Archive for August, 2016

The Mystique Of The Pelvic Floor Muscles (PFM)

August 27, 2016

Andrew Siegel MD 8/27/16

1.core muscles

 Note that PFM form floor of the “barrel” of core muscles. Illustration by Ashley Halsey from THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Our bodies are comprised of a variety of muscle types: There are the glamour, overt, seen-and-be-witnessed muscles that offer no secrets, the “what you see is what you get” muscles. Then there are muscles that are shrouded in secrecy, hidden from view, veiled from sight, concealed and covert. The pelvic floor muscles (PFM) are in the latter category.

Strong puritanical cultural roots influence our thoughts and feelings about our nether regions. Consequently, the genital and anal zones often fail to command the respect and attention that other areas of our bodies command. Frequently ignored and/or neglected, this locale rarely sees the light of day and most people never think about exercising the important functional muscles in this anatomical sector.

Most women and men can probably point out their “bi’s” (biceps), “tri’s” (triceps), “quads” (quadriceps), “pecs” (pectorals), etc., but who really knows where their “pelvs” (PFM) are located? For that matter, who even knows what they are and how they contribute to pelvic health? Think for a moment about the PFM…How essential—yet taken for granted—are sphincter control, support of your pelvic organs and, of course, their key contribution to sexual function?

Unlike the glitzy, for show, external, mirror-appealing glamour muscles, the PFM are humble muscles that are unseen and behind the scenes, often unrecognized and misunderstood. Cloaking increases mystique, and so it is for these PFM, not only obscured from view by clothing, but also residing in that most curious of nether regions—the perineum—an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the PFM, which straddle the gamut of being vital for what may be considered the most pleasurable and refined of human pursuits—sex—but equally integral to what may be considered the basest of human activities—bowel and bladder function.

The PFM are hidden gems that work diligently behind the scenes and on a functional basis you would be much better off having “chiseled” PFM as opposed to having “ripped” external muscles.” Tapping into and harnessing the energy of the PFM—those that favor function over form, “go” rather than “show”—is capable of providing significant benefits. The PFM are the floor of the core muscles and seem to be the lowest caste of the core muscles; however, they deserve serious respect because they are responsible for very powerful functions, particularly so when intensified by training. The PFM are among the most versatile muscles in our body, contributing to the support of our pelvic organs, control of bladder and bowel, and sexual function. Although the PFM are not muscles of glamour, they are muscles of “amour.”

Bottom Line: You can’t see your PFM in the mirror. Because they are out of sight and out of mind, they are often neglected or ignored, but there is great merit in exercising vital hidden muscles, including the heart, diaphragm and PFM. This goes for men as much as it does for women, since in both genders these muscles provide vital functions and are capable of being enhanced with training.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

 

Clomid: Not Just For The Ladies

August 20, 2016

Andrew Siegel MD 8/20/2016

Gender_differences_male_female

Frank Palopoli, Father Of Fertility

Frank Palopoli, the chemist who developed Clomid (clomiphene citrate), died last week at age 94. He conceived (pun intended) Clomid in the 1950s, a medication that stimulates ovulation and became the most widely prescribed fertility drug for women, resulting in pregnancy in millions of women who otherwise would not have been able to do so. Approximately 80% of women whose fertility is due to failure of ovulation respond to Clomid enabling conception. Clomid works by increasing production of hormones that spur egg ripening and release.

What’s Good For The Goose Is Good For The Gander

Clomid is not just for the ladies! In urology we have used it for many years to stimulate sperm production in infertile men with low sperm counts. But here is a little secret: it also raises testosterone levels nicely. It does so by stimulating the testes to secrete natural testosterone, as opposed to the other testosterone replacement products on the market that are external sources of testosterone that actually shut down testes production of sperm and testosterone. No shrunken testicles that have their function turned off, but respectable family jewels, happily churning out sperm and testosterone, as nature intended.

Clomid Biochemistry In A Nutshell (no pun intended!)

Clomid is a selective estrogen receptor modulator (SERM). It works by increasing levels of the pituitary hormones that trigger the ovaries to produce eggs and the testes to produce sperm and testosterone. It blocks estrogen at the pituitary, so the pituitary sees less estrogen and makes more LH (luteinizing hormone) that stimulates the testes to make testosterone, and more FSH (follicle stimulating hormone) that stimulates the testes to make sperm. This is as opposed to external testosterone, which does the opposite, increasing estrogen levels that prompt the pituitary to make less LH and FSH, which causes the testes to cease production of sperm and testosterone.

Clomid usually works like a charm in increasing testosterone levels and maintaining sperm production, testes anatomy (size) and function. Its safety and effectiveness profile has been well established and minor side effects occur in proportion to dose and may include (in a small percentage of people): flushes, abdominal discomfort, nausea and vomiting, headache, and rarely visual symptoms.

 One issue is that Clomid is not FDA approved for low testosterone, only for infertility. Many physicians are reluctant to use a medication that is not FDA approved for a specific purpose, requiring it to be used “off label.” However, Clomid is effective and less expensive than most of the other overpriced testosterone products on the market and has the major advantage of stimulating natural testosterone while not shutting down testicular function.

Bottom Line: By virtue of a very sophisticated biofeedback system involving the pituitary gland in the brain and the testes, the use of external testosterone to boost native testosterone results in whatever feeble function the testes might have had to virtually cease completely and the possibility of atrophied, non-functional testes that no longer produce any sperm or testosterone.

 Clomid is an oral, less expensive alternative to testosterone replacement that stimulates natural testosterone production as well as sperm production. Kudos to Dr. Palopoli, whose magic drug has not only helped millions of women get pregnant, but has also helped enable countless men to fertilize their partners as well as raise their testosterone levels. Clomid is safer and much more sensible than traditional testosterone replacement.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

Pelvic Floor Issues In Women

August 13, 2016

Andrew Siegel MD  8/13/16

shutterstock_femalebluepelvic

The pelvic floor muscles (PFM) are integral in maintaining healthy pelvic anatomy and function. When PFM impairments develop, there are typically one or more of five consequences:

  1. Urinary control issues
  2. Bowel control issues
  3. Sexual issues
  4. Pelvic organ prolapse and vaginal laxity
  5. Pelvic pain

25% of women have symptoms due to weak PFM and many more have weak PFM that is not yet symptomatic. Others have symptoms due to PFM that are taut and over-tensioned. More than 10% of women will undergo surgery for pelvic issues—commonly for stress urinary incontinence (urinary leakage with coughing, sneezing, exercise, etc.) and pelvic organ prolapse (sagging of the pelvic organs into vaginal canal and at times outside vagina)—with up to 30% requiring repeat surgical procedures.

The following quotes from patients illustrate the common pelvic issues:

 “Every time I go on the trampoline with my daughter, my bladder leaks. The same thing happens when I jump rope with her.”

–Brittany, age 29

“My vagina is just not the same as it was before I had my kids. It’s loose to the extent that I can’t keep a tampon in.”

–Allyson, age 38

“As soon as I get near my home, I get a tremendous urge to empty my bladder. I have to scramble to find my keys and can’t seem to put the key in the door fast enough. I make a beeline to the bathroom, but often have an accident on the way.”

–Jan, age 57

“Sex is so different now. I don’t get easily aroused the way I did when I was younger. Intercourse doesn’t feel like it used to and I don’t climax as often or as intensively as I did before having my three children. My husband now seems to get ‘lost’ in my vagina. I worry about satisfying him.”

–Leah, age 43

“When I bent over to pick up my granddaughter, I felt a strange sensation between my legs, as if something gave way. I rushed to the bathroom and used a hand mirror and saw a bulge coming out of my vagina. It looked like a pink ball and I felt like all my insides were falling out.”

–Karen, age 66

 “I have been experiencing on and off stabbing pain in my lower abdomen, groin and vagina. It is worse after urinating and moving my bowels. Sex is usually impossible because of how much it hurts.”

–Tara, age 31

These issues come under the broad term pelvic floor dysfunction, common conditions causing symptoms that can range from mildly annoying to debilitating. Pelvic floor dysfunction develops when the PFM are traumatized, injured or neglected. Pelvic floor muscle training (PFMT), a.k.a. “Kegels,” has the capacity for improving all of these situations.

PFM fitness is critical to healthy pelvic function and is an important element of overall health and fitness. PFMT is a safe, natural, non-invasive, first-line self-improvement approach to pelvic floor dysfunction that should be considered before more aggressive, more costly and riskier treatments. We engage in exercise programs for virtually every other muscle group in the body and should not ignore the PFM, which when trained can become toned and robust, capable of supporting and sustaining pelvic anatomy and function to the maximum. Should one fail to benefit from such conservative management, more aggressive options always remain available.

PFMT can be beneficial for the following categories of pelvic floor dysfunction:

  • Weakened pelvic support (descent and sagging of the pelvic organs including the bladder, urethra, uterus, rectum and vagina itself)
  • Vaginal laxity (looseness)
  • Altered sexual and orgasmic function
  • Stress urinary incontinence (urinary leakage with coughing and exertion)
  • Overactive bladder (the sudden urge to urinate with leakage often occurring before being able to get to the bathroom)
  • Pelvic pain due to PFM spasm
  • Bowel urgency and incontinence.

Additionally, PFMT improves core strength, lumbar stability and spinal alignment, aids in preventing back pain and helps prepare one for pregnancy, labor and delivery. PFMT can be advantageous not only for those with any of the previously mentioned problems, but also as a means of helping to prevent them in the first place. Exercising the PFM in your 20s and 30s can help avert problems in your 40s, 50s, 60s and beyond.

Bottom Line: Pelvic floor dysfunction is a common problem that causes annoying symptoms that interfere with one’s quality of life. It is often amenable to improvement or cure with a Kegel pelvic exercise program. There are numerous benefits to increasing the strength, tone, endurance and flexibility of your PFM. Even if you approach public training with one specific functional goal in mind, all domains will benefit, a nice advantage of conditioning such a versatile group of muscles.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc  

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 promo code “UROLOGY10” at checkout for 10% discount. 

Urethral Bulking Agents: Alternative To Stress Incontinence Surgery

August 6, 2016

Andrew Siegel MD    8/6/2016

macroplastique

Illustration of bulking agent being injected into urethral tissues to plump up and compress the urethra

Stress Urinary Incontinence (SUI)

SUI is a common condition that affects one in three women during their lifetimes, most often young or middle-aged women, although it can happen at any age. An involuntary spurt of urine occurs at times of sudden increases in abdominal pressure.  This can happen with coughing, sneezing, laughing, jumping or exercise. It can even happen with walking, changing position from sitting to standing or during sex.

SUI most often occurs because the tissues that support the urethra (the channel that conducts urine from the bladder) have weakened and no longer provide an adequate “backboard.” This allows the urethra to be pushed down and out of position at times of sudden increases in abdominal pressure, a condition known as urethral hyper-mobility. The key inciting factors are pregnancy, labor and delivery, particularly traumatic vaginal deliveries of large babies.

Although the predominant cause of SUI is inadequate urethral support, it may also be caused by a weakened or damaged urethra itself, a condition known as sphincter dysfunction. Risk factors for this are menopause, prior pelvic surgery, nerve damage, radiation and pelvic trauma. A severely compromised urethral sphincter causes significant urinary leakage with minimal activities and typically results in “gravitational” incontinence, a profound urinary leakage that accompanies positional change. In this situation the sphincter does not provide sufficient closure to pinch the urethra closed.

Useful analogy: Sphincter dysfunction is similar to a situation in which a sink faucet is leaky because of a brittle washer that has lost the suppleness to provide closure.

First-line Treatment For SUI: Pelvic Floor Muscle (PFM) Training (Kegels)

It is important to know that you can tap into the powers of your PFM and harness the natural reflex that inhibits stress urinary incontinence. Combatting SUI demands that the PFM contract strongly, rapidly and ultimately, reflexively. The goal of Kegels is to increase PFM strength, power, endurance and coordination to improve the urethral support and closure mechanism. This has the potential to improve or cure SUI in those who suffer with the problem and prevent it in those who do not have it.

Kegel exercises are most effective in women with mild or mild-moderate SUI. Kegels increase PFM bulk and thickness, including the sphincter mechanism, reducing the number of SUI episodes. Additionally, Kegels improve urethral support at rest and with straining, diminishing the urethral hyper-mobility that is characteristic of SUI. It also permits earlier activation of the PFM when coughing, more rapid repeated PFM contractions and more durable PFM contractions between coughs. PFM training can cure or considerably improve 60-70% of women who suffer with SUI. The benefits persist for many years, as long as the exercises are adhered to on an ongoing basis.

Urethral Bulking Agents

The “gold standard” treatment of SUI that does not respond to conservative measures is a mid-urethral sling, a surgical procedure that provides support and a “backboard” to the urethra.  Cure or significant improvement is in the 85-90% range with sling surgery.  An alternative to the sling surgery is the injection of a urethral bulking agent.

Urethral bulking agents are typically used for SUI due to weakened or poorly functional sphincter muscles.  A special material—a bulking agent—is injected into the tissues around the urethra in an effort to “plump” up the urethra to help provide closure to it, with the goal of improving urinary control. The material works by bulking up the layer of the urethra immediately under the inner urethral lining, providing closure of the urethra via compression. This outpatient procedure is simple to perform and generally takes only a few minutes. In theory, it is similar to the lip injections that are used by plastic surgeon in order to plump up the lips and make them appear fuller, suppler and more sensuous.

The urethral bulking agent procedure is done under direct visual control using a small, lighted scope (cystoscope) that is inserted into the urethra. The bulking material is injected into the tissue immediately under the urethral lining while the plumping and closure of the urethra is observed. Several treatments may be necessary for lasting results.

There are three materials that are FDA-approved bulking agents: carbon-coated beads suspended in a water gel (Durasphere); calcium hydroxylapatite (Coaptite); and silicone microparticles (Macroplastique).

For whom are bulking agents appropriate?

  • Women with SUI primarily due to sphincter dysfunction
  • Women who are too elderly or frail or have too many medical issues to undergo anesthesia and standard mid-urethral sling surgery
  • Women who have had unsuccessful or incompletely successful sling surgery
  • Women who wish to avoid surgery for SUI
  • Women who have SUI and wish to have more children
  • Women with mild SUI
  • Women with SUI who are anti-coagulated with “blood thinners” and whose anti-coagulation status cannot safely be reversed

How effective are bulking agents?

Generally, bulking agents result in a 75% improved or cure rate, including about 30% who are cured and 25% who fail to improve.  It is important to understand that the effectiveness of urethral bulking agents is inferior to that of sling surgery, the duration is limited and multiple repeat injections may be required. Improvement rather than cure is the goal.

Can urethral bulking agents be used for men as well as women?

Yes, they have been used in men with SUI after prostatectomy, but the results are less favorable than the results in women.

Bottom Line: Injection of urethral bulking agents is a reasonable alternative to mid-urethral sling surgery in certain populations of women who either are not medically fit for sling surgery, have failed sling surgery, or wish to defer or avoid sling surgery.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc  

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 promo code “UROLOGY10” at checkout for 10% discount.