Archive for February, 2017

Kegels Go Hollywood: From Ben Wa Balls To The Elvie Pelvic Trainer

February 26, 2017

Andrew Siegel MD  2/26/17

I do not ordinarily compose more than one blog entry per week, but Kegels Go Hollywood presented itself and is worthy of a timely discussion.

Photo below by Ivan Bandura [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commonsoscars_for_sale_6952722855

And the Oscar goes to….

arnold-kegel-gladser-studio-1953

Arnold Kegel MD (Gladser Studio, 1953)

“Fifty Shades of Grey” and “Fifty Shades of Darker” are not my cup of tea, although I confess to having read the first book to see what all the fuss was about.  According to The New Yorker reviewer Anthony Lane, the current “Fifty Shades of Darker” movie is lacking in thrills, “unless you count the nicely polished performance from a pair of love balls.” The movie popularizes the use of Ben Wa Balls, which apparently spend most of their time settled deeply in the vagina of female character Anastasia Steele (Dakota Johnson).

ben-wa

 Ben Wa Balls

Included in the swag bag of high-end gifts at tonight’s Oscars is a pelvic floor training device called the “Elvie.” Manufactured in the UK, Elvie is a sophisticated wearable, egg-shaped, waterproof, flexible device inserted vaginally. Pelvic floor muscle contraction strength is measured and sent via Bluetooth to a companion mobile app on a smartphone that provides biofeedback to track progress. Five-minute workouts are designed to lift and tone the pelvic floor muscles. The app includes a game designed to keep users engaged by trying to bouncing a ball above a line by clenching their pelvic floor muscles. The carrying case also serves as a charging device. Cost is $199 (Elvie.com).

elvie

Elvie Pelvic Training Device 

I have worked with the company that manufactures Elvie and recently wrote a blog for the Elvie website on the topic of “Myths about the pelvic floor.” To access, go to:

https://www.elvie.com/blog/12-myths-about-the-pelvic-floor-with-dr-siegel

As a physician, urologist, author and pelvic floor muscle training advocate, I am quite pleased by the newfound awareness and popularity accorded pelvic floor muscle training, a highly beneficial means of improving/maintaining pelvic, sexual, urinary and bowel health–despite its popularization in Hollywood.

Benefits of Pelvic Floor Muscle Training

The vagina has its own set of intrinsic muscles (within its wall), which are further layered with the pelvic floor muscles (external to the vaginal wall). An intense pelvic floor muscle workout—albeit a pleasurable one made possible through devices like Ben Wa Balls or the Elvie—accords some real advantages to the participant. A stronger and better toned pelvic floor increases vaginal blood flow, lubrication, orgasm potential and intensity, the ability to clench the vagina as well as partner pleasure, overall increasing the potential for sexual gratification.  Of no less importance, a powerful pelvic floor also improves urinary and bowel control. Keeping the pelvic floor fit can prevent the onset of many sexual, urinary, bowel and other pelvic issues that may emerge with the aging process.

Love Balls 101

Motion-induced friction applied to the vaginal wall is one of the key factors leading to sexual pleasure.  Ben Wa Balls provide such friction and can be thought of as erotic toys as well as medical devices that are used to train the pelvic floor and vaginal muscles. When exercise can be made pleasurable—not unlike playing tennis as opposed to working out in the gym—it unquestionably provides significant advantages.

There are numerous variations in terms of Ben Wa ball size (usually one to two inches in diameter), weight, shape, composition and number of balls. Some are attached to a string, allowing tugging on the balls to add more resistance. Another type has a compressible elastic covering that can be contracted down upon. Still others vibrate. There are some upscale varieties that are carved into egg shapes from minerals such as jade and obsidian.

Ben Wall Balls are classified under the general heading of vaginal weights, devices that are placed in the vagina and require pelvic floor muscle engagement in order that they remain in position and not fall out when the user is upright, providing resistance to contract down upon.

Ben Wa balls are not unlike vaginal cones, which consist of a set of weights that are of identical shape but vary in their actual weight. Initially, one places a light cone in the vagina and stands up and walks about, allowing gravity to come into play. Pelvic floor contractions are required to prevent the cone from falling out. The intent is to retain the weighted cone for fifteen minutes twice daily to improve pelvic strength.  Gradual progression to heavier cones challenges the pelvic floor and vaginal muscles to improve strength and tone. Ben Wa balls can be thought of as sexy versions of the vaginal cones.

vaginal-conesVaginal Cones

 

Sophisticated Pelvic Training Devices Like Elvie

There are many pelvic resistance devices on the market—some basic and simple, like Ben Wa balls and vaginal cones—but many newer ones are a “high tech” and sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. More information will follow about these complex devices in future blog entries.

Bottom Line: Pelvic floor muscle training can be done with or without resistance devices like Ben Wa balls, vaginal cones, and the more sophisticated devices such as the Elvie.  The use of resistance devices adds a dimension beyond what is achievable by contracting one’s pelvic muscles without resistance (against air).  From a medical and exercise physiology perspective, muscles increase in strength in direct proportion to the demands placed upon them and resistance exercise is one of the most efficient ways to stimulate muscular and metabolic adaptation.

The slang term “pussy” is often used to connote “weak” and “ineffectual.”  Anastasia Steele’s “vagina of steel” fashioned by using Ben Wa Balls as a vaginal resistance device clearly shows that this does not have to be the case!

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health http://www.TheKegelFix.com.  This book is written for educated and discerning women who care about health, well being, nutrition and exercise and enjoy feeling confident, sexy and strong.

The Kegel Fix is available in e-book format on the Amazon Kindle, iPad (Apple iBooks), Barnes & Noble Nook and Kobo and in paperback, all accessible via the following website: www.TheKegelFix.com. The e-book offers discretion, is less expensive, is delivered immediately, saves the trees, has adjustable fonts, as well as numerous hyperlinks—links to other sites activated by clicking—that access many helpful resources. Enjoy!

Leaking Havoc: Female Stress Urinary Incontinence

February 25, 2017

Andrew Siegel MD  2/25/17

*Credit for title “Leaking Havoc” goes to freelance writer Karen Gibbs who recently interviewed me for an article on this topic for New Jersey Family Magazine.

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

7. SUI

Illustration above of stress urinary incontinence, by Ashley Halsey from Dr. Siegel’s book : “The Kegel Fix”

In Europe, SUI is referred to as “exertion” incontinence, since some form of physical effort usually triggers it. This is less confusing than the American term “stress” incontinence since the word stress is most typically used in the context of emotional stress–but here I am referring to only the physical stress of a sneeze, jump, etc.

Who Knew? The triggers that most consistently provoke SUI are jumping up with a sudden stop as one’s feet touch down—jumping jacks, trampoline and jump rope.

 Who Knew? There are hereditary/racial differences in the prevalence of SUI with SUI being less common in women of African-American descent and more common in Caucasian women, thought to be on the basis of genetic differences in pelvic muscle bulk.

SUI most often occurs because the support to the urethra (the urinary channel that goes from the bladder out)—the pelvic floor muscles and connective tissues—has weakened and no longer provides an adequate “backboard” to the urethra. 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 for SUI are pregnancy, labor and delivery, particularly traumatic vaginal deliveries of large babies. SUI is uncommon in women who have not delivered vaginally or in women who have delivered by elective Caesarian section (a C-section without experiencing labor). However, emergency C-section done for failure of labor to progress has a similar risk for SUI as vaginal delivery.

Many women experience SUI during pregnancy. By their third month of pregnancy, 20% of women report SUI, as do 50% at full term. There are many reasons for its occurrence, including the pressure of the enlarging uterus on the bladder and stretching of the pelvic floor muscles and other connective tissues.

Who Knew? After giving birth to your newborn, in addition to buying diapers for your baby you may have to buy them for yourself!

Who Knew? The more vaginal deliveries one has, the greater the likelihood of developing SUI.

Who Knew? Numerous studies have demonstrated the benefits of pelvic floor muscle training (Kegels) in facilitating an early return of urinary control and improving the severity of SUI.

Some women experience persistent SUI after childbirth, while others find that it improves dramatically and resolves within 6 months. Others will not experience SUI until many years after childbirth, after promoting factors have kicked in. These factors include obesity, aging, menopause, weight gain, gynecological surgery (especially hysterectomy), and any condition that increases abdominal pressure. These include coughing (often from smoking), asthma, weight training and high impact sports (e.g., trampoline, gymnastics, pole vaulting, etc.) and occupations that require heavy physical labor. Chronic constipation is a major contributory factor because of pushing and straining on a daily basis, cumulatively causing the same weakening of urethral support as happens with obstetrical labor.

Who Knew? SUI is common in recreational as well as elite female athletes, particularly those who participate in high impact sports involving jumping. It can lead to poor athletic performance and ultimately avoiding sports participation.

The specific activities that provoke SUI and the severity of the leakage can vary greatly from woman to woman. Some only experience SUI with extreme exertion, such as when serving a tennis ball, swinging a golf club or with a powerful sneeze. Others experience SUI with minimal exertion such as walking or turning over in bed. Some women do not wear any protective pads or liners, changing their panties as necessary, whereas others wear many pads per day. Some are significantly bothered by even a minor degree of SUI, while others are accepting of experiencing many episodes of SUI daily.

Although the predominant cause of SUI is inadequate urethral support, it may also be caused by a weakened or damaged urethra itself. Risk factors for this are menopause, pelvic surgery, injury to the urethral nerve supply, radiation, and pelvic trauma. Such a severely compromised urethra usually causes significant urinary leakage with minimal activities and also results in “gravitational” incontinence, a profound urinary leakage that accompanies positional change.

Genuine SUI needs to be distinguished from other conditions that cause leakage of urine with increases in abdominal pressure that are not on the basis of inadequate urethral support or a weakened urethra. These other conditions can masquerade as genuine SUI. It is critical to distinguish between them since the treatments are very different. This is one reason why a thorough evaluation of SUI is important. The conditions that can masquerade as genuine SUI include: failure to empty the bladder; urethral diverticulum; vaginal voiding; and stress-induced involuntary bladder contraction.

Failure to empty the bladder can occur for a variety of reasons, including blockage of outflow of urine and an underactive bladder that contracts poorly. When the bladder is constantly full, it is easy to understand why a sudden increase in abdominal pressure can provoke leakage.

Who Knew? An extension of this is that if your bladder is full and you leak a small amount with jumping or laughing, it is not necessarily problematic, but just means that you need to urinate before engaging in such activities.

Urethral diverticulum is a small sac-like out-pouching from the urethra that can fill up with urine and leak during physical activities. The treatment is often surgical repair.

Vaginal voiding occurs in a small percentage of women who have an anatomical variation in which their urethral openings are internally recessed as opposed to the normal external urethral opening on the vestibule, immediately above the vaginal opening. When urinating, some of the urine pools in the vagina. Upon standing and physical exertion, the urine can then leak out of the vagina.

Stress-induced involuntary bladder contraction is a condition in which an involuntary contraction of the bladder (the bladder squeezing without its owner’s permission) is triggered by a maneuver that typically causes SUI. For example, a cough induces an involuntary bladder contraction, causing urinary leakage.

…To be continued next week when I will review how to diagnose and treat SUI.

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health http://www.TheKegelFix.com.  Much of the content of this entry was excerpted from this book, written for educated and discerning women who care about health, well being, nutrition and exercise and enjoy feeling confident, sexy and strong.

The Kegel Fix is available in e-book format on the Amazon Kindle, iPad (Apple iBooks), Barnes & Noble Nook and Kobo and in paperback, all accessible via the following website: www.TheKegelFix.com. The e-book offers discretion, advantageous for books about personal issues, is less expensive, is delivered immediately, saves the trees, has adjustable fonts, as well as numerous hyperlinks—links to other sites activated by clicking—that access many helpful resources.

Prostate Arterial Embolization To Treat Prostate Enlargement

February 18, 2017

Andrew Siegel MD  2/18/17

Note: Today’s entry was supposed to be on the topic of female stress incontinence, but this very interesting prostate topic presented itself to me, so the female incontinence entries will be continued next week.

Benign prostate enlargement (BPH) is a common condition of the middle-aged and older male in which the enlarging prostate gland obstructs urinary flow. It causes a number of annoying lower urinary tract symptoms, including a hesitant, weak and intermittent stream, prolonged emptying time, incomplete emptying, frequent urinating, urgency, nighttime urinating, and at times, urinary leakage. 

There are numerous treatment options available and one of the newest minimally invasive options is “super-selective prostate artery embolization”—a.k.a. “PAE”—a  procedure that is done by an interventional radiologist (a specialist x-ray doctor who does internal procedures without using conventional surgical techniques).  The blood supply to the prostate is purposely blocked (embolized) using micro-particles that are injected into one or more of the arteries to the prostate.  As a result of this embolization of the prostate artery, the part of the prostate served by the artery shrinks, opening up the obstructed urinary channel and improving the lower urinary tract symptoms.

Urinary difficulties attributable to BPH are commonly quantified using the International Prostatic Symptom Score (IPSS), a questionnaire consisting of seven symptom categories, with a range of increasingly severe symptom scores from 0 through 35. The score is based on the severity of each of the following lower urinary symptoms: hesitancy, decreased urinary stream, intermittency, sensation of incomplete emptying, nighttime urination, frequency, and urgency. The questionnaire responses are graded, with each of the seven symptom categories contributing a maximum of 5 points, for a total possible score of 35. Symptoms can be ranked as mild (0–7), moderate (8–19), and severe (20–35).  This IPSS is a useful metric both before and after a procedure like PAE, in order to document clinical symptomatic improvement.

Before pursuing PAE, a CT angiogram of the prostate is performed to determine prostate arterial anatomy, to help plan the PAE and to exclude patients with severe arterial disease or anatomic variations that will not allow PAE to be a consideration. Prior to pursuing a PAE procedure, it is vital to check PSA, perform a digital rectal examination and rule out prostate cancer.

 Technique of PAE

The PAE procedure takes place in the radiology department of the hospital under the supervision of the interventional radiologist. The femoral artery (thigh artery) is cannulated and by using an injection of contrast, the arterial supply to the prostate gland is identified. The prostate artery most commonly branches off the internal pudendal artery. Embolization of the anterolateral prostate artery, the main blood supply to the benign prostate growth, is attempted on both sides. The most challenging aspect is to identify and catheterize the tiny prostate arteries that are often only 1-2 mm in diameter.  Micro-particles (polyvinyl alcohol, trisacryl gelatin microspheres or other synthetic biocompatible materials) are injected into the prostate arteries to purposely compromise blood flow and cause partial necrosis (death of prostate cells) and shrinkage. After the embolization on one side, an angiogram (x-ray of pelvic arterial anatomy) is done before the sequence is repeated on the other side.

img_2064

Because of variation in prostate arterial anatomy and the types of micro-particles used, the extent of necrosis and shrinkage of the prostate is quite variable. Furthermore, prostate volume reduction does not precisely correlate with symptom improvement.  Although ideally performed on both sides, when done only on one side (left or right prostate artery) it still results in improvement of symptoms without as significant a reduction in prostate volume.

Although clinical improvement in urinary symptoms is less predictable after PAE as compared to standard treatments including surgical removal or laser treatment of the obstructing part of the prostate, the PAE has numerous points in its favor. Advantages of this new procedure are avoidance of general anesthesia and surgery an preservation of ejaculation, as opposed to surgical treatments of BPH, which commonly cause retrograde ejaculation (ejaculating backwards into the bladder with semen following the path of least resistance).  The PAE procedure is ideal for the older male with symptomatic BPH and significant prostate enlargement who for one of a variety of reasons is not a good candidate for conventional surgery.

Side effects of the PAE include urethral burning, fever, nausea and vomiting and perineal pain from prostate ischemia (damage to the blood supply), short-term inability to urinate as well as the radiation exposure necessary to perform the procedure.

Bottom Line:  Growing evidence supports the use of prostate arterial embolization to treat benign prostate enlargement.  Selectively occluding the prostate arterial supply results in damage to the prostate blood supply and ischemic necrosis (prostate tissue death) with reduction in the volume of the prostate gland with improvement in symptoms.  Safe and effective, it is a promising minimally invasive option that is an attractive alternative to surgery for symptomatic patients with large prostates and concomitant medical problems who have failed to respond well to pharmacological treatments.

 Dr. John DeMeritt is an interventional radiologist at Hackensack University Medical Center in Hackensack, New Jersey, who has particular expertise and experience in PAE.  He reported the first case study of PAE in the USA, has conducted numerous studies on the topic as well as written several medical journal articles and has been interviewed on the subject by Dr. Max Gomez on CBS news: https://www.youtube.com/watch?v=SdV8ZxtLqZU

Thank you to Dr. DeMeritt for provided me with information on the subject matter, both verbally and in the form of several excellent articles, including his original case report.  He also provided me with the PAE image.

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

 

Female Bladder Works

February 11, 2017

Andrew Siegel MD   2/11/17

This entry is a brief overview of bladder anatomy and function to help you better understand the two most common forms of urinary leakage—stress urinary incontinence and overactive bladder— topics for entries that will follow for the next few weeks.  Having a working knowledge of the properties of the bladder will serve you well in being able to understand when things go awry. 

                          6. bladder

                             Drawing of the bladder and urethra by Ashley Halsey from “The Kegel Fix:                           Recharging Female Pelvic, Sexual and Urinary Health”

The bladder is a muscular balloon that has two functions—storage and emptying of urine. The stem of the bladder balloon is the urethra, the tube that conducts urine from the bladder during urination and helps store urine at all other times. The urethra runs from the bladder neck (where the urinary bladder and urethra join) to the urethral meatus, the external opening located just above the vagina.

Bladder Control Issues—More Than Just a Physical Problem

Urinary incontinence is an involuntary leakage of urine. Although not life threatening, it can be life altering and life disrupting. Many resort to absorbent pads to help deal with this debilitating, yet manageable problem. It is more than just a medical problem, often affecting emotional, psychological, social and financial wellbeing (the cumulative cost of pads can be significant). Many are reluctant to participate in activities that provoke the incontinence, resulting in social isolation, loss of self-esteem and, at times, depression. Since exercise is a common trigger, many avoid it, which can lead to weight gain and a decline in fitness. Sufferers often feel “imprisoned” by their bladders, which have taken control over their lives, impacting not only activities, but also clothing choices, travel plans and relationships.

Bladder Function 101

Healthy bladder functioning depends upon properties of the bladder and urethra. Bladder control issues arise when one or more of these go awry:

Capacity

The average adult has a bladder that holds about 12 ounces before a significant urge to urinate occurs. Problem: The most common capacity issue is when the capacity is too small, causing urinary frequency.

Elasticity

The bladder is stretchy like a balloon and as it fills up there is a minimal increase in bladder pressure because of this expansion. Low-pressure storage is desirable, as the less pressure in the bladder, the less likelihood for leakage issues. Problem: The bladder is inelastic or less elastic and stores urine at high pressures, a setup for urinary leakage.

Sensation

There is an increasing feeling of urgency as the urine volume in the bladder increases. Problem: The most common sensation issue is heightened sensation creating a sense of urgency before the bladder is full, giving rise to the frequent need to urinate. Less commonly there exists a situation in which there is little to no sensation even when the bladder is quite full (and little warning that the bladder is full), sometimes causing the bladder to overflow.

Contractility

After the bladder fills and the desire to urinate is sensed, a voluntary bladder contraction occurs, which increases the pressure within the bladder in order to generate the power to urinate. Problem: The bladder is “under-active” and cannot generate enough pressure to empty effectively, which may cause it to overflow when large volumes of urine remain in the bladder.

Timing

A bladder contraction should only occur after the bladder is reasonably full and the “owner” of the bladder makes a conscious decision to empty the bladder. Problem: The bladder is “overactive” and squeezes prematurely (involuntary bladder contraction) causing sudden urgency with the possibility of urinary leakage occurring en route to the bathroom.

Anatomical Position

The bladder and urethra are maintained in proper anatomical position in the pelvis because of the pelvic floor muscles and connective tissue support. Problem: A weakened support system can cause urinary leakage with sudden increases in abdominal pressure, such as occurs with sneezing, coughing and/or exercising.

Urethra

In cross-section, the urethra has infoldings of its inner layer that give it a “snowflake” appearance. This inner layer is surrounded by rich spongy tissue containing an abundance of blood vessels, creating a cushion around the urethra that permits a watertight seal similar to a washer in a sink. The female hormone estrogen nourishes the urethra and helps maintain the seal. Problem: With declining levels of estrogen at the time of menopause, the urethra loses tone and suppleness, analogous to a washer in a sink becoming brittle, potentially causing leakage issues.

Sphincters

The urinary sphincters, located at the bladder neck and mid-urethra, are specialized muscles that provide urinary control by pinching the urethra closed during storage and allowing the urethra to open during emptying. The main sphincter (a.k.a. the internal sphincter) is located at the bladder neck and is composed of smooth muscle designed for involuntary, sustained control. The auxiliary sphincter (a.k.a. the external sphincter), located further downstream and comprised of skeletal muscle contributed to by the pelvic floor muscles, is designed for voluntary, emergency control. Problem: Damage to or weakness of the sphincters adversely affects urinary control.

The main sphincter is similar to the brakes of a car—frequently used, efficient and effective. The auxiliary sphincter is similar to the emergency brake—much less frequently used, less efficient, but effective in a pinch. The pelvic floor muscles are intimately involved with the function of the “emergency brake.”

Nerves

The seemingly “simple” act of urination is actually a highly complex event requiring a functional nervous system providing sensation of filling, contraction of the bladder muscle and the coordinated relaxation of the sphincters. Problem: Any neurological problem can adversely affect urination, causing bladder control issues.

Bladder Reflexes

A reflex is an automatic response to a stimulus, an action that occurs without conscious thought. There are three reflexes that are vital to bladder control:

Guarding Reflex: During bladder filling, the “guarding” (against leakage) pelvic floor muscles contract in increasing magnitude in proportion to the volume of urine in the bladder; this provides resistance that helps prevent leakage as the bladder becomes fuller.

Cough Reflex: With a cough, there is a reflex contraction of the pelvic floor muscles, which helps prevent leakage with sudden increases in abdominal pressure.

Pelvic Floor Muscle-Bladder Reflex: When the pelvic floor muscles are voluntarily contracted, there is a reflex relaxation of the bladder. This powerful reflex can be tapped into for those who have involuntary bladder contractions that cause urgency and urgency leakage.

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

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Much of the content of this entry was excerpted from his recently published book The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health: http://www.TheKegelFix.com

He is also the author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Penis Stretching (Traction Therapy): What You Should Know

February 4, 2017

Andrew Siegel MD  2/4 /17

“Tissue expansion” is a well-accepted concept employed in several medical disciplines for the purpose of gradually expanding specific anatomical parts, most commonly used in plastic and reconstructive surgery.  Traction therapy—a.k.a. mechanical transduction—involves the application of pulling forces to tissues in order to incrementally expand them.  The traction ultimately leads to cellular proliferation and formation of new collagen. Successful tissue expansion mandates adequate pulling forces with sufficient time of traction application and treatment duration. Traction so applied to body parts for extended periods of time will result in gradual lengthening and expansion, and the penis is no exception.

traction

Image above: Two nursing sisters erect traction apparatus for a patient’s leg in the Orthopaedic Ward of No. 2 RAF General Hospital in Algiers, 1944-1945

http://media.iwm.org.uk/iwm/mediaLib//52/media-52315/large.jpg

 

Penile traction is capable of lengthening or straightening the penis using mechanical pulling forces. It has become an increasingly popular option based upon its relative noninvasive nature, the side effects associated with alternative treatments, and the general difficulties in managing conditions that result in penile shortening. The biophysics of penile traction involves mechanical forces and stresses that are capable of positively affecting cellular and tissue growth.

Penile traction therapy has potential clinical use in a number of urological circumstances, including for purposes of penile lengthening, as primary management of Peyronie’s disease, as an secondary treatment after other forms of management for Peyronies (including the injection of medications into Peyronie’s scar tissue and surgery for Peyronies), and finally, prior to penile prosthesis implant surgery to optimize penile length at the time of the implantation. Penile traction necessitates a compliant patient willing to devote the time and effort to the relatively long treatment period required for effective lengthening.

For more information on Peyronie’s disease, refer to my previous blog entry: https://healthdoc13.wordpress.com/2015/05/23/peyronies-disease-not-the-kind-of-curve-you-want/

Situations That May Benefit From Penile Traction

  • Small penis stature
  • Penile dysmorphic disorder: a preoccupation with penis size, often related to the subjective perception of small penis size that has no objective basis
  • Penile shortening due to radical prostatectomy
  • Penile shortening and angulation due to Peyronie’s disease
  • Peyronie’s patients who have had injection therapy with medications (collagenase, verapamil, interferon, etc.) or surgery for Peyronie’s, as adjunctive treatment to optimize results
  • Prior to inflatable penile implantation to enable implantation of the largest possible prosthesis

 What Are The Commercially Available Penile Traction Devices?

  • FastSize Penile Extender (FastSize Medical, Aliso Viejo, CA)
  • Andro-Penis (Andromedical, Madrid, Spain)
  • Golden Erect Extender (Ronas Tajhiz Teb, Tehran, Iran)
  • SizeGenetics (GRT Net Services Inc., Gresham, OR)
  • Vimax Extender (OA Internet Services, Montreal, Canada)
  • ProExtender (Leading Edge Herbals, Greeley, CO)
  • PenimasterPro (MSP Concept, Berlin, Germany)

All of the aforementioned devices are similar in principle. For specific information on any product, a Google search will provide detailed information on each product and exactly how it is used.

The most sophisticated and best-engineered device is the PenimasterPro. For more information on this device: https://www.penimaster.com   (Available through www.urologyhealthstore.com use code “Urology 10” for 10% discount and free shipping.)

slider2-1

Image above: PenimasterPro

Bottom Line: Penile traction is a minimally invasive, relatively new option for managing conditions associated with shortened penile length. Studies have demonstrated the ability of traction therapy to modestly increase penile length without changing girth. It is capable of improving the penile curvature and shortening associated with Peyronie’s disease, particularly when initiated early during the acute phase, as well as following surgery or injection therapy. It also has utility in optimizing penile length prior to penile implant surgery and for the management of any condition causing penile shortening. It does require a dedicated and compliant user willing to wear the traction device for extended periods of time in order to achieve satisfactory lengthening. 

Resources for this entry:

External Mechanical Devices and Vascular Surgery for Erectile Dysfunction. L Trost, R Munarriz, R Wang, A Morey and L Levine: J Sex Med 2016; 13:1579-1617

Penile Traction Therapy for Peyronie’s Disease: What’s the Evidence? MF Usta and T Ipeckci: Transational Andrology and Urology 2016; 5(3):303-309

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com