Archive for December, 2017

Scrotal Sac Slack

December 30, 2017

Andrew Siegel MD   12/30/17

It is “scrotum-tightening December cold” outside, a most opportune time to blog about scrotal laxity and “long balls.”  Anyway, a  few weeks ago the topic was vaginal labial hypertrophy, so to be fair to the male gender today’s entry deals with a parallel issue, the low-hanging scrotal sac. A complaint voiced not infrequently by my middle-aged and older patients is that their testicles hang loosely, similar to the pendulous breasts of older women. At times, men complain that when they are seated on the toilet, their scrotum actually touches the water. Ouch!

In Curb Your Enthusiasm, S06E07, Larry ends up in the ER because he caught his testicles in the fly of his underwear and was diagnosed with “long balls.” https://www.youtube.com/watch?v=gmHf_1kqJc0

In summer camp, one of the traditional songs sung by campers (to the tune of the children’s song Do your ears hang low?) was the following:

Do your balls hang low?
Do they wobble to and fro?
Can you tie ’em in a knot?
Can you tie ’em in a bow?
Can you throw them over your shoulder
Like a continental soldier?
Do your balls hang low?

 I don’t know what the summer camp fascination with low-hanging balls was all about, but another song (to the tune of Italian love song That’s Amore) had the following lyrics:

When your balls hit the floor like a B-54 it’s a rupture.

Scrotal science 101

Figure_28_01_02Attribution of image above: By OpenStax College [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)%5D, via Wikimedia Commons

In early fetal development the testicles originate in the abdomen and by full-term they  descend south into the scrotum (the sac that houses the testicles).  At puberty, the testes increase in size substantially; with the increase in testes size there is a proportional increase in scrotal size, the scrotum being a very expansive cavity.

The scrotum has several roles, enveloping and protecting the testes as well as aiding in their function by regulating their temperature. For optimal sperm production, the testes need to be a few degrees cooler than core temperature; the dartos muscle within the scrotal wall relaxes or contracts depending on the ambient temperature, allowing the testes to elevate or descend to help maintain this optimal temperature. Under conditions of cold exposure, the dartos contracts, causing the scrotal skin to wrinkle and to bring the testicles closer to the body.  When exposed to heat, dartos relaxation allows the testicles to descend and the scrotal skin to smoothen.

The testes are suspended via the spermatic cord, a rope-like “cord” of tissue that traverses the groin and contains the life supply of the testes.  Both the testes and spermatic cord are covered by tissues that are extensions of the connective tissue coverings of three of the abdominal core muscles. The most important of these coverings surrounding the spermatic cord is the cremaster muscle, which elevates the testes north when it contracts.

Factoid: The cremasteric reflex is a reflex elevation of the testes from the scrotum to the groin when the upper thigh is gently stroked. The reflex is brisk in children and becomes weaker with aging.   

Why does scrotal laxity occur?

The combined factors of the weight of the testes, gravity and time cause a continued southward journey of the testes throughout life, particularly so as collagen and elastin connective tissues weaken and scrotal skin (like skin everywhere else) becomes less supple. With aging, there is also loss of muscle strength of the dartos and cremaster muscles, causing scrotal relaxation and looser hanging testes, respectively. Years ago, a common hernia repair (Shouldice technique) that was in vogue stripped the spermatic cord of cremaster muscle, rendering the testicle on the side of the repair to be “dangly.”

What are symptoms of scrotal laxity?

Aside from the wet scrotum scenario when seated on a toilet bowl, since the low-hanging testes is much less protected, it is more vulnerable to trauma and irritation than the well-supported testes. The low-hanging testes is susceptible to injury when one sits down and discomfort when one participates in cycling, motorcycling, horseback riding and other sports. The low-hanging testes can cause hygienic issues as well as embarrassment and the desire not to be seen naked by a sexual partner, in a locker room or even at the beach in a bathing suit.

Factoid: Nutcracker Suite.  A common complaint voiced by patients is a testicle getting crushed when getting into and sitting down in an automobile.

Factoid: The scrotum may hang so low that when one passes wind, the testicles may become airborne like a kite flying erratically in a sudden gust! 

What to do about scrotal laxity

Try to maintain a healthy lifestyle, stay in good physical shape and keep your core muscles fit.  Get in the habit of wearing briefs or boxer briefs, many of which are highly supportive like cycling shorts, as opposed to boxers.

If scrotal laxity has caused anatomical, functional or psychological concerns, know that there are effective surgical procedures to remedy the problem. Reducing the size of scrotum is known in medical speak as reduction scrotoplasty, a.k.a. scrotal lift.  There are a variety of techniques used to tailor and re-contour the excessive scrotal skin, with the goals of elevating the testes, eliminating the redundant scrotal sac tissue, minimizing scarring and retaining natural pigmentation.

Bottom Line: Time and gravity can be cruel conspirators when it comes to testes and scrotal support.  Although scrotal laxity is not a significant medical issue, it can result in quality of life and self-esteem issues.  If  you find your scrotum becoming waterlogged, testicles airborne, or have other functional and/or cosmetic concerns, reduction scrotoplasty (scrotal lift) is an effective procedure to improve the cosmetic appearance and resolve the annoying symptoms.  This is a procedure that can be performed by a urologist on an outpatient basis.

Final factoid: Testes self-examination.  There are no organs in the body—save the breasts—that are more external and easily accessible to examination than the testes.  Unlike the ovaries, the testes are “gift wrapped” in the scrotal sac and can easily be and should be checked periodically for lumps and bumps. Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20s, striking men at the peak of life.  Take advantage of this accessibility to do regular exams—it just might be lifesaving.

Wishing you the best of health in 2018,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx

 

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Love Muscles Illustrated

December 23, 2017

Andrew Siegel MD  12/23/17

Hermes Butchart Gardens, Victoria

Above photo of Hermes I took this past summer at Butchart Gardens, Victoria, Canada 

In this entry, words will be kept to a minimum because the illustrations tell most of the story.  The images of the superficial pelvic floor muscles (muscles of love) that follow derive from the 1918 edition of Gray’s Anatomy of the Human Body (public domain), modified by Uwe Gille.

Whether you are male or female, two vital muscles — bulbocavernosus (BC) and ischiocavernosus (IC— have an intimate relationship with your genitals and are the “motor” that drives their function.  Without them, your penis or vagina would be non-functional putty!  Notice how remarkably similar the muscles are in both genders, the only difference being that the BC muscle is split in women, divided by the vagina.

Factoid: The relationship of the BC and IC muscles to the vagina and penis parallels the relationship between the diaphragm and the lungs. Without a functioning diaphragm to move the lungs, your lungs would be non-functional bags of air. 

Male BC (top) and IC muscles (bottom)

Bulbospongiosus-Male

Ischiocavernosus-male

 

 

 

 

 

 

 

 

 

  • Transform “plump” penis to “rigid” penis by compressing erectile chambers (responsible for penile high blood pressure)
  • Enables you to move your erect penis up and down at will
  • Stabilizes erect penis so it stays rigid and skyward-angled
  • Contract at climax and responsible for forcible expulsion of semen

Factoid: The only place in the body it is desirable to have high blood pressure is the penis. The BP at the time of full rigidity is > 200 mm, the 80-100 mm increase over systolic BP achieved by virtue of contraction of these muscles.

 

 

 

 

Female BC (top) and IC muscles (bottom)

Bulbospongiosus-Female

Ischiocavernosus-female

 

 

 

 

 

 

 

 

  • Increase pelvic blood flow during arousal, contributing to lubrication and plumping of vulva
  • Transform clitoris from flaccid to erect
  • Enables tightening vagina at will
  • Contract at the time of climax contributing to physical sensation of orgasm

Factoid: Women capable of achieving “seismic” orgasms most often have very strong, toned, supple and flexible BC and IC muscles.

 

 

 

Bottom Line: In men, these muscles function as the “erector penis” and “ejaculator penis.”  In women, these muscles function as the “erector clitoris,” “constrictor vagina,” and “climaxer maximus.”  Whether you are female or male, optimize the function of these muscles by doing Kegel exercises and make sure you do them properly: Male Kegel Book; Female Kegel Book.  To quote Sam Sneed, “Exercise puts brains in your muscles,” totally appropriate to these vital muscles that govern sexual function. 

Wishing you the best of health, a merry Christmas and a wonderful 2018!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx

 

 

 

Kidney Cysts: To Worry Or Not?

December 16, 2017

Andrew Siegel M.D.  12/16/17

You may have had some sort of chest or abdominal imaging study and you were told that you have one or more cysts in your kidney(s). Is this any reason for concern?

Kidney cysts, a.k.a. renal cysts, are round sacs filled with fluid located within or attached to the kidney. Most are not symptomatic nor dangerous and are discovered incidentally on imaging studies (ultrasound, computerized tomography, or magnetic resonance imaging) done for other reasons.

Renal cysts are common, occurring in 25% or so of adults over age 40 and 50% of adults over age 50. They are quite variable in size, ranging from smaller than a pea to larger than a cantaloupe.  Most are defined as simple cysts: spherical, thin walled, fluid-filled, without septa (internal divisions), without calcification, without solid parts, and do not take up contrast on imaging studies. Although large cysts may become symptomatic by compressing adjacent organs, this is extremely unusual. Only under the rarest of circumstances do simple cysts require treatment or intervention.

Note: In my more than 25 year urology career I have only needed to remove simple cysts in two patients.  Both were slender women, one with a cyst so large that it distorted her abdomen, as if she was pregnant.  The other woman had the cyst located behind her stomach, displacing her stomach upwards towards her abdominal wall such that every time she ate, she could actually see the bolus of food moving from her stomach down her intestine.

Ultrasound (sonography) is a non-invasive imaging technique that does not require radiation nor contrast injection and is used for determining the number, location, and size of cysts and is also an excellent means of following cysts over time.

The following image is an ultrasound of a simple renal cyst:

Renal_cyst_ultrasound_110303120332_1218020

Attribution: © Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D, via Wikimedia Commons

Although most renal cysts are classified as simple cysts, there are cysts in the kidney that may be more complex, and on occasion a cyst can be malignant. If a cyst has a thick wall, internal components (septa), calcifications, or it enhances with contrast, it is not classified as a simple cyst, but as a complex cyst.

Renal cyst classification uses the Bosniak system, named for Dr. Bosniak, the radiologist who devised it:

I   Simple benign cyst: Hairline-thin and smooth wall and no septa, calcifications, or solid components. It has the tissue density of water and does not enhance with contrast. Malignancy potential: highly unlikely.

II Mildly complex benign cyst: May contain a few hairline septa, calcification may be present in the wall or septa, but no enhancement with contrast. Malignancy potential: 0-10%.      

IIF (F = follow-up) Moderately complex cyst: May contain hairline septa, minimal enhancement may be seen in the wall or septa and may contain calcifications. No soft tissue enhancing elements present. Malignancy potential: 5-25%.      

III Indeterminate complex cyst: Cystic mass that has thickened irregular walls or septa in which enhancement is present; should be explored surgically, although some will prove to be benign, including hemorrhagic cysts, chronic infected cysts, and multi-loculated cystic nephroma, while some will be malignant including cystic renal cell carcinoma. Malignancy potential: >50%.      

IV Complex cystic mass: Malignant cystic masses that have thickened and irregular walls and septa that enhance and also contain enhancing soft tissue components. These include cystic carcinomas and require surgical removal. Malignancy potential: > 90%.     

Bottom Line: The vast majority of renal cysts are picked up incidentally (on imaging studies done for other reasons) and are simple benign cysts (Bosniak I) that will never cause symptoms or problems. They are amenable to follow up with ultrasound and rarely require intervention. The answer to the question about whether or not to worry about cysts is usually: “Not to worry.”

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

Labial Hypertrophy (Large Vaginal Lips): What You Should Know

December 9, 2017

Andrew Siegel MD   12/9/2017

Presenting oneself in a physically positively way is important to many women (as it is to many men).  Coiffed hair, nicely-applied makeup, polished nails, attractive clothing and a physically fit body are pieces of the overall picture. The appearance of one’s genitals—although private and hidden—is often perceived as an important feature as well. 

Interestingly, one’s perception of what features make for attractive genitals is strongly influenced by one’s culture.  In the United States (and many other Western countries) the most desirable look is petite vaginal lips, whereas in certain Eastern countries including Japan the “winged butterfly” is the preferred appearance. In some regions of Sub-Saharan Africa, intentional inner lip stretching and manipulation are commonly performed, since large lips are prized and considered highly desirable.  

 

Labial Anatomy 101

miguel ferig, wikipedia commons 

Miguel Ferig, Wikipedia Commons (LM labia majora; VV vaginal vestibule; Lm labia minora; C clitoris; U urethra; V vagina; H hymen; A anus)

The vaginal lips (labia) are parts of the female external genitalia (vulva).  Within the outer lips (labia majora) are two soft, thin, hairless skin folds known as inner lips (labia minora), which surround the entrance to the vagina. A furrow on each side separates the inner labia from the outer labia. The upper part of each inner lip unites to form the clitoral foreskin (clitoral hood) at the upper part of the clitoris and the frenulum (a small band of tissue that secures the clitoral head to the hood) at the underside of the clitoris. The labia have a generous nerve and blood supply, which during sexual arousal results in substantial swelling and congestion.

Size Matters

There is tremendous variety in vulval appearance, size, shape and pigmentation among women.  The inner lips can range from petite, narrow, barely visible structures to wide, butterfly-appearing lips that can extend well beyond the outer lips and dangle downwards, as illustrated in collage below.

Vagina collage public domain

“Vagina Collage”  (public domain)

Large inner lips , a.k.a. labial hypertrophy (see image below) can affect one or both lips and, although there is no exact consensus, is defined as when the inner lips extend beyond the outer lips.  In a British study of 50 women, inner lip length (top to bottom) averaged 6.1 cm (2.4 inches), ranging from 2 – 10 cm (0.8 – 4 inches); depth (width) averaged 2.2 cm (0.9 inch), ranging from 0.7 – 5 cm (0.3 – 2 inches).

Labia_minora_2009

By Schamlippen (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

Factoid: Intentional labial stretching is a widespread practice in many countries in Sub-Saharan Africa, resulting in significant lip enlargement as deep as 20 cm (8 inches) and low hanging lips (pendulous labia).  See image below.

Khoisan.apron, public domain

Khoisan apron–Khoisan women with pendulous lips visible (public domain)

Symptoms  

Having generously-sized lips is an anatomical variant that is most often harmless and should be considered more of a cosmetic issue than a medical problem.  However, large lips can cause a number of symptoms, including discomfort as a result of compression and rubbing from tight fitting clothes and exercising.  It can also cause irritation, painful sexual intercourse (particularly upon penetration), hygienic issues and on occasion a lip can get caught in a zipper (ouch!).  Psychologically, large lips can be a source of embarrassment, self-esteem issues and concerns about the presence of a “bulge” in the underwear and with tight fitting clothes.

Factoid: Some women with particularly oversized inner lips need to fold them and tuck them within the vagina to minimize the external protuberance.

What to Do?

If your inner lips are outsized but not causing concerns, there is no need for worry.  However, if there are anatomical, functional or psychological concerns, you should know that there are effective surgical procedures to remedy the problem.  Reducing the size of the lips is known in medical speak as “reduction labiaplasty.”  There are a variety of techniques to tailor and re-contour the lips, with the goals of resolving the issues that prompted the surgery, minimizing scarring and retaining the natural lip pigmentation.

Julie W pre- VP, PP, LP

Above photo, before labiaplasty (and other pelvic reconstructive procedures), (c) Michael P. Goodman MD, used with permission

Julie W 2 mos posyt LP wedge, rch, pp.

Above photo, after labiaplasty, (c) Michael P. Goodman MD, used with permission

Bottom Line: Although “loose lips sink ships,” labial hypertrophy is rarely a significant medical issue, but rather can occasionally foster a combination of cosmetic, anatomical, functional and psychological concerns.  Anthropologically speaking, what is considered attractive is highly variable across cultural lines, with some cultures favoring the petite look, others butterfly-style, wide lips, and still others practicing intentional stretching to create oversized and pendulous lips.  Reduction labiaplasty is an effective surgical procedure that can improve the cosmetic appearance of the lips and resolve the accompanying physical and emotional issues. 

Reference: Labia minora hypertrophy: causes, impact on women’s health, and treatment options, Gulia et al, Int Urogynecol J (2017) 28:1453-1461

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

6 Reasons You May Be Peeing Too Often (That Do Not Require A Urologist)

December 2, 2017

Andrew Siegel MD  12/2/2017

512px-Manneken_Pis_Brussel

Photo of Mannekin Pis in Brussels by Pbrundel (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

Some Necessary Basic Science

The kidneys are the paired organs that regulate urine production. They function by  filtering waste and excess volume from the blood and excreting these as urine. The volume of excretion by the kidneys is based upon several factors: One key factor is your state of hydration—for example, if you have not consumed enough liquid (state of dehydration) there will be scant urine production that is very concentrated appearing (amber color).  On the other hand, if you have over-consumed fluid (state of over-hydration), there will be abundant urine production that is very dilute (like water).  Another important factor determining volume of excretion is the effect of two hormones that regulate kidney function: Anti-diuretic hormone (ADH) is a pituitary hormone that restricts urine production (in order to maintain blood volume and blood pressure), whereas atrial natriuretic peptide (ANP) is a heart muscle hormone that increases urine production and inhibits ADH (in order to decrease blood volume and blood pressure).

ADH Trivia:

  • It is also known as Vasopressin, since it causes arteries to contract
  • It is sometimes used for shock (with severely low blood pressures) and also to stop gastro-intestinal bleeding
  • Certain cancers and other disorders can cause a syndrome called Inappropriate Secretion of ADH in which excessive ADH is produced, resulting in the kidneys over-concentrating urine, causing fluid and electrolyte imbalance, muscle cramps, confusion and convulsions
  • There is a biorhythmic pattern to ADH production, with less ADH production while sleeping, sometimes giving rise to  frequent nocturnal urination. Some people have very suppressed ADH production while asleep and therefore do most of their urinating during sleep hours and minimal urinating during the day.  This can be treated with administration of synthetic ADH.
  • Bedwetting in children is often treated with synthetic ADH

 

6 Reasons You May Be Peeing Too Frequently

  1. Too Much Fluid Intake

As obvious as this one is, it is often overlooked by the over-zealous drinker. As mentioned above, the kidneys play a vital role in fluid regulation and blood pressure.  If you drink excessive volumes of any fluid (this goes for consuming foods high in water content, especially fruit and veggies), you will be making frequent trips to the bathroom to relieve yourself, generally full volumes of dilute-appearing urine. All too often I see patients in the office with urinary urgency and frequency who are never without their water bottle…everything in moderation!

  1. Too Much Caffeine and/or Alcohol

Caffeine (present in coffee, tea, colas, many sports and energy drinks and chocolate) is a diuretic, meaning it makes you urinate.  Similarly, alcohol has a diuretic-like effect (by inhibiting ADH). So, if you are running to the bathroom after drinking a Starbuck’s Venti or alternatively, after drinking 3 beers at the sports bar, it is not a shocker!

  1. Diuretics (water pills)

Many people are on diuretic medications, often for high blood pressure, fluid collection in the ankles and legs (edema) and congestive heart failure.  These medications (some of which are very potent), are geared to make you pee a lot to reduce fluid volumes and blood pressure. So, if you are on Hydrochlorthiazide, Lasix, etc., and are peeing up a storm, it’s not a bladder or prostate problem, but simply the medication doing its job!

  1. Diabetes Mellitus (mellitus meaning sweet)

When diabetes is poorly controlled, high levels of blood sugar cause sugar to spill in the urine, which causes a diuretic-like effect.  In fact, many undiagnosed diabetics present to the urologist with urinary frequency and a dipstick of their urine reveals the presence of glucose and makes the diagnosis of diabetes.  Once diabetic control is achieved, the frequency dramatically improves.  If you have diabetes that is not well-controlled and are peeing hourly, the first visit should be to the internist or endocrinologist to get the diabetes finely tuned.

Certain diabetic medications (SGLT-2 Inhibitors) function by eliminating excess blood sugar in the urine, causing the same diuretic effect and therefore have the side effect of inducing urinary frequency.  These medications include Jardiance, Invokana and Farxiga.

     5. Diabetes Insipidus (insipidus meaning tasteless)

This is a rare cause of frequent urination of large volumes of dilute urine caused by either the failure of production of ADH by the pituitary or alternatively, the ineffectiveness of this hormone in inducing the kidneys to restrict water excretion.

  1. Obstructive Sleep Apnea (OSA)

OSA is a chronic medical disorder that adversely affects sleep, health and quality of life. Repeated complete or partial interruptions of breathing during sleep occur due to mechanical obstruction of the upper airway passage.

Labored efforts to breathe against an obstructed airway result in negative pressures in the chest. This increases the volume of venous blood that returns to the heart, causing distension of the right heart chambers.  The heart responds to this distension as a false sign of fluid volume overload, with the hormonal response of ANP secretion. As a result of the ANP secretion, high volumes of urine are produced during sleep, resulting in sleep-disruptive nighttime urination. There may be as many as 6 or more nighttime awakenings to urinate. When OSA is treated it results in a significant improvement, if not complete resolution of the frequent nocturnal urinating.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx