold Kegel, Gladser Studio, 1953)
A Brief Recap from Last Week
In the 1940s, the seminal work of Los Angeles gynecologist Dr. Arnold Kegel resulted in pelvic floor exercises achieving the stature and acclaim that they deserved. His legacy is the name that many use to refer to pelvic exercises—“Kegels” or “Kegel exercises.” Despite Kegel’s pelvic regimen proving effective for many female pelvic issues (pelvic relaxation, vaginal laxity and sexual issues, urinary leakage, etc.) what came to be referred to as Kegel exercises in the post-Kegel era had little resemblance to what he so brilliantly described in his classic series of medical articles sixty-five years ago. His regimen incorporated a critical focus and intensity that were unfortunately not upheld in most of the pelvic floor muscle training programs that followed his reign.
The Pelvic (Kegel) Revolution
After years of “stagnancy” following the transformative work of Dr. Arnold Kegel, there is a resurgence of interest in the pelvic floor and in the benefits of pelvic floor training. In 2016, we are in the midst of a pelvic floor “sea change” that is gaining momentum and traction. There is increasing recognition of pelvic floor dysfunction (when pelvic floor function goes awry) as the root cause for a variety of pelvic issues including pelvic organ prolapse, stress urinary incontinence, overactive bladder, sexual dysfunction and pelvic pain syndromes. There is an evolution in progress with respect to management of pelvic floor dysfunction, including “smart” pelvic floor muscle programs that are tailored to the specific pelvic floor dysfunction, the advent of a host of novel, high-technology pelvic floor training resistance devices and the expanding use of a specialty niche of physical therapy—pelvic floor physical therapy. Of note, pelvic floor physical therapy has been popular in Europe for many years and it is only recently that its utility has been recognized in the USA. (I am grateful for the wonderful services provided by my pelvic physiotherapy colleagues who have been so helpful and beneficial for many of my patients with pelvic floor dysfunctions.)
It is my belief that the next few years will bear witness to continued advances in pelvic floor muscle training and focus that will restore pelvic training to the classic sense established by Arnold Kegel—a “renaissance” to a new era of “pelvic enlightenment.” Books such as The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health (www.TheKegelFix.com) introduce new-age, next-generation pelvic programs—progressive, home-based, tailored exercise programs consisting of strength, power and endurance training regimens—designed and customized for each specific pelvic floor dysfunction. 2016 will usher in the availability of high quality follow-along pelvic training programs, e.g., the PelvicRx (www.PelvicRx.com)—a comprehensive, interactive, FDA-registered training regimen accessible via DVD or streaming. Furthermore, based upon Dr. Kegel’s perineometer resistance device, technological advances have resulted in the emergence of numerous pelvic floor muscle training devices, many of which are sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. Although most provide the same basic functionality—insertion into the vagina, connection to a smartphone app, biofeedback and tracking—each has its own unique features. This market for resistance devices is evolving at a remarkably rapid pace.
Another major refinement is the concept of functional pelvic fitness—teaching patients how to put their pelvic knowledge and skills to real life use with practical and actionable means of applying pelvic muscle proficiency to daily tasks and common everyday activities, an area that has been sorely neglected in the past, with prior emphasis solely on achieving a conditioned pelvic floor.
An additional element of the pelvic revolution is the increasing awareness and acceptance by the urological-gynecological-gastrointestinal community of the concept that stress and other psychosocial factors can give rise to physical complaints such as pelvic floor tension myalgia, a condition in which the pelvic floor muscles exist in an over-contracted, painful state. At one time, this diagnostic entity was not even a consideration; however, an understanding of this condition is slowly gaining recognition and traction and there is a burgeoning understanding that many pelvic pain issues (interstitial cystitis/chronic pelvic pain syndrome, prostatitis, irritable bowel syndrome, fibromyalgia, endometriosis, etc.) can, in actuality, be manifestations of pelvic floor hyper-contractility and over-tensioning.
Pelvic floor physical therapy has become and will continue to be increasingly in vogue. This specialized branch of physical therapy that deals with pelvic floor issues treats a wide range of pelvic floor dysfunctions ranging the gamut from pelvic muscle weakness to pelvic muscle over-tensioning. Pelvic floor physical therapy sessions can be of great help for those with pelvic floor dysfunctions and it is clear that patients do better with supervised regimens than they do without. Pelvic physical therapy is particularly useful for pelvic pain syndromes. In France, the government subsidizes the cost of post-partum pelvic training (“La rééducation périnéale après accouchement”), including up to 20 sessions of pelvic PT intended to tone and “re-educate” the postnatal pelvic muscles.
The final piece of the pelvic revolution is the broadening appreciation that pelvic floor muscle training in males is no less important than in females, potentially beneficial in the management of stress urinary incontinence that follows prostatectomy, overactive bladder, post-void dribbling, erectile dysfunction, premature ejaculation and pelvic pain due to pelvic muscle spasm.
Demand for the management of pelvic floor disorders will increase over the next decade. There is major growth opportunity for services that utilize non-physician providers (nurse practitioners, physician assistants and physical therapists) to teach patients pelvic muscle training and other behavioral treatments.
If Arnold Kegel were alive today, in all likelihood he would take great pleasure and pride in the breath of life being infused into his seminal work following decades of dormancy. His legacy and the fertile ground and transformative changes nurtured by his pioneering efforts will result in the continued empowerment of patients, with improvement in their pelvic health and quality of life.
Wishing you the best of health,
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Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– newly available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo (paperback edition will be available May 2016).
Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48
Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc
Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food
Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon. In the works is the female PelvicRx pelvic floor muscle training DVD.
Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use code “UROLOGY10” at checkout for 10% discount.
Tags: Andrew Siegel MD, Arnold Kegel MD, ejaculatory dysfunction, erectile dysfunction, Kegel exercises, Kegel Revolution, male pelvic fitness, overactive bladder, pelvic floor dysfunction, pelvic floor muscle exercises, pelvic floor muscle training, pelvic organ prolapse, pelvic pain, Pelvic Revolution, post-void dribbling, sexual dysfunction, stress urinary incontinence, The Kegel Fix