Posts Tagged ‘dropped bladder’

IT’S ALL MESHED UP: FDA Decision on Pelvic Prolapse Repair Mesh Sets Back Women’s Health

April 20, 2019

Andrew Siegel MD 4/20/19

This past Tuesday, the U.S. Food and Drug Administration (FDA) ordered the manufacturers of all remaining surgical mesh products for trans-vaginal repair of pelvic organ prolapse (Boston Scientific and Coloplast) to stop selling and distributing their products in the USA, effective immediately. According to the FDA, the manufacturers in their premarket applications failed to provide reasonable assurance that the benefits of the products outweighed their risks, compared with trans-vaginal surgical tissue repair without mesh. The inaccessibility of these products will severely hamper treatment options for many women with pelvic organ prolapse and is a genuine disservice to the female population and a blow to women’s health, which has otherwise made major strides forward in the last few decades.

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Boston Scientific Uphold Lite Mesh

 

Clearly, the issue is NOT the mesh, which is a synthetic material—polypropylene—that has been used safely and effectively for years as a suture material and for virtually all hernia repairs. Rather, the issues are threefold—inappropriate manufacturing company marketing, inexperienced surgeon implanters, and our “ambulance-chasing” financially-motivated legal culture.

For years, the manufacturers of these mesh products—many of which ultimately removed themselves from the mesh business—assertively marketed these mesh products in “weekend” courses to surgeons (who were not surgically trained to perform these procedures).  These inexperienced physicians then became avid mesh implanters and often engendered complications in the patients whom they implanted, setting the scene for law firms to aggressively advertise and seek clients for litigation.

Sadly, there is excellent scientific data to support the safety and efficacy of vaginal mesh when done in properly selected patients by skilled pelvic surgeons. Millions of such vaginal mesh surgeries have been performed successfully with minimal complications by pelvic surgeons with training in a subspecialty of urology and gynecology—female pelvic medicine and reconstructive surgery. This requires several years of specialty fellowship training after completion of urology or gynecology residency and a second board examination in addition to board certification in urology or gynecology, thus most in this subspecialty are dual board certified.

Why mesh in the first place?  Why use a synthetic material when native tissues can be used?  The answer lies in the nature of pelvic organ prolapse.  Analogous to a hernia, pelvic organ prolapse is a weakness in connective tissue support allowing a pelvic organ (often the bladder) to pooch down into the vagina and at times outside the vagina, causing an annoying bulge, pressure and often difficulties with urination. The mesh principle is using a structurally sound material instead of a patient’s defective connective tissues (that has already failed) to rebuild support. If a brick wall collapses because of structural issues, would one use the same bricks to rebuild the wall?  Clearly the answer is no.  This is why polypropylene mesh is used in the vast majority of hernia repairs: hardy structural support is needed to compensate for the native connective tissue defect.

The mesh principle: For anatomic defects, using weakened/defective native tissues for a structural repair often causes failures.

In the properly selected patient operated on with the appropriate surgical technique by the experienced surgeon, the results of vaginal mesh repairs have been extraordinarily gratifying and nothing short of a paradigm shift from the native tissue repair era.  This procedure passes muster and the “MDSW” test—meaning I would readily encourage my mother, daughter, sister or wife to undergo the procedure if the situation called for it.

When performed by a skilled pelvic surgeon, the likelihood of cure or vast improvement is very high.   Meshes are strong, supple and durable and the procedure itself is relatively simple, minimally-invasive and amenable to doing on an outpatient basis.  When patients are seen several years after a mesh repair, their pelvic exams typically reveal restored anatomy with remarkable preservation of vaginal length, axis, caliber and depth.

Meshes act as a scaffold for tissue in-growth and ultimately should become fully incorporated by the body.  I think of the meshes in a similar way to backyard chain-link fences that have in-growth of ivy.  Meshes examined microscopically years after implantation demonstrate a dense growth of blood vessels and collagen in and around the mesh.

When mesh is used for bladder repair, there is rarely any need for trimming of the vaginal wall, which maintains vaginal dimensions as opposed to the native tissue repairs, which often demand some trimming of vaginal wall with alteration of vaginal anatomy.  Another advantage of the mesh repair is that if there is some uterine prolapse accompanying the dropped bladder, the base of the mesh can be anchored to the cervix and thus provide support to the uterus as well as the bladder, potentially avoiding a hysterectomy.

The bottom line is that mesh repairs for pelvic organ prolapse have been revolutionary in terms of the quality and longevity of results—a true game-changer.  They represent a dramatic evolution in the field of female urology and urological gynecology, offering a vast improvement in comparison to the pre-mesh era.

That said, they are not without complications, but the complication rates should be reasonably low under the circumstances of proper patient selection, a skilled and experienced surgeon performing the procedure, proper surgical technique, and proper patient preparation. Three factors are integral to proper mesh integration: mesh factors, patient factors and surgeon factors.

The gold standard mesh is a piece of large-pored, elastic, monofilament polypropylene—any other synthetic can result in integration issues.  This is the standard for sling surgery as well, and time has proved this to be the best synthetic mesh.

Patient considerations are very important as risk factors for integration problems include the following: compromised or poor-quality vaginal tissues; diabetes; patients on steroids; immune-compromised patients; radiated tissues; and tobacco users.

Foremost, a well-trained, experienced surgeon should be the one doing the mesh implantation. It is sensible to check if your surgeon is specialized, and if not, at least has significant clinical experience doing mesh procedures. It is particularly important that the surgeon performing the mesh implant is capable of taking care of any of the small percentage of complications that may arise and are most often quite manageable.

Again, many of the problems that have occurred are not intrinsic to the mesh itself, but are potentially avoidable issues that have to do with either the surgical technique used to implant the mesh or to patient selection.  Rather than addressing these issues, the FDA has chosen to throw out the proverbial “baby with the bath water,” leaving in the wake of this short-sighted decision many female patients who will needlessly suffer.

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. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

Andrew Siegel’s latest book: PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

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

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

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

 

 

 

 

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60 Minutes Disses Boston Scientific Meshes: WTF?

May 18, 2018

Andrew Siegel MD  5/18/2018

60 Minutes Trashes Boston Scientific and Pelvic Meshes

Last Sunday, a piece aired on the CBS weekly 60 Minutes concerning Boston Scientific meshes that are used in the field of female urology. The segment was spun in such a way that many viewers were likely to get the wrong impression about Boston Scientific products that are used for two common pelvic floor issues–stress urinary incontinence and pelvic organ prolapse.  These meshes are composed of polypropylene, a synthetic material that is commonly used inside the human body for many purposes, including  hernia repairs as well as a suture material.   I cannot speak for the provenance of the raw materials used for Boston Scientific meshes, although the issue has apparently been addressed by Boston Scientific as well as the FDA, but I can certainly vouch for the safety and effectiveness of their slings and meshes.  After watching the 60 Minutes piece, one might wrongly conclude that Boston Scientific meshes specifically, and all polypropylene meshes generally, are downright dangerous and should never be used in humans.

Au contraire!  Boston Scientific is a reputable company dedicated to both female and male pelvic health and their mesh products (Obtryx mid-urethral sling for stress urinary incontinence and the Uphold Lite for anterior and apical pelvic organ prolapse) are well-designed and clinically effective. I have implanted these products successfully in hundreds of women with stress incontinence and pelvic organ prolapse over the course of many years and will continue to use them.  Furthermore, I have always found the Boston Scientific “reps” to be knowledgeable, available and helpful and the company always willing to provide ample educational opportunities for physicians.  With respect to meshes used for pelvic reconstructive surgery, polypropylene has been the “gold standard” for many years.  Many clinical publications support the safety and effectiveness of polypropylene pelvic floor meshes and numerous medical societies and regulatory bodies have endorsed the utility of polypropylene pelvic meshes for pelvic floor dysfunction.

Proper Repair of a Dropped Bladder (Cystocele)

Not every cystocele is the same, differing in type, extent, symptoms, and degree of bother. The central type (top image below) is a central weakness of the support tissues of the bladder that can cause a pronounced degree of prolapse. The lateral type (bottom image below) is a detachment of the bladder support from the pelvic sidewalls, usually causing only a modest degree of prolapse. Most women have a combination of these two, a combined central-lateral type.

CD

lat defect

 

In my opinion, the classic “plication” repair (sewing together of native tissues)— a.k.a. colporrhaphy—is best suited to a central cystocele in which satisfactory native tissues are present.  However, this will not adequately address a lateral defect cystocele or a combined cystocele. Thus, it is important to determine the type of cystocele in terms of repairing it with native tissues. One of the advantages of a mesh repair is that it addresses all three types of cystocele. Additionally, instead of using native tissue that has already failed in terms of providing adequate structural support, mesh repairs use a strong and durable material to provide support.

Factors influencing me to do a mesh repair over a classic colporrhaphy are the following: poor tissues; risk factors for recurrence including chronic constipation, cough, obesity, and occupations that require manual labor; a relatively young patient who will need a durable repair; and those patients who have already failed a native tissue repair.

In the appropriately selected patient operated on with the proper surgical technique, the results of polypropylene mesh repairs have been extraordinarily gratifying. These procedures pass muster and the “MDSW” test—meaning I would readily encourage my mother, daughter, sister or wife to undergo the procedure if needed. When performed by a skilled pelvic surgeon, the likelihood for cure or vast improvement is great and the likelihood for complications is minimal. Meshes are strong, supple and durable and the procedure itself is relatively simple, minimally-invasive and amenable to outpatient surgery. When patients are seen years after a mesh repair, they are usually extremely satisfied and their pelvic exams typically reveal restored anatomy with remarkable preservation of vaginal length, axis, caliber and depth.

Meshes act as a scaffold for tissue in-growth and ultimately should become fully incorporated by the body. I think of a surgical mesh in a similar way to a backyard chain-link fence that has in-growth of ivy. Meshes examined microscopically years after implantation demonstrate a dense growth of blood vessels and collagen in and around the mesh.

As compared to the classic plication, when a mesh is used for bladder repair, there is rarely any need for trimming the vaginal wall, which makes for a more anatomical repair in terms of vaginal preservation. Another advantage of mesh repairs is that if the patient has a mild-moderate degree of uterine prolapse accompanying the cystocele, the base of the mesh can be anchored to the cervix and thus provide support to the uterus as well as the bladder, potentially avoiding a hysterectomy.

In my opinion, the keys to success are the following: estrogen cream preoperatively in the post-menopausal patient; intravenous and topical antibiotics; a small vaginal incision; good surgical exposure; careful technique making sure the mesh is anchored at the appropriate anatomical sites; trimming the mesh to use the least mesh load possible; avoiding mesh folding, redundancy and tension; and vaginal packing and oral antibiotics post-operatively.

The bottom line is that mesh repairs for pelvic organ prolapse have been revolutionary in terms of the quality and longevity of results—a true game changer. They represent a dramatic evolution in the field of female urology and urological gynecology, offering a vast improvement in comparison to the pre-mesh era. That said, they are not without complications, but the complication rates should be reasonably low under the circumstance of proper patient selection, a skilled and experienced surgeon performing the procedure, excellent surgical technique, utilization of the optimal mesh and patient preparation.

Mesh Integration

Three factors are integral to mesh integration, the process by which the mesh incorporates seamlessly into the body: mesh, patient, and surgeon factors. The goal is for the mesh to fully incorporate into the body so that it can serve its role in providing support to the urethra and/or bladder to cure/improve the stress incontinence and/or cystocele, respectively.

The “gold standard” mesh is large-pored, elastic, monofilament polypropylene. This has been the standard for sling surgery for stress urinary incontinence for over 20 years and for pelvic reconstructions for many years as well. This material is also the standard for mesh hernia repairs and also serves as a hardy suture used for closure of the abdominal wall.

Patient considerations are equally vital.  Risk factors for integration problems include: compromised or poor-quality vaginal tissues; radiated tissues; diabetes; patients on steroids; immune-compromised patients; and patients who use tobacco.

Foremost, a well-trained, experienced pelvic surgeon should be the person doing the mesh implantation. The surgeons most skilled and adept fake newsat this type of surgery are those who have undertaken fellowship training in female pelvic medicine and reconstructive surgery after completion of their urology or gynecology training. It is sensible to check if your surgeon is specialized, and if not, at least has significant clinical experience doing mesh implantation procedures. It is particularly important that the surgeon performing the mesh implant is capable of taking care of any complications that may arise.

The “Mesh-up”

Historically, many of the problems that occurred resulting from mesh implantations were not intrinsic to the mesh itself but were potentially avoidable issues that had to do with surgical technique and/or patient selection. Complications with integration such as mesh exposure—a situation where the mesh is “exposed” in the vagina and is not positioned in the correct surgical plane—can and do occur in a small percentage of patients (even when properly selected and when done by a well-trained pelvic surgeon).  When this situation occurs, it is generally quite manageable, although it will often involve revision surgery if it does not respond to conservative measures.

The crux of the “mesh-up” problem was that a few years ago several of the companies that sold mesh products–in an effort to amplify sales and profits–inappropriately and aggressively promoted their products to physicians who were not trained pelvic surgeons.  They offered “weekend training courses” to general gynecologists, many of whom started implanting pelvic meshes into patients after only a brief training period, often with disastrous results, with many patients sustaining incorporation issues.  This ultimately led to lawsuits and litigation and thereafter several of the mesh companies including Johnson and Johnson Gynecare and American Medical Systems pulled their mesh products off the market.  Fortunately for pelvic surgeons and patients alike, Boston Scientific remained in business, and it is their sling and mesh products that I most commonly implant for female pelvic surgical procedures.

This is not to say that there have not been bad mesh products on the market.  Historically, both the Mentor ObTape and the Tyco IVS sling were poorly designed mesh slings that did not have favorable incorporation features, had horrific results and were ultimately withdrawn from the market.

All of the slings and meshes that remain on the market that are used for pelvic floor surgery in the USA—including the Boston Scientific products–have favorable incorporation features and have been time-tested and have demonstrated their utility. Boston Scientific did not deserve a reaming on 60 Minutes, but I suppose it is irresponsible “spin” that makes for a story and commands advertising dollars.

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 (female version is in the works): PelvicRx

6 Ways To Reduce Risk for Pelvic Problems: Urinary Leakage, Dropped Bladder & Sexual Issues

November 4, 2017

Andrew Siegel MD  11/4/17

shutterstock_femalebluepelvic

Ease into this topic with a write-up by Melanie Hearse about altered vaginal anatomy after childbirth and what to do and not to do about it, from BodyandSoul.com Australia: This woman has a warning about ‘fixing’ your downstairs after birth.

Our health culture in the USA is largely reactive as opposed to proactive.  Undoubtedly, a better model is prevention as opposed to intervention.  Attention to a few basic measures can make all the  difference in your pelvic health “destiny”:

  • Maintain a healthy lifestyle. Weight gain and obesity increase the occurrence of urinary control problems, dropped bladder, sexual, and other pelvic issues. Follow the advice of Michael Pollan: “Eat food. Not too much. Mostly plants.”  Consume a nutritionally-rich diet with abundant fruits and vegetables (full of anti-oxidants, vitamins, minerals and fiber) and real food, versus processed and refined food products.  A healthy diet (quality fuel) is essential for ongoing tissue repair, reconstruction and regeneration. Stay physically active, obtain sufficient sleep, manage stress as best as possible, avoid tobacco (an awful habit, with chronic cough contributing to pelvic floor issues) and consume alcohol moderately.  Physical activity should include aerobic (cardio), strength, flexibility and core training (yoga, Pilates, etc.), the latter of which is especially helpful in preventing pelvic issues since the pelvic floor muscles form the floor of the core. A recent Harvard Medical School health report entitled “Best exercises for your body” recommended swimming, Tai chi, strength training, walking and Kegel exercises.
  • Prepare before pregnancy. Pregnancy, labor and vaginal delivery are the most compelling risk factors for pelvic floor issues. Commit to healthy lifestyle measures and pelvic floor muscle training as detailed above even before considering pregnancy in order to prevent/minimize the onset of pelvic issues that commonly follow pregnancy and childbirth.  The following article, written by Corynne Cirilli for Refinery 29 on October 6, addresses this issue in detail and is well worth reading: Why Aren’t We Talking About Pre-Baby Bodies?
  • Pelvic floor muscle training. Kegel exercises to increase pelvic muscle strength and endurance are vital to prevent pelvic floor issues. The Kegel Fix is a paperback book that guides you how to do Kegel contractions properly, provides specific training programs for each pelvic issue and teaches you how to put this skill set into practical use—Kegels “on demand.”
  • Avoid constipation and other forms of chronic increased abdominal pressure. Chronic constipation (bowel “labor”) can be as damaging to the pelvic floor as vaginal deliveries. Coughing, sneezing, heavy lifting (particularly weight training) and high impact sports all increase abdominal pressures, so take measures to suppress coughing, treat allergies to minimize sneezing and not overdo weight training and high-impact sports.
  • Consider vaginal estrogen therapy. After menopause, topical estrogen can nourish and nurture the vaginal and pelvic tissues that are adversely affected by the cessation of estrogen production. Low dose topical therapy can be effective with minimal systemic absorption, providing benefits while avoiding systemic side effects.
  • Get checked! Be proactive by periodically seeing your physician for a pelvic exam. It is best to diagnose a problem in its earliest presentation and manage it before it becomes a greater issue.

Bottom Line: Prepare and prevent rather than repair and prevent!

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 individuals who care about health, well-being, fitness and nutrition and enjoy feeling strong and confident.

 

 

What’s That Bulge Coming Out Of My Vagina?

October 15, 2016

Andrew Siegel MD   10/15/2016

untitled

Photo above: typical appearance of  a vaginal bulge (in this case a dropped bladder)

“The thought was delivered just after my newborn’s placenta: A sneaking suspicion that things were not quite the same down there, and they might never be again…my daughter had finished using my vagina as a giant elastic waterslide.”

-Alissa Walker, Gizmodo.com, April 2, 2015

Between A Rock And A Hard Place

The bony pelvis provides the infrastructure to support the pelvic organs and to allow childbirth. Adequate “closure” is needed for pelvic organ support, yet sufficient “opening” is necessary to permit vaginal delivery. The female pelvis evolved as a compromise between these two important, but opposing functions.

The pelvic floor muscles (PFM) divide the abdominal and pelvic cavities above from the perineum below, forming an important structural support system that keeps the pelvic organs in place. Many physical activities result in significant increases in abdominal pressure, the force of which is largely exerted downwards towards the pelvic floor, especially when upright. This pelvic floor “loading” puts the PFM at particular risk for damage with the potential for pelvic organ prolapse, a.k.a. pelvic relaxation or pelvic organ hernia.

Pelvic Organ Prolapse (POP)

POP is a common condition in which there is weakness of the PFM and other connective tissues that provide pelvic support, allowing the pelvic organs to move from their normal positions into the space of the vaginal canal and, at its most severe degree, outside the vaginal opening. It is a situation in which the pelvic organs go wayward, literally “popping” out of place. POP often causes a bulge outside the vaginal opening, appearing like a man’s scrotum…little wonder why most women are disturbed by this condition.

Two-thirds of women who have delivered children have anatomical evidence of POP (although most are not symptomatic) and 10-20% will need to undergo a corrective surgical procedure. POP is not life threatening, but can be a distressing and disruptive problem that negatively impacts quality of life. Despite how common an issue it is, many women are reluctant to seek help because they are too embarrassed to discuss it with anyone or have the misconception that there are no treatment options available or fear that surgery will be the only solution.

POP may involve any of the pelvic organs including those of the urinary, intestinal and gynecological tracts. The bladder is the organ that is most commonly involved in POP. POP can vary from minimal descent—causing few, if any, symptoms—to major descent—in which one or more of the pelvic organs prolapse outside the vagina at all times, causing significant symptoms. The degree of descent varies with position and activity level, increasing with the upright position and exertion and decreasing with lying down and resting, as is the case for any hernia.

POP can give rise to a variety of symptoms, depending on which organ is involved and the extent of the prolapse. The most common complaints are the following: a vaginal bulge or lump, the perception that one’s insides are falling outside, and vaginal “pressure.” Because POP often causes vaginal looseness in addition to one or more organs falling into the space of the vaginal canal, sexual complaints are common, including painful intercourse, altered sexual feeling and difficulty achieving orgasm as well as less partner satisfaction.

When one’s bladder or rectum descends into the vaginal space, there can be an obstruction to the passage of urine or stool, respectively. This often requires placing one or more fingers in the vagina to manually push back the prolapsed organ. Doing so will straighten the “kink” in order to facilitate emptying one’s bladder or bowels. Pushing (and holding in place) a prolapsed organ back into position with one’s finger(s) is called “splinting.”

Why Do I Have A Bulge Coming Out Of My Vagina?

POP results from a combination of factors including multiple pregnancies and vaginal deliveries (especially deliveries of large babies), menopause, hysterectomy, aging and weight gain. Additionally, conditions that give rise to chronic increases in abdominal pressure contribute to POP. These include chronic constipation, asthma, bronchitis and emphysema (chronic wheezing and coughing), seasonal allergies (chronic sneezing), high-impact sports, and repetitive heavy lifting, whether work-associated or due to weight training. Other causes are genetic predispositions to POP and connective tissue disorders.

Childbirth is one of the most traumatic events that the female body experiences and vaginal delivery is the single most important factor in the development of POP. Passage of the large human head through the female pelvis causes intense mechanical pressure and tissue trauma (stretching, tearing, compression and crushing) to the PFM and PFM nerve supply. This results in separation or weakness of connective tissue attachments and alterations and damage to the integrity of the pelvis. POP that occurs because of a difficult vaginal delivery may not manifest until decades later. It is unusual for women who have not had children or who have delivered by elective caesarian section to develop significant POP.

To be continued…

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

He has previously authored Male Pelvic Fitness: Optimizing Sexual & Urinary Health; Promiscuous Eating: Understanding And Ending Our Self-Destructive Relationship With Food; and Finding Your Own Fountain Of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity. Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro. Area and Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

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

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