Archive for the ‘health and wellness’ Category

Understanding Female Sexual Fluids

August 11, 2018

Andrew Siegel MD  8/11/2018

Women are capable of releasing a “cocktail” of genital fluids during sexual activity. Controversy exists regarding the nature, volume, and composition of these secretions and their mechanisms of expulsion. Today’s entry delves into the origins of female sexual fluids—vaginal, glandular (Skene and Bartholin glands) and the urinary bladder—and the means of their release.  In the image below, the anatomical structures in boldface are those responsible for the genital fluids.

Image below: note Swedish “slida” is vagina (literally “sheath”); note Skenes and Bartholins gland  openings, “urinrorsmynning” = urethra; “klitoris” = clitoris

Skenes_gland-svenska.jpg

Attribution of image above: By Nicholasolan (Skenes gland.jpg) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY-SA 2.5 (https://creativecommons.org/licenses/by-sa/2.5)%5D, via Wikimedia Commons

 

Vaginal secretions

Lubrication that originates from the vagina is an ultra-filtrate of blood resulting from the increased blood flow and pelvic congestion that happens with erotic and tactile stimulation. The surge of blood to the genitals at the time of arousal results in the seeping of this natural lubrication fluid. There is often a substantial drop in the amount of vaginal lubrication that occurs after menopause with the sudden cessation of estrogen production by the ovaries.  By the way, if you are interested in testing your knowledge of female anatomy, visit: how high is your vaginal I.Q.?

Skene gland secretions…the female “prostate”

The Skene glands (a.k.a. para-urethral glands) are homologous to the male prostate gland.  These paired glands are located within the top wall of the vagina near the urethra and drain into the urethra and to tiny openings near the urethral opening (see image above). At the time of sexual climax, they can release a small amount of fluid into the urethra, paralleling the male release of prostate fluid at the time of ejaculation.

Bartholin gland secretions…the female “bulbourethral” glands

The Bartholin glands (a.k.a. greater vestibular glands) are paired, pea-size structures located in the superficial perineal pouch.  These glands open below and to the sides of the vagina (see image above).  They are homologous to the male bulbourethral glands that produce a clear, sticky fluid that lubricates the male urethra, often referred to as “pre-cum.”  The Bartholin glands secrete mucus that functions to provide lubrication to the inner labia that helps moisten the opening into the vagina.

Bladder and urethra

Because of the anatomical proximity of the bladder and urethra to the vagina, urine stored in the urinary bladder can be involuntarily released at the time of sexual activity.  Urine can be expelled during initial vaginal penetration, in the midst of the act of sexual intercourse, or at the time of sexual climax.

Urinary discharge that occurs during initial vaginal penetration and/or during sexual intercourse often occurs because of the presence of the penis in the vagina that displaces and elevates the bladder (anatomically situated directly above the vagina) and the massaging effect of penile thrusting.  This is not uncommonly seen in women who have either stress urinary incontinence, the involuntary leakage of urine with exercising, coughing, sneezing, etc., or bladder prolapse, a condition in which weakened bladder support allows descent of the bladder into the vaginal space.

Urine can also be involuntarily expelled from the urethra at the time of sexual climax.  For many women it is unpleasant, highly frustrating and embarrassing  situation for which they seek treatment, a condition known as coital incontinence. This orgasmic release of urine often occurs in women who suffer with overactive bladder, a condition in which the bladder contracts without its owner’s permission (a.k.a., involuntary bladder contractions).  For other women, the release of urine at the time of climax is viewed positively, correlated with intensive sexual arousal and a powerful and cathartic orgasm.  Under these circumstances, this situation is known as “squirting.”

(Excellent reference: Differential diagnostics of female “sexual” fluids: a narrative review   Z Pastor and R Chimel, Intern Urogynecological Journal (2018) 29:621-629)

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

Cover

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

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

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

Advertisements

Thankful for Tough Tissues: Big Head/ Little Head

August 4, 2018

Andrew Siegel MD   8/4/2018

Midas penis in cage

Image above from Phallological Museum in Reyjkavik that I recently visited

 

The toughest connective tissues in the human body, exclusive of bone and teeth (in order of strength) are:

  1. Dura mater (of brain and spinal cord)
  2. Tunica albuginea (of penis and clitoris)

Is it not fitting that the two toughest and hardiest connective tissues in the human body are located in the brain and genitals, providing protection and support to arguably two of our most vital and important human possessions? 

The hardest organs in the body are bones (calcium and other minerals) and teeth (enamel), but when it comes to connective tissue, the brain and penis/clitoris reign supreme. The brain and spinal cord are enveloped and protected by the dura mater (Latin, “hard mother”), the robust outermost membrane. The erectile chambers of the penis (and the clitoris, although on a miniaturized scale) are covered with a tough fibrous envelope called the tunica albuginea (Latin, “white membrane”).

The White Membrane

The tunica albuginea consists mostly of collagen with a sprinkling of elastin to allow it to stretch. It has an important role in maintaining both penile and clitoral erections.  When a penis is flaccid the tunica is 2 mm or so thick and with an erection it stretches to 0.25 to 0.5 mm thick.  At the time of erectile rigidity, the blood pressure in the penis exceeds 200 mm of mercury, the only place in the body where hypertension is desirable and necessary for proper function. The tunica albuginea supports the penis at these times of penile hypertension, allowing for full erectile rigidity and durability and protecting the penis against injury from the torquing and buckling stresses of sexual intercourse.

Acute Trauma to the White Membrane

On rare occasions, the tunica surrounding the erectile chambers of the penis ruptures under the force of a strong blow to the erect penis, a situation referred to as a penile fracture. It is not unlike the tire of a car being driven forcibly into a curb, resulting in a gash in the tread and deflation from the blow out. Such an acute blunt traumatic injury rarely occurs to the non-erect penis by virtue of its mobility, flaccidity, and 2 mm thick tunica. However, when the penis is rigid, there is peak tension and stretch on the white membrane. The leading cause of penile fractures is vigorous sexual intercourse, most often when the penis slips out of the vagina and strikes the perineum (area between the vagina and anus). She “zigs,” he “zags,” and a miss-stroke occurs of sufficient force as to rupture the white membrane.

Fracture can also occur under the circumstance of rolling over or falling onto the erect penis as well as any other situation that inflicts damage to the erect penis, such as walking into a wall in a poorly illuminated room or forcible masturbation.

Penile fracture is a medical emergency, and prompt surgical repair is necessary to maintain erectile function and minimize scarring of the erectile chambers that could result in permanent penile bending and angulation.

Chronic Trauma to the White Membrane

Chronic traumatic injuries to the white membrane are often asymptomatic for many years. Just the simple act of obtaining a rigid erection puts tremendous compression stress forces on the white membrane and the potential for micro-trauma to it increases exponentially when one inserts his erect penis into a vagina and two parties move, bump and grind, creating intense shearing stress forces on the penis. Certain positions angulate the penis and create more potential liability for injury than others. Even gentle sex can be rough with a single act of intercourse resulting in hundreds of thrusts with significant rotational, axial and torquing strains and stresses placed upon the erect penis with the potential for subtle buckling injuries.

Repeat performance perhaps a few times a week for many decades and by the time a man is in his 50s, on a cumulative basis, traumatic penile injuries—often asymptomatic in their developmental stages—can cause scarring to the white membrane, ultimately resulting in Peyronie’s disease.  This often manifests with a hard lump, shortening, curvature, narrowing, a visual indentation of the penis described as an hour-glass deformity, pain with erections and less erectile rigidity. Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse.

Bottom Line:  The human body is nothing short of amazing and should be accorded the greatest respect. We should be grateful for our dura mater and tunica albuginea that protect and allow function of our brains and penises/clitorides, respectively.  Given the service that our penises provide, it is surprising that penile fracture and Peyronie’s disease are not more common than they actually are.

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 (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Female Pelvic Floor Muscle Resistance Training Part 2: Sophisticated PFMT Devices

July 28, 2018

Andrew Siegel MD  7/28/2018

Following last week’s entry that reviewed the basic resistance devices, today’s entry reviews some of the more complex pelvic floor muscle (PFM) resistance devices.  These are complex and often expensive devices that provide resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. Many provide specific PFM training programs to follow for optimal results. This entry reviews a the most popular devices.

 

elvie

Above image is of the Elvie, one of the more sophisticated pelvic training devices (Elvie.com)

 

Lovelife Krush: Made by sex technology company OhMiBod, this is a dumbbell-shaped device that you insert vaginally and connect via Bluetooth to a companion app TASL (The Art and Science of Love).  Its voice-guided training program tracks PFM contraction pressure, endurance and number of reps and provides vibrational stimulation as you perform the exercises. Cost is $129 (Lovelifetoys.com/lovelife-krush).

kGoal:  Its name is a play on the word “Kegel.” It is an interactive “smart” device that consists of an inflatable and squeezable plastic “pillow” that is attached to an external handle.  It provides feedback, resistance and tracking. You insert the pillow in your vagina and inflate or deflate it with a button control to obtain a good fit.  When you contract your PFM properly, the device vibrates to give you biofeedback. The kGoal app can be downloaded on your smartphone and connected to the device via Bluetooth. The interface provides a guided workout including pulses, 5-second holds and slow and deliberate holds. It provides visual and auditory feedback and tracks your progress. The device measures the strength of your vaginal contractions and at the end of a workout you receive a score of 1-10 to help monitor your progress. Cost is $149 (Minnalife.com).

Vibrance Kegel Device: This biofeedback tool can be set at different resistance levels and provides audio guidance and coaching.  It consists of a pressure-sensitive element that you insert in your vagina.  When you contract your PFM properly, it delivers mild vibrational pulsations.  It has three different training sheaths of increasing stiffness that provide graduated levels of resistance for different training intensities. Cost is $165 (VibrancePelvicTrainer.com).

Elvie:  Manufactured in the UK, Elvie is a wearable, egg-shaped, waterproof, flexible device that you insert in your vagina. Your PFM contraction strength is measured and sent via Bluetooth to a companion mobile app that provides biofeedback to track progress. Five-minute workouts are designed to lift and tone the PFM.  The app includes a game designed to keep users engaged by bouncing a ball above a line by clenching their PFM. The carrying case also serves as a charging device. Cost is $199 (Elvie.com).

PeriCoach:  Manufactured in Australia, PeriCoach is a vaginal device that measures PFM contraction strength, which is relayed to your smartphone via Bluetooth to a companion mobile app. It provides a guided exercise program, data monitoring and audio-visual biofeedback. It is available only by prescription. Cost is $299 (PeriCoach.com).

InTone: This device must be prescribed by a physician and is specifically for stress urinary incontinence and overactive bladder. It combines voice-guided PFM exercises with visual biofeedback and electro-stimulation. It consists of an inflatable vaginal probe that provides resistance and measures PFM contractile strength. The probe is attached to a handle and a separate control unit furnishes the guided program and biofeedback. An illuminated bar graph displays the strength of your PFM contractions and objective data to track your progress. Exercise sessions are 12 minutes in length. Cost is $795 (Incontrolmedical.com).

As reported in the International Journal of Urogynecology, a 3-month clinical trial of the InTone device resulted in significant subjective and objective improvements in patients with stress incontinence and overactive bladder.

Do you really need to use a resistance device? 

You can strengthen your PFM and improve/prevent pelvic floor dysfunction without using resistance, so it is not imperative to use a device that is placed in the vagina in order to derive benefits from PFMT. Some women are unwilling or cannot place a device in the vagina. However, using resistance is the most efficient means of accelerating the muscle adaptive process as recognized and espoused by Dr. Kegel, since muscle strengthening occurs in direct proportion to the demands placed upon the muscle.  There is a real advantage to be derived from squeezing against a compressible device as opposed to against air. Furthermore, the biofeedback that many of the resistance devices provide is invaluable in ensuring that you are contracting your PFM properly and in tracking your progress.

Which resistance device will work best for you?

There are many resistance devices available in a rapidly changing, competitive and evolving market. Most of the sophisticated training devices provide the same basic functionality—insertion into the vagina, connection to a smartphone app, and biofeedback and tracking—although each device has its own special features. The goal is to find a device that is comfortable and easy to use.  Some devices are more medically-oriented whereas others are more sex toy-oriented.  Each has unique bells and whistles, some offering programs with guidance and coaching and a few incorporating games to make the PFMT process entertaining. I urge you to visit the website of any device that you might be interested in to obtain more information. Read their reviews in order to make an informed choice as to which product is most appropriate for you.

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 (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

 

 

 

 

 

Female Pelvic Floor Muscle Resistance Training

July 21, 2018

Andrew Siegel MD   7/21/2018

30D6603200000578-3429696-image-m-59_1454495206349-678x381

            Kim Anami started the trend of vaginal weightlifting; visit her website at http://www.kimanami.com

 

 “In the preservation or restoration of muscular function, nothing is more fundamental than the frequent repetition of correctly guided exercises instituted by the patient’s own efforts.  Exercise must be carried out against progressively increasing resistance, since muscles increase in strength in direct proportion to the demands placed upon them.”

–JV Luck, Air Surgeon’s Bulletin, 1945

“Resistance exercise is one of the most efficient ways to stimulate muscular and metabolic adaptation.”

–Mark Peterson, PhD

Resistance

Resistance training is a means of strength conditioning in which work is performed against an opposing force. The premise of resistance training is that by gradually and progressively overloading the muscles working against the resistance, they will adapt by becoming bigger and stronger. Pelvic floor muscle training (PFMT) using resistance optimizes pelvic floor muscle (PFM) conditioning, resulting in more power, stability and endurance and the functional benefits to pelvic health that accrue. It also helps to rebuild as well as maintain PFM mass that tends to decrease with aging.

Applying resistance training to the pelvic floor muscles

Resistance is easy to understand with respect to external muscles, e.g., it is applied to the biceps muscles when you do arm curls with dumbbells. Resistance training can be applied to the PFM by contracting your PFM against a compressible device placed in your vagina.  Its presence gives you a physical and tangible object to squeeze against, as opposed to basic training, which exercises the PFM without resistance. Resistance PFMT is similar to weight training—in both instances, the adaptive process gradually but progressively increases the capacity to do more reps with greater PFM contractility and less difficulty completing the regimen. In time, the resistance can be dialed up, accelerating the adaptive process.

In the late 1940s, Dr. Arnold Kegel devised the perineometer that enabled resistance PFM exercises. It consisted of a pneumatic vaginal chamber connected by tubing to a pressure manometer.  This device provided both a means of resistance and visual biofeedback. The chamber was inserted into the vagina and the PFM were contracted while observing the pressure gauge (calibrated from 0-100 mm mercury). With training, the PFM strength increased in proportion to the measured PFM contractions.

PFMT resistance tools

There are many PFM resistance devices on the market and my intention is to provide information about what is available, but NOT to endorse any product in particular. What follows is by no means a comprehensive review of all products. Some are basic and simple, but many of the newer ones are “high tech” and sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. I classify the devices into vaginal weights, electro-stimulation devices, simple resistance devices and sophisticated resistance devices.  Within each category, the devices are listed in order of increasing cost.

Vaginal Weights

These weighted objects are placed in the vagina and require PFM engagement in order that they stay in position. They are not intended to be used with any formal training program but do provide resistance to contract down upon.

Vaginal Cones: These are a set of cones of identical shape but variable weights.  Initially, you place a light cone in your vagina and stand and walk about, allowing gravity to come into play. PFM 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 the strength of the PFM.  Gradual progression to heavier cones challenges the PFM.  (Search “vaginal cones” as there are several products on the market.)

Word of advice: Be careful not to wear open-toed shoes when walking around with the weighted cones…a broken toe is a possible complication!

Ben Wa Balls:  These are similar to vaginal cones but appear more like erotic toys than medical devices. There are numerous variations on the theme of weighted balls that can be inserted in your vagina, available in a variety of different sizes and weights.  Some are attached to a string, allowing you to tug on the balls to add more resistance. Another type has a compressible elastic covering that can be squeezed down upon with PFM contractions. Still others vibrate. There are some upscale varieties that are carved into egg shapes from minerals such as jade and obsidian. (Search “Ben Wa Balls.”)

Kim Anami is the queen of vaginal kung fu, a life and sex coach who advocates vaginal “weightlifting” to help women physically and emotionally “reconnect” to their vaginas and become more in tune with their sexual energy. Her weightlifting has included coconuts, statues, conch shells, etc.  According to her, vaginal weightlifting increases libido, lubrication, orgasm potential and sexual pleasure for both partners.                                                                                                                       

Electro-Stimulation Devices

These devices work by passive electrical stimulation of the PFM.  Electrical impulses trigger PFM contractions without the necessity for active engagement.  Many clinical studies have shown that electro-stimulation in conjunction with PFMT offers no real advantages over PFMT alone. Like the electrical abdominal belts that claim to tone and shape your abdominal muscles with no actual work on your part, these devices seem much better in theory than in actual performance.

Intensity: This is a battery-powered erotic device that looks like the popular “rabbit” vibrator sex toy.  It consists of an inflatable vaginal probe that has an external handle. It has contact points on the probe that electro-stimulate the PFM and vibrators for both clitoral and “G-spot” stimulation. It has 5 speeds and 10 levels of stimulation. Cost is $199 (Pourmoi.com).

ApexM:  This device is intended for use by patients with stress urinary incontinence.  It consists of an inflatable vaginal probe and control handle. It is inserted inside the vagina, inflated it for a snug fit and powered on.  Electric current is used to induce PFM contractions. The intensity is increased until a PFM contraction occurs, after which the device is used 5-10 minutes daily. Cost is $299 (Incontrolmedical.com).

Simple PFMT Resistance Devices

These are basic model, inexpensive resistance devices. They consist of varying physical elements that you place in your vagina to give you a tangible object to contract your PFM upon. They provide biofeedback to ensure that you are contracting the proper muscles. Some offer progressive resistance while others only a single resistance level.

These devices can be used in conjunction with the specific programs that were specified in a previous blog entry.  To do so, repeat the 4-week program for your specific pelvic floor dysfunction while incorporating these devices into the regimen. You may discover that the 4-week programs using the devices that offer progressive resistance become too challenging as you dial up the resistance level. If this is the case, you can continue with the first week’s program while increasing the resistance over time. Customize and modify the programs to make them work for you, as was recommended for the tailored programs without using resistance.

Educator Pelvic Floor Exercise Indicator:  This is a tampon-shaped device that you insert into your vagina. It is attached to an external arm that moves when you are contracting the PFM properly, giving you positive feedback. Cost is $32.99 on Amazon (Neenpelvichealth.com).

Gyneflex: This is a flexible V-shaped plastic device that is available in different resistances. You insert it in your vagina (apex of the V first) and when you squeeze your PFM properly, the external handles on each limb of the V close down, the goal being to get them to touch. Cost is $39.95 (Gyneflex.com). The Gyneflex is similar in form and function to hand grippers that increase grip strength. 

Pelvic Toner:  Manufactured in the UK, this is a spring-based resistance device that you insert into your vagina.  It has an external handle and two internal arms that remain separated, so the device must be held closed and inserted. When your hold is released the device springs open and, by contracting your PFM, you can close the device. It offers five different levels of resistance. Cost is 29.99 British pounds (Pelvictoner.co.uk).

Magic Banana: This is a PFM exerciser that consists of a loop of plastic and silicone tubing joined on a handle end. The loop is inserted in the vagina and squeezed against.  When the PFM are contracted properly, the two arms of the loop squeeze together. Cost is $49.99 (Magicbanana.com).

KegelMaster: This is a spring-loaded device that you insert in your vagina and is squeezed upon. It has an external handle with a knob that can be tightened or loosened to provide resistance by clamping down or separating the two arms of the internal component. Four springs offer different levels of resistance. Cost is $98.95 (Kegelmaster.com).

Kegel Pelvic Muscle Thigh ExerciserThis is a Y-shaped plastic device that fits between your inner thighs.  When you squeeze your thighs together, the gadget squeezes closed. This exerciser has NOTHING to do with the PFM as it strengthens the adductor muscles of the thigh, serving only to reinforce doing the wrong exercise and it is shameful that the manufacturer mentions the terms “Kegel” and “pelvic muscle” in the description of this product.

To be continued next week, with a review of sophisticated PFMT resistance devices.

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

Cover

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

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

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

Male Fountain of Youth in a Pill

July 14, 2018

Andrew Siegel MD 7/14/2018

fountain-of-youth-sign-st-augustine

Thank you http://www.goodfreephotos.com for the image above

I only believe in prescribing (and taking) medications when absolutely necessary,  after simpler measures have been tried (usually lifestyle modification) and have failed to improve the issue and when advantages outweigh disadvantages.  That stated, there is one medication in particular that can lop off a number of years in terms of its positive effect on male form and function.  Requirements for any medication are twofold—safety and effectiveness.  Recent studies conducted over the course of twenty years confirm the safety and effectiveness of this medication. The chief investigator presented his long-term findings at the 2018 American Urological meeting in San Francisco and called the findings of the study “transformational.”

Aging can be unkind and Father Time is responsible for a host of changes that occur with the aging process. The aging male often suffers with an enlarging prostate gland that can cause annoying urinary symptoms as the enlargement crimps the flow of urine. Aging is also a key risk factor for the occurrence of prostate cancer. As we know all too well, aging also often causes the loss of one’s youthful full head of hair, leaving a balding and shiny scalp subject to sunburn and often managed by combovers or shaving one’s head.

What if I told you that there is a drug that can shrink the prostate and often alleviate the symptoms of prostate enlargement?  That would be considered a good drug.  What if I told you that it could also reduce the risk of prostate cancer?  Now we’re talking excellent drug.  Finally, what if I told you that it could reverse male pattern baldness?  Now we are talking exceptional drug.  This drug not only exists, but also is generic, inexpensive and yours truly is proof of its success!

Prostate Cancer Prevention Trial

The Prostate Cancer Prevention Trial was a clinical experiment that tested whether the drug finasteride (brand name Proscar) could prevent prostate cancer. The medicine works by blocking the activation of testosterone to DHT (dihydrotestosterone).

This trial was based on two facts:

  1. Prostate cancer does not occur in the absence of testosterone
  2. Men born without the enzyme that converts testosterone to its activated form DHT do not develop benign or malignant prostate growth (nor hair loss, for that matter).

This 7-year study enrolled almost 20,000 men who were randomly assigned to finasteride or placebo. The study was terminated early because men in the finasteride arm of the study were found to have a 25% risk reduction for prostate cancer.  The original study in the 1990s also demonstrated a slight increase in aggressive prostate cancer in the finasteride arm.  This negative finding resulted in a “black box” warning from the FDA, as a result of which many men were frightened about the prospect of using the drug.

Recent follow-up on the original clinical trial (median follow-up > 18 years) presented at the 2018 American Urological Association meeting found 42 deaths from prostate cancer in the finasteride arm and 56 in the placebo arm. The study concluded that finasteride clearly reduces the occurrence of prostate cancer and that the initial concerns regarding high grade prostate cancer were unfounded.

Prostates in those treated with finasteride were 25% smaller at the end of the study as opposed to the prostates in the placebo group. Finasteride (and other medications in its class) lower prostate specific antigen (PSA) by 50%, so any man on this class of medications will need to have his PSA doubled to estimate what the PSA would be if not taking the medication.

proscar-tablet.jpg

When my thinning hair progressed to the point that I had a sunburn on my crown, I started using Propecia (a.k.a. finasteride). In a matter of a few years I had a full regrowth of hair. After the Prostate Cancer Prevention Trial report revealed a 25% risk reduction for prostate cancer with finasteride use, I was strongly motivated to continue using the drug, particularly since my father had been diagnosed with prostate cancer at age 65 (he is thriving over two decades later).

The 2 photos are proof of my fine head of hair, thank you finasteride

 IMG_7168

 

IMG_7169 

 The bottom line is that finasteride (Proscar and Propecia) and dutasteride (Avodart) can help prevent prostate cancer, shrink the prostate gland, improve lower urinary tract symptoms due to prostate enlargement, help prevent the need for prostate surgery and grow hair on one’s scalp… a fountain of youth dispensed in a pill form if ever there was one!

For more information on the fascinating tale of how this drug was developed–one of the most interesting backstories on drug development–see my entry: Girl at Birth, Boy At Puberty…and A Blockbuster Drug.

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 (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

On the topic of “fountain of youth,” my first foray into writing was Finding Your Own Fountain of Youth: The Essential Guide to Health, Wellness, Fitness & Longevity.  If you see me as a patient and ask for a copy, it’s yours for free.  Alternatively, if you would like to download a free copy in PDF format, visit www.AndrewSiegelMD.com and click on “books.”

 

 

 

5 Reasons Your Penis May Be Shrinking

July 7, 2018

Andrew Siegel MD   7/7/18

Today’s entry is not about the moment-to-moment changes in penis size based upon ambient temperature and level of arousal, but to permanent alterations in penile length and girth that can occur for a variety of physical reasons. The preservation of penile dimensions is contingent upon having healthy, well-oxygenated, supple and elastic penile tissues that are used on a regular basis for the purposes nature intended.

 sculpture emasculated Reykjavik

Above photo I recently shot in Reykjavik, Iceland

Penis size is a curiosity and fascination to men and women alike. An ample endowment is often associated with virility, vigor, and sexual prowess.   There is good reason that the words “cocky” and “cocksure” mean possessing confidence.

What’s normal?

With all biological parameters, there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. The penis is no exception, with some men phallically endowed, some phallically challenged, but most somewhere in the middle. Alfred Kinsey studied 3500 penises and found that the average flaccid length was 8.8 centimeters (3.5 inches), the average erect length ranged between 12.9 -15 centimeters (5-6 inches) and the average circumference of the erect penis was 12.3 centimeters (4.75 inches).

Who cares?

Interestingly, 85% or so of women are perfectly satisfied with their partner’s penile size, while only 55% of men are satisfied with their own penis size.

5 Reasons for a Shrunken Penis

  1. Weight gain: Big pannus/small penis

The ravages of poor lifestyle habits wreak havoc on penile anatomy and function.  The big pannus (“apron” of abdominal fat) that accompanies weight gain and especially obesity cause a shorter appearing penis.  In actuality, most of the time penile length is intact, with the penis merely buried in the fat pad.  It is estimated that for every 35 lbs of weight gain, there is a one-inch loss in apparent penile length.

The shorter appearing and more internal penis can be difficult to find, which causes less precision of the urinary stream that sprays and dribbles, often requiring the need to sit to urinate. Additionally, the weight gain and poor lifestyle give rise to difficulty achieving and maintaining erections.  This shorter and less functional penis and the need to sit to urinate is downright emasculating.

Solution: Lose the fat and presto…the penis reappears and urinary and sexual function improve.

  1. Disuse atrophy: Use it or lose it

Like any other organ in the body, the penis needs to be used on a regular basis, as nature intended.  If one goes too long without an erection, collagen, smooth muscle, elastin and other erectile tissues may become compromised, resulting in a loss of penile length and girth and limiting one’s ability to achieve an erection. In a vicious cycle, loss of sexual function can lead to further progression of the problem as poor genital blood flow causes low oxygen levels in the genital tissues, that, in turn, can induce scarring, which further compounds the problem.

Solution: Exercise your penis by being sexual active on a regular basis, just as you maintain your general fitness by going to the gym or participating in sports.

  1. Peyronie’s disease: Scar in a bad place

Peyronie’s disease is scarring of the covering sheaths of the erectile chambers. It is thought to be due to the cumulative effects of chronic penile micro-trauma.  The scar tissue is hard and inelastic and prevents proper expansion of the erectile chambers, resulting in penile shortening, deformity, angulation and pain. In the early acute phase—that can evolve and change over time—most men notice a painful lump or hardness in the penis when they have an erection as well as a bent or angulated erect penis. In its more mature chronic phase, the pain disappears, but the hardness and angulation persist, often accompanied by penile shortening and narrowing where the scar tissue is that gives the appearance of a “waistband.”  Many men as a result of Peyronies will have difficulty obtaining and maintaining an erection.

Peyronies can also occur as a consequence of a penile fracture, an acute traumatic injury of the covering sheath of the erectile chamber.  This most commonly happens from a pelvic thrusting miss-stroke during sexual intercourse when the erect penis strikes the female perineum or pubis and ruptures.  This is an emergency that requires surgical repair to prevent the potential for Peyronie’s disease.

Solution: If you notice a painful lump, a bend, shortening and deformity, see a urologist for management as the Peyronies is treatable once the acute phase is over and the scarring stabilizes.  If you experience a penile fracture after a miss-stroke—marked by an audible pop, acute pain, swelling and bruising—head to the emergency room ASAP.

  1. Pelvic surgery

After surgical removal of the prostate, bladder or colon for management of cancer, it is not uncommon to experience a decrease in penile length and girth.  This occurs due to damage to the nerves and blood vessels to the penis that run in the gutter between the prostate gland and the colon. The nerve and blood vessel damage can cause erectile dysfunction, which leads to disuse atrophy, scarring and penile shrinkage.

In particular, radical prostatectomy—the surgical removal of the entire prostate gland as a treatment for prostate cancer—can cause penile shortening. The shortening is likely based on several factors. The gap in the urethra (because of the removed prostate) is bridged by sewing the bladder neck to the urethral stump, with a consequent loss of length from a telescoping phenomenon.  Traumatized and impaired nerves and blood vessels vital for erections give rise to erectile dysfunction. The lack of regular erections results in less oxygen delivery to penile smooth muscle and elastic fibers with subsequent scarring and shortening, a situation discussed above (disuse atrophy).

Solution: Resuming sexual activity as soon as possible after radical pelvic surgery will help “rehabilitate” the penis and prevent disuse atrophy. There are a number of effective penile rehabilitation strategies to get “back in the saddle” to help prevent disuse atrophy.

  1. Anti-testosterone treatment

“Androgen deprivation therapy” is a common means of suppressing the male hormone testosterone, used as a form of treatment for prostate cancer. Because testosterone is an important hormone for maintaining the health and the integrity of the penis, the low testosterone levels resulting from such therapy can result in penile atrophy and shrinkage.

Solution: This is a tough one.  Because of the resulting low testosterone levels, most men have a diminished sex drive and simply lose interest in sex and “use it or lose it” becomes challenging. Furthermore, many men on this therapy have already had a radical prostatectomy and or pelvic radiation therapy, so often have compromised erections even before using androgen deprivation therapy. Anecdotally, I have had a few patients who have managed to pursue an active sex life and maintain penile stature with the use of Viagra or other medications in its class. 

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 (female version is in the works): PelvicRx

 

 

Ladies, If You Leak When You Exercise

June 30, 2018

Andrew Siegel MD  6/30/18

Exercise is of vital importance to physical and psychological health, reduces risk for diabetes, cardiovascular disease and cancer, is a great stress reducer and improves muscle strength, endurance, coordination and balance. It is an important factor in maintaining a healthy weight, decreasing body fat, increasing longevity and decreasing mortality. All good!girl-woman-sport-photographer-train-recreation-1165198-pxhere.com (1).jpg

image above, Creative Commons

Urinary incontinence is an annoying condition that women experience much more commonly than do men.  One of the main types is leakage with physical activities and exercise, a.k.a. stress urinary incontinence (SUI). When a woman suffers from SUI it often acts as a barrier to exercising because no one wants to be put in the embarrassing and inconvenient situation of wetting themselves every time they jump, bounce or move vigorously. Some women adapt by modifying the types of exercise that they participate in, while others give up completely on exercising, an omission that can contribute to poor physical and psychological health, a greater risk for medical issues, weight gain, etc.

What physical activities cause leakage?

The most common exercises that provoke SUI are high impact, vertical deceleration activities in which there is repeated contact with a hard surface with both feet simultaneously, e.g. skipping, trampoline, jumping jacks, jumping rope, running and jogging.

Other physical activities that commonly provoke SUI are exercises that combine dynamic abdominal and pelvic movements, e.g., burpees, squats, sit ups and weight bearing exercises, e.g., weighted squats, overhead kettle bell swings, etc.  The classic weight lifting style exercises are occasional triggers of SUI.

Activities that cause SUI (in order of those most likely to provoke the SUI)

  1. Skipping
  2. Trampoline
  3. Jumping jacks
  4. Running
  5. Jogging
  6. Box jumps
  7. Burpees
  8. Squats
  9. Sit ups
  10. Weighted squats
  11. Kettle bell swings
  12. Dead lifts
  13. Push ups
  14. Wall balls
  15. Shoulder press
  16. Clean and jerk
  17. Snatch
  18. Bench press
  19. Rowing

 So, what to do?

Many women figure out the means to improve or diminish the problem.  Common sense measures include urinating immediately before exercising and if possible taking washroom breaks during the activity (not always possible and inconvenient).  Even so, most women do not empty the bladder 100%, so if 1-2 ounces remain after emptying, there is still plenty of urine to potentially leak.  Other adaptive measures are fluid restriction (not particularly healthy before vigorous activity, risking dehydration).  Wearing a protective pad or incontinence tampon is certainly a way around the problem (although not ideal).  Another strategy is to modify one’s exercise program, such as reducing the duration, frequency or intensity of the activity.  Avoiding high impact exercises entirely and substituting them with activities that involve less impact is another possibility. However, these are adaptive and coping mechanisms and not real solutions.

There is a better solution

Urologists–particularly those like myself who have expertise in female pelvic medicine–can help manage the condition of stress urinary incontinence.  First line treatment is  Kegel pelvic floor exercises that—when done properly (as they are often not) with the right program—can often significantly improve the situation.

New video on pelvic floor exercises.

If a concerted effort at a Kegel program fails to sufficiently improve the situation, a 30-minute outpatient procedure called a mid-urethral sling is a highly effective means of treating the exercise incontinence.

Bottom Line: Physical activities most likely to induce urinary leakage are high impact exercises including skipping, trampoline, jumping jacks, jump rope and jogging.  Coping mechanisms and adaptive behaviors include fluid restriction (not healthy before exercise), urinating before activities (reasonable), taking breaks from exercise to urinate (inconvenient), pads (ugh), dialing down the intensity of exercising, modifying type of exercise or complete avoidance of exercising (undesirable).  If coping and adaptive behaviors are not effective, consider seeing a urologist who focuses on incontinence.  The goal of treatment is to be able to return to the physical activities that you enjoy without the fear of urinary leakage.   

Excellent resource: Urinary leakage during exercise: problematic activities, adaptive behaviors, and interest in treatment for physically active Canadian women: E Brennand, E Ruiz-Mirazo, S Tang, S Kim-Fine, Int Urogynecol J (2018)29: 497-503

Wishing you the best of health and a happy 4th of July holiday!

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 (female version is in the works): PelvicRx

 

 

Noctiva: A New Treatment for Annoying Nighttime Peeing

June 23, 2018

Andrew Siegel MD    6/23/18

bottles-8MM[1]There is compelling medical evidence that a good night’s sleep is of vital importance for one’s health. We recognize this intuitively when we compare how we feel after a night of sleeping well as opposed to a night of sleep deprivation, but it goes way beyond mere fatigue.  Sleeping well is a key component to cognitive and physical fitness as well as overall health, equally important to diet and exercise. Aside from daytime fatigue, weight gain because of altered eating patterns, and increased risk of traffic accidents and fall-related nighttime injuries, sleep deprivation has been associated with an assortment of medical problems that negatively affect quality and quantity of life.  

Although there are many reasons for failing to obtain sufficient sleep, one such cause is interrupted sleep from the need to frequently empty one’s bladder. This can be disruptive to achieving a good night’s sleep, with many nighttime voiders unable to get back to sleep after urinating. Today’s entry reviews a new medication that can help sleep-disruptive nighttime urinating when it is caused by overproduction of urine, a causal factor in over 80% of cases of nighttime urination.

Nighttime urination—nocturia in medical speak—is a complex condition that aside from affecting quality of sleep and quality of life can be a symptom of underlying medical issues, e.g., diabetes, obstructive sleep apnea and cardiovascular issues. It is common in both women and men, tends to increase with aging, and its underlying basis is often multifactorial.  If it occurs once or twice a night and is not too bothersome and one can readily get back to sleep, it is no big deal.  However, if it occurs more than twice a night and is sleep-disruptive, it may be time to consider a means of improving the situation. Importantly, although nocturia is typically a complaint that drives patients to urologists, most of the time the nocturia is NOT urological in origin.

A simple test to help assess nocturia is a 24-hour voiding diary, which requires a pen and paper, a watch or clock and a measuring cup. The time at which urination occurs and the volume of each urination are recorded. Typical bladder capacity is 10–12 ounces with 4–6 urinations per 24 hours. Such a diary will help differentiate between those with a reduced bladder capacity, those who produce lots of urine only while sleeping, and those who produce lots of urine both day and night.

Reduced bladder capacity is often a sign of urological issues including overactive bladder, benign prostate enlargement, neurological diseases affecting the bladder, and loss of elasticity of the bladder as may occur with pelvic radiation.

Those who produce lots of urine only while sleeping are commonly found to have the following causes: increased fluid intake in the evening, obstructive sleep apnea, edematous states such as congestive heart failure, and failure to produce sufficient quantity of a hormone that regulates urine production.

Drinking a few cups of coffee or tea after dinner or a few beers before bedtime will cause nighttime urination and has an obvious solution. Obstructive sleep apnea is a under-appreciated and common cause of full-volume nighttime urination that when treated with CPAP (continuous positive airway pressure) or other means will significantly reduce the nocturia. Edema is fluid within the tissues–-typically the ankles and legs–that tends to accumulate aided by gravity over the course of the day. Upon assuming the lying-down position when sleeping, the legs are relatively elevated as opposed to standing and this tissue fluid returns into circulation, causing the kidneys to increase urine production. In general, those with peripheral edema go to sleep with ankles and legs engorged with edema fluid and wake up with thinner legs, as the return of some of the fluid to the circulation and the subsequent increased urination rids them of this. Another possibility is an abnormality in the nocturnal secretion of anti-diuretic hormoneThis pituitary hormone causes the kidneys to concentrate urine and pull water back into the circulation; nocturia may occur because of an age associated decline in its secretion while sleeping.

Those who produce lots of urine both day and night often have overzealous fluid intake, diabetes mellitus or diabetes insipidus, or are on certain medications (e.g., lithium) that can cause the problem.

Noctiva (Desmopressin) to treat nocturnal excessive urine production

One of the most common reasons for nocturia is excessive nighttime urine production, defined as nighttime urine volume exceeding 1/3 of the 24-hour urine production.  If this is demonstrated on the voiding diary, you may be a candidate for this anti-diuretic medication that works by decreasing nocturnal urinary production.

Desmopressin is a synthetic version of anti-diuretic hormone. The function of this hormone is to put the “brakes” on the kidneys so that the kidneys do not allow excessive loss of body water, which could be detrimental to one’s health and lead to severe dehydration. For years, desmopressin has been used for children who are bed wetters.

Noctiva (Desmopressin) nasal spray is a new formulation of intranasal desmopressin for those who have full-bladder volume nocturia two or more times.  It is a modification of desmopressin that is designed to enhance absorption from the nasal lining, available in doses of 0.83 and 1.66 microgram.  One spray in either nostril is used about 30 minutes prior to sleep.

The absorption of this product is enhanced as compared to that of the oral version (8% vs. 0.3%), which means more consistent dosing and rapid absorption and elimination allowing more rapid onset and less prolonged drug activity.  It is well tolerated with the most common side effect low levels of sodium and other side effects including nasal irritation, nasal congestion, nosebleeds, sneezing, and high blood pressure.  The drug cannot be used in the face of excessive fluid intake, low serum sodium, steroids or loop diuretic use, heart failure, uncontrolled high blood pressure, poor kidney function, and with illnesses causing fluid and electrolyte imbalances. Sodium levels need to be monitored periodically.

Bottom Line: Nocturnal urinary frequency should be investigated to determine its cause, which may in fact be related to conditions other than urinary tract issues.  Nighttime urination is not only bothersome but may also pose real health risks as chronically disturbed sleep can lead to a host of collateral wellness issues. Noctiva is a new addition to the armamentarium to combat nighttime urination when it is due to excessive nocturnal urinary production.

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 (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Blood in the Urine in Patients on Anticoagulants

June 16, 2018

Andrew Siegel MD  6/16/2018

klee-3424581_1920

TY, Pixabay, for image above

Many people take blood thinners to prevent clotting complications that may occur as a result of cardiac arrhythmias—particularly atrial fibrillation, cardiac valvular disease; cardiomyopathy, mechanical heart valves, as well as for treatment or prevention of venous clotting and pulmonary embolism. Visible urinary bleeding is not uncommon in patients on anticoagulants, especially under the circumstance of being “over”-anti-coagulated.  Anticoagulants per se do not usually cause urinary bleeding, but if there is an underlying urinary tract abnormality they can provoke and perpetuate the bleeding.  Thus the importance of doing an evaluation to search for an underlying cause of the urinary tract bleeding.

Commonly used anticoagulants (blood thinners)

  • Fragmin (dalteparin)
  • Lovenox (enoxaparin)
  • Heparin
  • Coumadin (warfarin)
  • Eliquis (apixaban)
  • Pradaxa (dabigatran)
  • Xarelto (rivaroxaban)
  • Plavix (clopidogrel)
  • Brilinta (ticagrelor)

Hematuria

Medical speak for blood in the urine is hematuria.  When blood can be seen it is called gross hematuria, although I prefer the term visible hematuria. Visible hematuria may cause red urine if the bleeding is fresh or tea or cola-colored urine if the bleeding is old. Sometimes hematuria is accompanied by blood clots. At times hematuria is only evident by seeing bloodstains on one’s underwear or appearing on toilet tissue after wiping.

Most hematuria is painless. When there is pain associated with hematuria, it is often a symptom of a kidney stone or urinary infection. Like a nosebleed, hematuria can be a non-significant problem due to a ruptured blood vessel, or alternatively, it can be due to a serious issue that mandates treatment, such as a kidney or bladder cancer, which are  two of the most serious causes of hematuria. Those who use or who have used tobacco and have hematuria have a much higher risk of bladder  and kidney cancer than non-tobacco users. The most common cause of hematuria in men is benign prostate enlargement (as the prostate grows, so does the blood supply) and the most common cause in women is a urinary infection.

Hematuria can occur after vigorous exercise, particularly in people who have bladder stones or an underlying structural abnormality of the urinary tract. Hematuria can be a side effect occurring many years following pelvic radiation to treat cancers of the bladder, prostate, rectum, uterus, cervix, etc.

What to do If you experience urinary tract bleeding while anti-coagulated:

  1. Inform your doctor who prescribed the anticoagulant and  ensure that you are on the appropriate dosage.
  2. If the bleeding is severe enough, it may be necessary to temporarily halt the use of the anticoagulant. Make sure this decision is discussed with the doctor who prescribed the anticoagulant.
  3. Restrict exertional activities and straining with bowel movements and any other activity that may exacerbate the bleeding.
  4. Step up your fluid intake to dilute the urine and promote passage of blood clots.
  5. See your urologist to be properly evaluated.

How hematuria is evaluated

Urine Cytology:  Pap smear of a specimen of urine that looks for abnormal cells.

Urine Culture: Lab test to see if a urinary infection is present.

Imaging Tests: Ultrasound, computerized tomography (CT), magnetic resonance imaging (MRI) and cystoscopy with contrast injected into the ureters to image the inner aspects of the upper urinary tract (retrograde studies) are all possibilities.

Cystoscopy: A visual inspection of the bladder with a narrow, flexible instrument performed on a video monitor with magnification.

Bottom Line:  Regardless of whether or not you are anti-coagulated, never ignore blood in urine, whether visible or microscopic (seen on a urinalysis test).  It may be “nothing” (not a sign of a serious illness) or may be “something” (a warning sign of a potentially life-threatening illness), so it is always beneficial to seek proper evaluation.  If you experience hematuria while anti-coagulated, do not assume that it is an expected consequence of the medication, since there may be serious underlying problems that are “provoked” or “unmasked” by the anticoagulant. Do not panic since the cause can usually be readily determined and treatment initiated; even if the precise cause cannot be pinpointed, serious underlying causes can be excluded.

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 (female version is in the works): PelvicRx

 

Try This First Before Seeing A Urologist

June 9, 2018

Andrew Siegel MD  6/9/2018

Picture1

Many suffer with urinary urgency and frequency, requiring repeated trips to the bathroom.  Although not serious or life-threatening, it is annoying and inconvenient.  After happening repeatedly, it can be become an ingrained habit that is difficult to break.  Concerns surface about sitting in traffic, traveling, seeing a Broadway show, getting the right seat on an airplane, etc.

 If you are dealing with an urgency/frequency issue, you may benefit from “bladder retraining.”  It is relatively simple, requires neither medication nor surgery, and can help you control when you urinate, how often you urinate and allow you to delay urinating. 

What happens under normal circumstances

As the bladder gradually fills, most people ignore the initial sense of urgency, continuing to go about their life and carrying on with their activities.  As the bladder continues to fill, they continue to tune out the sense of urgency until the point that it becomes compelling enough so that they are motivated to leave their activity and go to the bathroom to empty their bladder.

What happens to the frequent urinator

For one reason or another, the frequent urinator often becomes “hyper-vigilant” about their sense of urinary urgency.  For him or her, the bladder is “front burner” and not “back burner.”  This may be based on a previous physical bladder problem that gave rise to the hyper-focus, commonly a urinary infection. The frequent urinator often responds to the initial sense of urgency by acting upon it and heading to the bathroom to empty their bladder.  When this behavior is habitually repeated, it becomes a dysfunctional ingrained habit—the “new normal,” and again, a habit that is tough to break. The bottom line is that when there is excessive focus on the sensations arising from the bladder (or for that matter, any part of the body), one will be hyper-acutely aware of sensations that they normally are not cognizant of.

As another example of this, if you focus on the weight of your watch on your wrist or your ring on your finger, within a matter of minutes, their presence will start annoying you.  No good comes of when background becomes foreground!

A 24-hour bladder diary (log of urination recording time of urinating and the volume of each urination) is a simple but helpful tool in sorting out the different causes of urgency/frequency.  Since normal bladder capacity is about 12 ounces, if the diary shows frequent voids of full volumes, the problem is most likely related to excessive fluid intake (or rarely a kidney or hormonal problem that can cause excessive urinary production).  However, if the diary shows frequent voids of small volumes (e.g., 4 ounces), the problem can often be improved with bladder retraining. If the diary shows frequent voids of small volumes during the day, but full volume voids while sleeping or no voids while sleeping, it points to frequency on a psychological basis and also can often be improved with bladder retraining. It is important to know that frequent voiding of smaller volumes is not always a dysfunctional habit and may be on the basis of prostate or bladder issues that might require the services of your friendly urologist.  However, no harm can come from an initial attempt at bladder retraining.

Fixing it

The goal of bladder retraining is to break the dysfunctional habit and restore normal—or at least better—bladder functioning.  Bladder retraining can be challenging, yet rewarding, and requires a positive attitude and being willing, informed and engaged.

  1. FLUID AND CAFFEINE IN MODERATION

Urgency will often not occur until a “critical” urinary volume is reached, and by limiting fluid intake, it will take a longer time to achieve this volume. Try to sensibly restrict your fluid intake (without causing dehydration) in order to decrease the volume of urinary output. Caffeine (present in tea, coffee, colas, some energy drinks and chocolate) can increase urinary output and is a urinary irritant, so it is best to limit intake of these beverages/foods.  Additionally, many foods—particularly fruits and vegetables—have hidden water content, so moderation applies here as well.  It is important to try to consume most of your fluid intake before 7:00 PM to improve nighttime frequency.

  1. ASSESS MEDICATIONS

Diuretic medications (water pills) can contribute to frequency by design. If you are on a diuretic, it may be worthwhile to check with your medical doctor to see if it is possible to change to an alternative, non-diuretic medication. This will not always be feasible, but if it is, may substantially improve your frequency.

  1. AVOID BLADDER IRRITANTS

Irritants of the urinary bladder may be responsible for worsening your symptoms.  Consider eliminating or reducing one or more of the following irritants and then assessing whether your frequency improves:

Tobacco

Alcoholic beverages

Caffeinated beverages: coffee, tea, colas and other sodas and certain sport and energy drinks

Chocolate

Carbonated beverages

Tomatoes and tomato products

Citrus and citrus products: lemons, limes, oranges, grapefruits

Spicy foods

Sugar and artificial sweeteners

Vinegar

Acidic fruits: cantaloupe, cranberries, grapes, guava, peaches, pineapple, plums, strawberries

Dairy products

  1. URGENCY INHIBITION

The act of reacting to the first sense of urgency by running to the bathroom needs to be modified.  Stop in your tracks, sit, relax and breathe deeply. Pulse your pelvic floor muscles rhythmically to deploy your own natural reflex to resist and suppress urinary urgency (more about this below).

  1. INTERVAL TRAINING

Imposing a gradually increasing interval between urinations will help establish a more normal pattern of urination. If you are urinating small volumes on a frequent basis, your own sense of urgency is not providing you with accurate information about the status of your bladder fullness.  Urinating by the “clock” and not by your own sense of urgency will keep your voided volumes more appropriate. Voiding on a two-hour basis is usually effective as a starting point, although the specific timetable has to be tailored, based upon the bladder diary.  A gradual and progressive increase in the interval between voiding can be achieved by consciously delaying urinating.  A goal of an increase in the voiding interval by 15-30 minutes per week is desirable.  Eventually, a return to more acceptable voiding intervals is possible. The urgency inhibiting techniques mentioned above are helpful with this process.

  1. BOWEL REGULARITY

A rectum full of gas or fecal material can contribute to urinary difficulties. Because of the proximity of the rectum and bladder, a full rectum can put internal pressure on the bladder, resulting in worsening of urgency and frequency.

  1. PELVIC FLOOR MUSCLE TRAINING (PFMT)

The pelvic floor muscles (PFM) play a VITAL role in inhibiting urgency and frequency.  Voluntary rhythmic pulsing of the PFM can inhibit urgency and frequency and PFMT hones the inhibitory reflexes between the pelvic floor muscles and the bladder.

Initially, one must develop an awareness of the presence, location, and nature of the PFM and then train these muscles to increase their strength and tone.  These are not the muscles of the abdominal wall, thighs or buttocks.  A simple means of recognizing the PFM for a female is to insert a finger inside her vagina and squeeze the PFM until the vagina tightens around her finger.  Another means of identifying the PFM for either gender is to start urinating and when about half completed, to abruptly stop the stream. It is the PFM that allows one to do so.  When feeling the urge to urinate, rhythmic pulsing of the PFM–“snapping” the PFM several times—can diminish the urgency and delay a trip to the bathroom.

  1. LIFESTYLE MEASURES: HEALTHY WEIGHT, EXERCISE, TOBACCO CESSATION

The burden of excess pounds can worsen frequency by putting pressure on the urinary bladder, similar to the effect that excessive weight has on your knees. Even a modest weight loss may improve the situation.  Pursuing physical activities can help maintain general fitness and improve frequency. Lower impact exercises–yoga, Pilates, cycling, swimming, etc.–can best help alleviate pressure on the urinary bladder by boosting core muscle strength and tone and improving posture and alignment. The chemical constituents of tobacco constrict blood vessels, impair blood flow, decrease tissue oxygenation and promote inflammation, compromising the bladder, urethra and pelvic muscles.  By eliminating tobacco, symptoms can be improved.

Bottom Line: Bladder retraining can be an effective means of whipping your bladder (and your mind) into shape to help convert dysfunctional habits into more normal and appropriate voiding patterns.  This has the potential of helping many people. However, if the aforementioned strategies fail to improve your situation, you should have a basic urological evaluation, including a urinalysis (dipstick exam of the urine), a urine culture (test for urinary infection) if indicated, and determination of how much urine remains in your bladder immediately after emptying.  At times, tests such as cystoscopy (a visual inspection of the urethra and bladder with a narrow, flexible instrument) and urodynamics (sophisticated tests of bladder function) will need to be done as well. Urologists have the wherewithal to improve this situation and your quality of life.

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

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: PelvicRx

Female version in the works: Female PelvicRx