Posts Tagged ‘pelvic floor dysfunction’

Nuts and Bolts of Pelvic Floor Muscle Training: Part 4

March 3, 2018

Andrew Siegel MD   3/3/2018

There are few, if any, pelvic programs in existence targeted for specific pelvic floor dysfunctions, as what you will generally find is a “one-size-fits-all” approach.

What follows are focused pelvic training programs, each designed for the nuances of the specific pelvic dysfunction at hand.  I have designed a general program as well as programs for poor pelvic muscle endurance, stress urinary incontinence (SUI), overactive bladder (OAB), pelvic organ prolapse (POP)/vaginal laxity, sexual/orgasm issues, bowel incontinence and pelvic pain. These programs have been carefully crafted based on my specialized training in pelvic medicine and surgery, clinical experience, interactions with physical therapists, exercise/fitness experts, Pilates and yoga instructors, and most importantly, my patients.

 General PFMT Program

The general program is a balanced program that incorporates strength and endurance training.  It is intended for women who are found to have poor PFM strength or poor strength and endurance on the preliminary testing. It is also appropriate for women without specific pelvic issues who wish to pursue a PFM exercise program to make their PFM stronger, more durable and to help prevent the onset of pelvic floor issues.

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each week try to step up the intensity of the PFM contractions and duration of the short contractions; allot equal time to relaxing phase as contracting phase; refer back to previous pages if you need a refresher on snaps, shorts and sustained.

 Week 1: snaps x20; 2-5 second shorts x15; 10 second sustained x1 = 1 set 

 Week 2: snaps x30; 2-5 second shorts x20; 10 second sustained x2 = 1 set 

 Week 3: snaps x40; 2-5 second shorts x25; 10 second sustained x3 = 1 set 

 Week 4: snaps x50; 2-5 second shorts x30; 10 second sustained x3 = 1 set 

Week 5 and on: Advance to resistance training. However, if you were severely challenged by this non-resistance program or cannot or prefer not to use resistance—which requires the placement of a device in your vagina—you can continue this as a “maintenance” program, consisting of the Week 4 regimen performed twice weekly (as opposed to every other day).

 PFMT for Poor PFM Endurance

This program is designed for those with satisfactory PFM strength (Oxford grades 3-5), but poor endurance. The number of contractions performed and contraction duration are gradually increased over the course of the training program as adaptation occurs.

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; allot equal time to relaxing phase as contracting phase.

 Week 1: snaps x15; 2 second shorts x15; 6 second sustained x1 = 1 set 

 Week 2: snaps x25; 3 second shorts x20; 8 second sustained x2 = 1 set 

 Week 3: snaps x35; 4 second shorts x25; 10 second sustained x3 = 1 set 

 Week 4: snaps x50; 5 second shorts x30; 10 second sustained x4 = 1 set 

 Week 5 and on: Advance to resistance training.  If you found yourself severely challenged by this non-resistance program or cannot/prefer not to use resistance (which requires the placement of a device in your vagina), you can continue this as a “maintenance” program consisting of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for POP/Vaginal Laxity

Endurance training is especially relevant for those with POP and poor vaginal tone. Focusing on sustained contractions will benefit the slow twitch endurance PFM fibers that are the prime contributors to pelvic tone and support. 

 Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each successive week, work on stepping up the intensity of the PFM contractions; allot equal time to relaxing phase as contracting phase.

 Week 1: snaps x20; 2-5 second shorts x15; 10 second sustained x1 = 1 set 

 Week 2: snaps x30; 2-5 second shorts x20; 10 second sustained x2 = 1 set 

 Week 3: snaps x40; 2-5 second shorts x25; 10 second sustained x3 = 1 set 

 Week 4: snaps x50; 2-5 second shorts x30; 10 second sustained x4 = 1 set 

 Week 5 and on: Advance to resistance training.  However, if you were severely challenged by this non-resistance program or cannot or prefer not to use resistance—which requires the placement of a device in your vagina—you can continue using this as a “maintenance” program, which will consist of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for Sexual/Orgasm Issues

The PFM contract intensively at the time of climax with each contraction lasting about 0.8 of a second, about how long snaps last. A series of vigorous snaps is precisely the PFM contraction pattern experienced at the time of orgasm. If you have issues with achieving an orgasm or with orgasm intensity, this natural contraction pattern is replicated in this program, which focuses on high-intensity pulses of the PFM (snaps) that benefit the fast twitch explosive fibers.  Endurance training is also important for sexual function since sustained contractions benefit the slow twitch endurance PFM fibers that contribute to pelvic support and vaginal tone.    

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each week work on stepping up the intensity of the snap PFM contractions; allot equal time to relaxing phase as contracting phase.

Week 1: snaps x30; 2-5 second shorts x15; 10 second sustained x1 = 1 set 

Week 2: snaps x40; 2-5 second shorts x20; 10 second sustained x2 = 1 set 

Week 3: snaps x50; 2-5 second shorts x25; 10 second sustained x3 = 1 set 

Week 4: snaps x60; 2-5 second shorts x30; 10 second sustained x4 = 1 set 

Week 5 and on: Advancing to the resistance training.  However, if you were severely challenged by this non-resistance program or cannot/prefer not to use resistance—which requires the placement of a device in your vagina—you can continue using this as a “maintenance” program, consisting of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for SUI

Strength and power training are critical for managing SUI, with the power element (i.e., how rapidly you can maximally contract your PFM) vital in order to react quickly to SUI triggers.  Focusing on moderate intensity contractions that last for several seconds (shorts) will benefit SUI, as this type of PFM contraction deployed prior to and during any activity that induces the SUI will help prevent its occurrence.  Attention directed to these short contractions will allow earlier activation of the PFM with SUI triggers, as well as increased contraction strength and durability to counteract the sudden increase in abdominal pressure that induces SUI.  Effort applied to sustained contractions is equally important since the slow twitch endurance PFM fibers are prime contributors to pelvic tone and pelvic support of the urethra, which promote urinary continence.

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each successive week try to step up the PFM contraction intensity as well as the activation speed (how long it takes to get to peak intensity); allot equal time to relaxing phase as contracting phase.

Week 1: snaps x20; 5 second shorts x15; 10 second sustained x1 = 1 set 

Week 2: snaps x30; 5 second shorts x20; 10 second sustained x2 = 1 set 

Week 3: snaps x40; 5 second shorts x25; 10 second sustained x3 = 1 set 

Week 4: snaps x50; 5 second shorts x30; 10 second sustained x4 = 1 set 

Week 5 and on: Advance to resistance training.  However, if you were severely challenged by this non-resistance program or cannot or prefer not to use resistance—which requires the placement of a device in your vagina—you can continue this as a “maintenance” program, which consists of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for OAB and Urinary/Bowel Incontinence

Focusing on high-intensity pulses of the PFM (snaps) will benefit the fast twitch explosive fibers that are critical for inhibiting urinary and bowel urgency/urgency incontinence. These snaps will generate increased PFM strength and power to enhance the inhibitory reflex between PFM and the bladder/bowel, permitting a speedy reaction to urgency and facilitating the means to counteract urinary and bowel urgency, frequency and incontinence. Of equal importance is endurance training of the slow twitch, fatigue-resistant fibers that contribute to baseline tone of the voluntary urinary and bowel sphincters.

Perform the following: 3 sets; one-minute break between each set; do 3-4 times weekly; with each successive week try to step up the intensity of the PFM contractions; allot equal time to relaxing phase as contracting phase.

Week 1: snaps x20; 2-5 second shorts x15; 10 second sustained x1 = 1 set 

Week 2: snaps x30; 2-5 second shorts x20; 10 second sustained x2 = 1 set 

Week 3: snaps x40; 2-5 second shorts x25; 10 second sustained x3 = 1 set 

Week 4: snaps x50; 2-5 second shorts x30; 10 second sustained x4 = 1 set 

Week 5 and on: Advance to resistance training.  However, if you were severely challenged by this non-resistance program or cannot/prefer not to use resistance (which requires the placement of a device in your vagina), you can continue using this as a “maintenance” program, which will consist of the Week 4 regimen performed twice weekly (as opposed to every other day).

PFMT for Pelvic Pain Due to Tension Myalgia: “Reverse” PFMT

Focusing on the relaxing aspect of the PFM contraction/relaxation cycle is the key to “down-train” the PFM from their over-tensioned, knot-like state. Those with over-contracted and over-toned PFM will not benefit from the typical strengthening PFMT done for most PFM dysfunctions—and can actually worsen their condition—so the emphasis here is on the relaxation phase of the PFM. This is “reverse” PFMT, conscious unclenching of the PFM in which the PFM drop and slacken as opposed to rise and contract. Reverse PFMT strives to stretch, relax, lengthen and increase the flexibility of the PFM. 

“Reverse” Kegels can be a confusing and difficult concept, particularly because these exercises demand conscious relaxation of the PFM, which only occurs subconsciously in real life. Recall that the PFM have a baseline level of tone and that complete PFM relaxation only occurs at the time of urination, bowel movements, passing gas or childbirth. 

To make this easier to understand, think of a PFM contraction on a scale of 0-10, with 0 being complete relaxation and 10 being maximal contraction. I have arbitrarily chosen 2 as the baseline level of PFM tone.  In reverse Kegel exercises you strive to go from 2 to 0 as opposed to standard exercises in which the effort is to go from 2 to 10.  When you urinate, move your bowels or pass gas, the PFM relax to a level of 0, so this is the feeling that you should strive to replicate, while continuing to breathe regularly without straining or pushing.  A deep exhalation of air will facilitate PFM relaxation, as it does for other muscle groups.

Perform the following: A very gentle PFM contraction to initiate PFM engagement, followed by deep relaxation and release of the PFM lasting as long as the contraction; 3 sets; one-minute break between each set; do 3-4 times weekly.

Week 1: reverse snaps x20; reverse 2-5 shorts x15; reverse 10 second sustained x1 = 1 set 

Week 2: reverse snaps x30; reverse 2-5 shorts x20; reverse 10 second sustained x2 = 1 set 

Week 3: reverse snaps x40; reverse 2-5 shorts x25; reverse 10 second sustained x3 = 1 set 

Week 4: reverse snaps x50; reverse 2-5 shorts x30; reverse 10 second sustained x3 = 1 set 

Week 5 and on: There is no role for using resistance exercises for tension myalgia. Continue using this program as a “maintenance” program, consisting of the Week 4 regimen done twice weekly (as opposed to every other day). Make a concerted effort at keeping the PFM relaxed at all times, not just while pursuing the PFMT program.

…To be continued.

Wishing you the best of health,

2014-04-23 20:16:29

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

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

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

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

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

 

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When Sex Hurts (and Pain Replaces Pleasure)

February 24, 2018

Andrew Siegel MD    2/24/2018

Sex should be pleasurable and enjoyable, but sadly, that is not always the case.  Dyspareunia is doctor-speak for difficult or painful sexual intercourse, derived from dys, meaning “difficult” and the Greek term pareunos, meaning “lying with.” Although more typically a female complaint, dyspareunia does not spare the male gender.

ouch-147868_1280

Thank you Pixabay for image above

A Mechanistic View of Sexual Intercourse

A mechanical view of sexual intercourse is that it is an activity that involves moving parts that need to be lubricated and fit together properly for optimal function.  The “piston” component of an engine moves up and down within the “cylinder,” requiring appropriate fitting together of these component parts and sufficient lubrication to avoid excessive friction among the moving parts. “Piston clearance” is the clearance or gap between piston and cylinder.  If piston clearance is too small, the piston can “seize” inside the cylinder on expansion. If the pistons fits too tightly within the cylinder, it can result in excessive friction and damage to the cylinder wall.  The bottom line is that problems can arise if the piston does not properly fit the cylinder or if there is inadequate lubrication of contact points.

 Causes of Female Dyspareunia

  • Size discrepancy with partner – The vagina is an incredibly accommodating organ capable of tremendous stretch and expansion—think vaginal delivery of a 10-lb. baby—so this is relatively rare, but a woman with petite anatomy who couples with an outsized male can be a formula for pain. A lengthy penis can strike the cervix or vaginal fornix and a penis with formidable girth may prove excessive for a narrow vagina, resulting in “collision dyspareunia.”
  • Vaginal scarring – Scar tissue from pelvic or vaginal surgery, birth trauma, or poor healing of episiotomies can alter vaginal anatomy and make sexual intercourse painful and challenging.
  • Menopause – Estrogen nourishes and nurtures the genital tissues.  Declining levels of estrogen after menopause cause the vaginal walls to thin, become more fragile and less supple, and the amount of vaginal lubrication to diminish.
  • Infection – Vaginitis (vaginal infections), bacterial cystitis (bladder infection), interstitial cystitis, pelvic inflammatory disease, and infections of the paraurethral (Skene’s glands) can all give rise to pain.
  • Endometriosis –The lining tissue within the uterus called the endometrium can implant outside the uterus, causing painful intercourse.
  • Hypertonic pelvic floor – This is a condition–also called vaginismus– in which the pelvic floor muscles are taut and over-tensioned and fail to relax properly, which can cause painful intercourse, if sex is even possible.
  • Vulvodynia – This is a condition marked by hypersensitive vulvar tissues that are extremely tender to touch.
  • Loss of vaginal lubrication –  This can happen from menopause (natural or from surgery), side effects of medications, breast-feeding, as well as insufficient foreplay.
  • Disuse atrophy – Use it or lose it; if one has not been sexually active for prolonged times, there can be loss of tissue integrity and vaginal atrophy.   Staying sexually active keeps one’s anatomy toned and supple.
  • Urethral diverticulum – This is an acquired outpouching from the urethra channel that can cause a cystic mass in the vagina that can result in pain with sex.
  • Psychological/emotional – “The mind suffers…the body cries out.” Emotionally or physically traumatic sexual experiences can negatively affect future sexual experiences.

Causes of Male Dyspareunia

Urologists sometimes refer to male dysparenuia as “his-pareunia–not a legitimate medical word, but to the point!

  • Infections —Infections of the prostate (prostatitis) and urethra (urethritis) can cause pain with ejaculation.
  • Peyronie’s disease – Scarring of the sheath of the erectile cylinders gives rise to an angulated and often painful penis, particularly so with erections.
  • Phimosis — This is a condition is which the foreskin is tight and cannot be drawn back, leading to inflammation, pain and swelling.
  • Tethered frenulum — The frenulum is a narrow band of tissue that attaches the head of the penis to the shaft; at times it can tear during sexual intercourse, causing bleeding and pain.
  • Penile enlargement procedures – Efforts to “bulk up” the penis with injections of fat, silicone and other tissue or prosthetic grafts can result in an unsightly, lumpy, discolored, and painful penis.
  • Improperly sized penile implants – Penile implants can be lifesavers for the sexually non-functional or poorly functional male, but need to be sized precisely, like shoes for one’s feet.  If too large, they can result in penile pain and pain with sex.
  • Her issues causing his pain – Mesh exposure is a condition in which a mesh implant–used in females to help support dropped pelvic organs and to cure stress urinary incontinence–is “exposed” in the vagina, which feels on contact like sandpaper and can result in both female and male dyspareunia.

Wishing you the best of health,

2014-04-23 20:16:29

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

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

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

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

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

 

The Nuts and Bolts of Pelvic Floor Muscle Training (PFMT): Part 3

February 17, 2018

Andrew Siegel MD   2/17/2018

What follows in this and the next few blog entries are pelvic training programs that I have crafted based on my specialized training in pelvic medicine and surgery; clinical experience; and interactions with physical therapists, exercise/fitness experts, Pilates instructors, yoga instructors and most importantly, my patients. Programs have been designed to treat areas of pelvic floor muscle weakness, e.g., if strength is the issue, emphasis on strength training is in order, whereas if  pelvic stamina is the issue, focus on endurance training is appropriate.

There are few, if any, pelvic programs in existence that are designed for specific pelvic floor dysfunctions, as what is generally out there is a “one-size-fits-all” approach.  I have created “tailored” PFMT exercise routines, customized for the particular pelvic health issue at hand, including stress urinary incontinence (SUI), overactive bladder (OAB), pelvic organ prolapse (POP), sexual/orgasm issues and pelvic pain.

Program Flexibility

These programs are not designed with the intent that they be rigidly adhered to, as they can be customized to make them work for you, recognizing that every woman and every pelvic floor is unique. You can modify the programs and experiment with all variables—intensity, power, contraction and relaxation duration, number of reps and number of sets, with the ultimate objective of challenging the pelvic muscles to make them stronger, better toned, firmer, more flexible and healthier.

Do what feels right and works for you, building to your maximal potential over time. If you feel fatigued before completing the number of reps recommended, do as many quality contractions as you can do.  If you cannot maintain contraction intensity for the duration recommended, do the best you can. Three sets per session are ideal, but if you find this too challenging, you can do two sets, or even just one. If you find that completing 3 sets becomes a simple task, you can do 4 or 5 sets as your PFM become stronger and more durable.

The 3 Types of Pelvic Floor Muscle Contractions

There are three basic types of PFM contractions based upon the duration and intensity of the contraction.  Three “S” words make these contractions easy to remember: Snaps, Shorts and Sustained.

Snaps are rapid, high intensity pulses of the PFM that take less than one second per cycle of contracting and relaxing. These are the type of PFM contractions that occur involuntarily at the time of sexual climax, so should be easy to understand and perform.

Shorts are slower, less intense squeezes of the PFM that can last anywhere from two to five seconds (with equal time allotted to the relaxing phase).

Sustained PFM contractions are less intense squeezes that last ten seconds or longer (with an equal time in the relaxing phase).  These are the type of PFM contractions that you use when you have a strong desire to urinate or move your bowels but do not have access to a bathroom and must apply effort to “hold it in.”

Warming Up

Before starting the PFMT program, I recommend a warm-up week to practice and become familiar with snaps, shorts and sustained contractions. Do not start the formal PFMT until you feel comfortable with all three contractions. Do the Oxford strength and endurance testing to obtain baseline values before you begin the warm-up week.

If your Oxford grade is 0-2, consider yourself to have weak PFM. If you cannot do more than 20 snaps, 15 shorts or one-10 second sustained contraction, consider your endurance poor. If your PFM strength is good, but your endurance is poor, use the program tailored for poor endurance. If you have a specific pelvic dysfunction that you would like to focus on improving, use the program tailored to that specific dysfunction. If you suffer with more than one pelvic floor dysfunction, e.g., both pelvic organ prolapse  and stress urinary incontinence, determine which issue is most compelling and disturbing to you and start with that specific program. If you feel that the problems are equal in degree, complete one program followed in succession by the other.

Warm-Up Week: Do as many good quality snaps as possible until you feel that you can no longer do them with full intensity.  Take a short break and then do as many good quality shorts until you feel that your efforts are diminishing.  Finally, do a sustained contraction for as long as you can until fatigue sets in. After a short break, repeat the sustained contraction.  Do this warm-up every other day for this preliminary week before proceeding with the programs.

…To be continued in 2 weeks.  Next week’s entry will take a break from PFM training to cover “When Sex Hurts and Pain Replaces Pleasure.”

Wishing you the best of health,

2014-04-23 20:16:29

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

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

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

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

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

 

The Nuts and Bolts of Pelvic Floor Muscle Training (PFMT): Part 1

February 3, 2018

Andrew Siegel MD  2/3/18

I received intensive exposure to surgical aspects of pelvic health at UCLA School of Medicine, where I spent a year training in pelvic medicine and reconstructive surgery following completion of my urology residency at University of Pennsylvania School of Medicine. This background, coupled with my passion for health, fitness and the benefits of exercise, led to my interest in PFMT as a means of optimizing pelvic health and to avoid, or at times facilitate, surgical management of pelvic floor dysfunctions.  Is it traditional for a pelvic surgeon to espouse non-surgical treatments?  Not at all, but after decades in the urology/gynecology “trenches,” I have concluded that PFMT is a vastly unexploited resource that offers significant benefits.

Photo below: Yours truly on left with Dr. Shlomo Raz (UCLA professor who is “father” of female urology) on right (1988)

shlomo and andy

 

“Strength training improves muscle vitality and function.” These seven words embody a key principle of exercise physiology that is applicable to the PFM.

Introduction

There is little to no consensus regarding the nuances and details of PFMT programs.  There is no agreement on the best position in which to do PFMT; the number of sets to perform; the number of repetitions per set; the intensity of PFM contractions; the duration of PFM contractions; the duration of PFM relaxation; and how often to do PFMT. The particulars of many PFMT routines are arbitrary at best. In fact, Campbell’s Urology—the premier textbook—concludes: “No PFMT regimen has been proven most effective and treatment should be based on the exercise physiology literature.”  

My goal is to take the arbitrary out of PFMT, providing thoughtfully designed, specifically tailored programs crafted in accordance with Dr. Arnold Kegel’s precepts, exercise physiology principles and practical concepts.

Dr. Kegel’s precepts are summarized as follows:

  • Muscle education
  • Feedback
  • Progressive intensity
  • Resistance

Exercise physiology principles as applied to PFMT include the following (note that there is some overlap with Dr. Kegel’s precepts and practical concepts):

  • Adaptation: The process by which muscle growth occurs in response to the demands placed upon the PFM, with adaptive change in proportion to the effort put into the exercises.
  • Progression: The necessity for more challenging exercises in order to continue the process of adaptive change that occurs as “new normal” levels of PFM fitness are established. This translates into slowly and gradually increasing contraction intensity, duration of contractions, number of PFM repetitions and number of sets.
  • Distinguishing strength, power and endurance training: Strength is the maximum amount of force that a muscle can exert; power is a measure of this strength factoring in speed, i.e., a measure of how quickly strength can be expressed. Endurance or stamina is the ability to sustain a PFM contraction for a prolonged time and the ability to perform multiple contractions before fatigue sets in. High intensity PFM contractions build muscle strength, whereas less intensive but more sustained contractions build endurance. Power is fostered by rapidly and explosively contracting the PFM.
  • “Use it or lose it”: The “plasticity” of the PFM—the adaptation in response to the specific demands placed on the muscles—requires continued training, at minimum a “maintenance” program after completion of a course of PFMT.
  • Full range of motion: The goal of PFMT is not only to increase strength, power and endurance, but also flexibility. This is accomplished by bringing the muscle through the full range of motion, which at one extreme is full contraction (muscle shortening), and at the other, complete relaxation (muscle lengthening). The exception to this is for muscles that are already over-tensioned, which need to be relaxed through muscle lengthening exercises.

Practical concepts encompass the following:

  • Initially training the PFM in positions that remove gravity from the picture, then advancing to positions that incorporate gravity.
  • Beginning with the simplest, easiest, briefest PFM contractions, then proceeding with the more challenging, longer duration contractions.
  • Slowly and gradually increasing exercise intensity and degree of difficulty.
  • Aligning the specific pelvic floor dysfunction with the appropriate training program that focuses on improving the area of weakness, since each pelvic floor dysfunction is associated with specific deficits in strength, power and/or endurance.

To be continued….

Wishing you the best of health,

2014-04-23 20:16:29

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

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

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

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

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

 

 

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.

 

 

5 Kegel Exercise Mistakes You Are Probably Making

October 21, 2017

Andrew Siegel MD 10/21/17

Do it right or don't do it

I have always been fond of this sentiment, the words of which were immortalized for me on a coffee mug courtesy of then 10-year-old Jeff Siegel (my son).  This statement holds true for everything in life, including pelvic floor exercises. 

Dr. Arnold Kegel (1894-1981), a gynecologist who taught at USC School of Medicine,  popularized pelvic floor muscle exercises to improve the sexual and urinary health of women following childbirth. His legacy is the pelvic exercise that bears his name—Kegels.

“Do your Kegels” is common advice from many a gynecologist (and from well-intentioned friends and family), particularly after a difficult childbirth has caused problems “down there.”  These pelvic issues include urinary leakage, drooping bladder, and stretching of the vagina such that things look and feel different and sex is just not the same.

“Do your Kegels” is sensible advice since this strengthens the pelvic floor muscles that support the pelvic organs, contribute to urinary and bowel control, and are intimately involved with sexual function. Developing strong and durable pelvic floor muscles is capable of improving, if not curing, these pelvic issues. Unfortunately, mastery of the pelvic floor is not as easy as it sounds because these muscles are internal and hidden and most often used subconsciously (unlike the external glamour muscles that are external and visible and used consciously).  

  The Kegel problem is threefold:

  1. Many women do not know how to do a proper Kegel contraction.
  2. Of those that can do a proper Kegel contraction, most do not pursue a Kegel exercise training program.
  3. Even those women who do know how to do a proper Kegel contraction and pursue a Kegel exercise training program are rarely, if ever, taught the most important aspect of pelvic muscle proficiency: how to put the Kegels to practical use in real-life situations  (“Kegels-on-demand”).

If a Kegel pelvic floor contraction is done incorrectly, not only will the pelvic issue not be helped, but actually could made worse. Only doing pelvic muscle contractions without pursuing a well-designed pelvic floor muscle training program is often an invitation to failure. Finally, if “Kegels-on-demand” to improve pelvic issues are not taught, it is virtually pointless to learn a proper contraction and complete a program, since the ultimate goal is the integration of Kegels into one’s daily life to improve quality. 

How does one do a proper Kegel pelvic contraction?  Simply stated, a Kegel is an isolated contraction of the pelvic floor muscles that draw in and lift the perineum (the region between vagina and anus). The feeling should be of this anatomical sector moving “up” and “in.”

5 Common Kegel Exercise Mistakes

Mistake # 1: Holding Your Breath

Breathe normally.  The Kegel muscles are the floor of the core group of muscles, a barrel of central muscles that consist of the diaphragm on top, the pelvic floor on the bottom, the abds in front and on the sides, and the spinal muscles in the back. Holding your breath pushes the diaphragm muscle down and increases intra-abdominal pressure, which pushes the pelvic floor muscles down, just the opposite direction you want them moving.

Mistake # 2: Contracting the Wrong Muscles

When I ask patients to squeeze their pelvic floor muscles during a pelvic exam, they often contract the wrong muscles, usually the abdominals, buttocks or thigh muscles. Tightening up the glutes is not a Kegel!  Others squeeze their legs together, contracting their thigh muscles.  Still others lift their butts in the air, a yoga and Pilates position called “bridge.” The worst mistake is straining and pushing down as if moving one’s bowels, just the opposite of a Kegel which should cause an inward and upward lift.

Fact: I have found that even health care personnel—those “in the know,” including physical therapists, personal trainers and nurses—have difficulty becoming adept at doing Kegels. 

Sadly, there is a device on the market (see below) called the “Kegel Pelvic Muscle Thigh Exerciser,” a Y-shaped plastic device that fits between your inner thighs such that when you squeeze your thighs together, the gadget squeezes closed. This exerciser has NOTHING to do with pelvic floor muscles (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.

kegeler

Learning to master one’s pelvic floor muscles requires an education on the details and specifics of the pelvic floor muscles, learning the proper techniques of conditioning them and finally, the practical application of the exercises to one’s specific issues.

Mistake # 3: Not Using a Kegel Program

Kegel exercises can potentially address many different pelvic problems—pelvic organ prolapse, sexual issues, stress urinary incontinence, overactive bladder/bowel, and pelvic pain due to excessive pelvic muscle tension.  Each of these issues has unique pelvic floor muscle shortcomings.  Doing casual pelvic exercises does not compare to a program, which is a home-based, progressive, strength, power and endurance training regimen that is designed, tailored and customized for the specific pelvic floor problem at hand. Only by engaging in such a program will one be enabled to master pelvic fitness and optimize pelvic support and sexual, urinary and bowel function.

Mistake # 4: Impatience

Transformation does not occur overnight!  Like other exercise programs, Kegels are a “slow fix.”  In our instant gratification world, many are not motivated or enthused about slow fixes and the investment of time and effort required of an exercise program, which lacks the sizzle and quick fix of pharmaceuticals or surgery. Realistically, it can take 6 weeks or more before you notice improvement, and after you do notice improvement, a “maintenance” Kegel training regimen needs to be continued (use it or lose it!)

Mistake # 5: Not Training for Function (“Kegels-on-Demand”)

Sadly, most women who pursue pelvic training do not understand how to put their newfound knowledge and skills to real life use. The ultimate goal of Kegels is achieving functional pelvic fitness, applying one’s pelvic proficiency to daily tasks and common everyday activities so as to improve one’s quality of life.  It is vital, of course, to begin with static and isolated, “out of context” exercises, but eventually one needs to learn to integrate the exercises on an on-demand basis (putting them in to “context”) so as to improve leakage, bladder and pelvic organ descent, sexual function, etc.

Bottom Line: Kegel pelvic floor muscle exercises are a vastly under-exploited and misunderstood resource, despite great potential benefits of conditioning these small muscles.  In addition to improving a variety of pelvic issues (urinary and bowel leakage, sexual issues, dropped bladder, etc.), a strong and fit pelvic floor helps one prepare for pregnancy, childbirth, aging and high impact sports.  The Kegel Fix book is a wonderful resource that teaches the reader how to do proper Kegels, provides specific programs for each unique pelvic issue, and reveals the specifics of “Kegels-on-demand,” how to put one’s fit pelvic floor and contraction proficiency to practical use in the real world.

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.

 

 

Kegels: One Size Does Not Fit All!

October 7, 2017

Andrew Siegel MD   10/7/17

shutterstock_femalebluepelvic

Athletes use a variety of fitness and strength-training programs to maximize their strength and endurance. A one-size-fits-all approach—the same exercise regimen applied to all—is clearly not advantageous because of the varying functional requirements for different sports.  Specific, targeted and individualized exercise programs are used to enhance and optimize performance, depending upon the particular sport and individual athlete. The ultimate goal of training is “functional fitness,” the achievement of strength, power, stamina and the skill set to improve performance and prevent specific functional impairments (injuries).

Pelvic floor dysfunction is a broad term applied to the scenario when the pelvic muscles and connective tissues are no longer functioning optimally.  This gives rise to pelvic issues including pelvic organ prolapse, urinary and bowel incontinence, sexual dysfunction and pelvic pain syndromes.  A one-size-fits-all Kegel pelvic floor muscle exercise approach has traditionally been used to manage all forms of pelvic floor dysfunctions. For many years, patients who were thought to be able to benefit from Kegels were handed a brochure with instructions to do 10 repetitions of a 10-second Kegel contraction followed by 10 rapid contractions, three times daily.

Are their shortcomings with this one-size-fits-all approach?  Clearly, the answer is yes. A one-size-fits-all approach lacks the nuance necessary to properly tackle the different types of pelvic floor dysfunction. Aligning the pelvic floor dysfunction with the appropriately tailored training program that focuses on improving the area of weakness is vitally important, since each pelvic floor dysfunction is associated with unique and specific deficits in pelvic muscle strength, power and/or endurance. One size does not fit all!

After decades of “stagnancy” following the 1940s transformative work of Dr. Arnold Kegel—the physician who was singularly responsible for popularizing pelvic floor exercises in women after childbirth–there has been a resurgence of interest in pelvic floor training. I am humbled and honored to have contributed to this “pelvic renaissance” with the publication of the short paperback book The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health, which introduces home-based, progressive, tailored exercises consisting of strength, power and endurance pelvic training regimens customized for each specific pelvic floor problem.

The initial goal of pelvic floor muscle training is muscle adaptation, the process by which pelvic muscle growth occurs in response to the demands placed it, with adaptive changes occurring in proportion to the effort put into the exercises. More challenging exercises are needed over time in order to continue the growth process that occurs as “new normal” levels of pelvic fitness are established. This translates into slowly and gradually increasing contraction intensity, duration of contractions, number of repetitions and number of sets.  The “plasticity” of the pelvic muscles require continued training, at minimum a “maintenance” program after completion of a course of pelvic training.

Although the short-term goal of pelvic floor muscle training is adaptation, the long-term goal is the achievement of functional pelvic fitness.  The vast majority of women who are taught Kegel exercises are not instructed how to put them into practical use. Go figure!  This concept of functional pelvic fitness is the actionable means of applying pelvic conditioning to daily tasks and real-life common activities. This is the essence of Kegel pelvic floor training—not simply to condition the pelvic floor muscles, but to apply this conditioning and proficiency in such a way and at the appropriate times so as to improve quality of one’s life.   These Kegels-on-demand—as I refer to them—can be lifesavers and quite a different take on Kegels, as opposed to static, isolated, out of context exercises.

Important Nuances and Details of Pelvic Training

Contraction intensity: This is the extent that the pelvic muscles are squeezed, ranging from a weak flicker of the muscles to a robust and vigorous contraction. High intensity contractions build muscle strength, whereas less intensive, but more sustained contractions, build endurance.

Contraction Type: Pelvic contractions vary in duration. It is relatively easy to intensively contract the pelvic muscles for a brief period, but difficult to maintain that intensity for a longer duration contraction. Snaps are rapid, high intensity pulses that take less than one second per cycle of contracting and relaxing. Shorts are slower, less intense squeezes that can last anywhere from two to five seconds. Sustained are less intense squeezes that last ten seconds or longer.

Relaxation duration: The amount of time the pelvic muscles are unclenched between contractions.

Repetitions: The number of contractions performed in a single set.

Set: A unit of exercise.

Strength: The maximum amount of force that a pelvic muscle can exert.

Power: The ability to rapidly achieve a full intensity contraction, which is a measure of contraction strength and speed–in other words, how quickly strength can be expressed.  Power is fostered by rapidly and explosively contracting the pelvic muscles.

Endurance (stamina): This is the ability to sustain a pelvic contraction for a prolonged time and the ability to perform multiple contractions before fatigue sets in.

Range of motion: The cycle of full pelvic contraction (muscle shortening) to complete relaxation (muscle lengthening).  This is vital in pelvic muscle training because the goal is not only to increase strength, power and endurance, but also flexibility, which is accomplished by bringing the muscle through the full range of motion.

Bottom Line:  A one-size-fits-all Kegel pelvic floor exercise program does not suit all women with pelvic floor dysfunction. To obtain optimal results, pelvic training must be tailored to the specific dysfunction. The achievement of functional pelvic fitness is one of the key goals (“key-goals”… get it?) of Kegel exercises and of the Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.  Finally, it is important to know that pelvic exercises are appropriate not only for women suffering with the aforementioned pelvic floor dysfunctions, but also for those who wish to maintain healthy pelvic functioning and prevent future problems.

Wishing you the best of health,

2014-04-23 20:16:29

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

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

For informative information on pelvic floor muscle training, please consult the following books by the author:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

Cover

The Kegel Fix is written for educated and discerning women who care about health, well-being, fitness, nutrition and enjoy feeling confident, sexy and strong.  The book has separate chapters on each of the pelvic floor dysfunctions and provides a specific, targeted pelvic floor training regimen for each.

 

The Little Muscles That Could: The Mysterious Muscles You Should Be Exercising

November 5, 2016

Andrew Siegel MD 11/5/2016

This entry was a feature article in the Fall 2016 edition of BC The Magazine: Health, Beauty & Fitness.

(A new blog is posted weekly. To receive the blogs via email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com)

3-superficial-and-deep-pfm

Image above: female pelvic floor muscles, illustration by Ashley Halsey from The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health

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Image above: male pelvic floor muscles, illustration by Christine Vecchione from Male Pelvic Fitness: Optimizing Sexual and Urinary Health

There are over 600 muscles in the human body and they all are there for good reasons. However, some are more critical to health and survival than others. In the class rank it is a no-brainer that the heart muscle is valedictorian, followed by the diaphragm. What may surprise you is that the pelvic floor muscles (a.k.a. Kegel muscles) rank in the top ten of the hierarchy.

The pelvic floor muscles are a muscular hammock that make up the floor of the “core” muscles. They are located in the nether regions and form the bottom of the pelvis. They are among the most versatile muscles in the body, equally essential in both women and men for the support of the pelvic organs, bladder and bowel control and sexual function. Because they are out of sight they are frequently out of mind and often not considered when it comes to exercise and fitness. However, without functional pelvic muscles, our pelvic organs would dangle and we would be diapered and asexual.

Our bodies are comprised of a variety of muscle types: There are the glamour, for show, mirror-appeal, overt, seen and be witnessed muscles that offer no secrets—“what you see is what you get”—the biceps, triceps, pectorals, latissimus, quadriceps, etc. Then there are muscles including the pelvic floor muscles that are shrouded in secrecy, hidden from view, concealed and covert, unseen and behind the scenes, unrecognized and misunderstood, favoring function over form, “go” rather than “show.” Most of us can probably point out our “bi’s” (biceps), “tri’s” (triceps), “quads” (quadriceps), “pecs” (pectorals), etc., but who really knows where their “pelvs” (pelvic floor muscles) are located? For that matter, who even knows what they are and how they contribute to pelvic health?

Strong puritanical cultural roots influence our thoughts and feelings about our nether regions. Consequently, this “saddle” region of our bodies (the part in contact with a bicycle seat)—often fails to attain the respect and attention that other zones of our bodies command. Cloaking increases mystique, and so it is for these pelvic muscles, not only obscured by clothing, but also residing in that most curious of regions–an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the pelvic floor muscles, which straddle the gamut of being critical for what may be considered the most pleasurable and refined of human pursuits—sex—but equally integral to what may be considered the basest of human activities—bowel and bladder function.

The deep pelvic floor muscles span from the pubic bone in front to the tailbone in the back, and from pelvic sidewall to pelvic sidewall, between the “sit” bones. The superficial pelvic floor muscles are situated under the surface of the external genitals and anus. The pelvic floor muscles are stabilizers and compressors rather than movers (joint movement and locomotion), the more typical role that skeletal muscles such as these play. Stabilizers support the pelvic organs, keeping them in proper position. Compressors act as sphincters—enveloping the urinary, gynecological and intestinal tracts, opening and closing to provide valve-like control. The superficial pelvic floor muscles act to compress the deep roots of the genitals, trapping blood within these structures and preparing the male and female sexual organs for sexual intercourse; additionally, they contract rhythmically at the time of sexual climax. Although the pelvic floor muscles are not muscles of glamour, they are certainly muscles of “amour”!

Pelvic floor muscle “dysfunction” is a common condition referring to when the pelvic floor muscles are not functioning properly. It affects both women and men and can seriously impact the quality of one’s life. The condition can range from “low tone” to “high tone.” Low tone occurs when the pelvic muscles lack in strength and endurance and is often associated with stress urinary incontinence (urinary leakage with coughing, sneezing, laughing, exercising and other physical activities); pelvic organ prolapse (when one or more of the female pelvic organs falls into the space of the vagina and at times outside the vagina); and altered sexual function, e.g., erectile dysfunction or vaginal looseness.  High tone occurs when the pelvic floor muscles are over-tensioned and unable to relax, giving rise to a pain syndrome known as pelvic floor tension myalgia.

A first-line means of dealing with pelvic floor dysfunction is getting these muscles in tip-top shape. Tapping into and harnessing their energy can help optimize pelvic, sexual and urinary health in both genders. Like other skeletal muscles, the pelvic muscles are capable of making adaptive changes when targeted exercise is applied to them. Pelvic floor training involves gaining facility with both the contracting and the relaxing phases of pelvic muscle function. Their structure and function can be enhanced, resulting in broader, thicker and firmer muscles and the ability to generate a powerful contraction at will—necessary for pelvic wellbeing.

Pelvic floor muscle training can be effective in stabilizing, improving and even preventing issues with pelvic support, sexual function, and urinary and bowel control. Pursuing pelvic floor muscle training before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery; it will also allow for the effortless resumption of the exercises in the post-partum period in order to re-tone the vagina, as the exercises were learned under ideal circumstances, prior to childbirth. Similarly, engaging in pelvic training before prostate cancer surgery will facilitate the resumption of urinary control and sexual function after surgery. Based upon solid exercise science, pelvic floor muscle training can help maintain pelvic integrity and optimal function well into old age.

Bottom Line: Although concealed from view, the pelvic floor muscles are extremely important muscles that deserve serious respect. These muscles are responsible for powerful and vital functions that can be significantly improved/enhanced when intensified by training. It is never too late to begin pelvic floor muscle training exercises—so start now to optimize your pelvic, sexual, urinary, and bowel health.

Wishing you the best of health,

2014-04-23 20:16:29

www.AndrewSiegelMD.com

Andrew Siegel MD practices in Maywood, NJ. He is dual board-certified in urology and female pelvic medicine/reconstructive surgery and is Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and attending urologist at Hackensack University Medical Center. He is a Castle Connolly Top Doctor New York Metro area and Top Doctor New Jersey. He is the author ofTHE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health (www.TheKegelFix.com) and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health (www.MalePelvicFitness.com). He is co-creator of PelvicRx, an interactive, FDA-registered pelvic floor muscle-training program that empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance, this program helps improve sexual function and urinary function. In the works is the female PelvicRx pelvic floor muscle training for women. Visit: http://www.UrologyHealthStore.com to obtain PelvicRx. Use promo code “UROLOGY10” at checkout for 10% discount.

Loose (Vaginal) Lips Sink Ships

September 17, 2016

Andrew Siegel MD 9/17/2016

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“Loose lips sink ships.” These four words convey the warning “be very cautious of unguarded talk.” Dating back to WWII, this phrase appeared on posters created by the War Advertising Council to advise the public to be discreet with conversation, since information in the wrong hands could have disastrous consequences.

In the context of pelvic health—the topic that I often write about—“loose lips sink ships” has an entirely different meaning. When I use the term “loose lips,” I mean the literal term “loose lips,” referring to sagging and lax female genital anatomy that is a not uncommon occurrence after multiple vaginal births and other promoting factors. When I use the term “sink ships,” I refer to a variety of pelvic problems that can occur in women with “loose lips,” including urinary, bowel and sexual issues (that can affect the partner as well ).

Obstetrical Factors Can CauseLoose Lips”

Genital anatomy, particularly the all-important structural supportive muscles of the pelvis–the pelvic floor muscles (PFM)–take a beating from pregnancy, labor and vaginal delivery. Pregnancy incurs maternal weight gain, a change in body posture, pregnancy-related hormonal changes, the pressure of a growing uterus and fetal weight, all of which may reduce the supportive and sphincter (urinary and bowel control) functions of the PFM.

Labor is called so for a genuine reason…the hours one spends pushing and straining are often unkind to the PFM. Elective Caesarian section avoids labor and affords some protection to the PFM, but prolonged labor culminating in an emergency C-section is equally as potentially damaging to the PFM as is vaginal delivery.

Vaginal delivery is the ultimate PFM traumatic event. The soft tissues of the pelvis (including the PFM) get crushed in the “vise” between baby’s bony skull and mother’s bony pelvis and are simply no match for the inflexibility of these bones. The PFM and connective tissues are frequently stretched, if not torn, from their attachments to the pubic bone and pelvic sidewalls, and the nerves to the pelvic floor are often affected as well. The undesirable consequences of this obstetric “trauma” include altered PFM anatomy with loss of vaginal tone and function, a.k.a. birth-related laxity (“loose lips”).

Studies measuring PFM strength before and after first delivery show a decrease in PFM strength in about 50% of women. Vaginal delivery is much more likely to reduce PFM strength than C-section delivery. Not surprisingly, following delivery, the larger the measured diameter of the vaginal opening, the weaker the vaginal strength.

Although the process of childbirth will not inevitably change one’s vaginal and pelvic anatomy and function, it does so commonly enough. After a vaginal delivery, the vagina becomes looser and more exposed, the vaginal lining becomes dryer, and hormonal-related pigmentation changes often cause a darker appearance to the vulva.

Beyond childbirth, the PFM can also become weakened, flabby and poorly functional with menopause, weight gain, a sedentary lifestyle, poor posture, sports injuries, pelvic trauma, chronic straining, pelvic surgery, diabetes, tobacco use, steroid use, and disuse atrophy (not exercising the PFM). Sexual inactivity can lead to their loss of tone, texture and function. With aging there is a decline in the muscle mass and contractile abilities of the PFM, often resulting in PFM dysfunction.

“Sink Ships”

 As a urologist who cares for many female patients, my clinical sessions bear witness to common pelvic floor complaints that can be classified under the category of “loose lips”:

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

–Allyson, age 38

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

–Leah, age 43

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

–Karen, age 66

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

–Brittany, age 29

How “Loose Lips” Affect You and Your Partner

Weakness in the PFM cause the following anatomical changes: a wider and looser vaginal opening, decreased distance between the vagina and anus, and a change in the vaginal orientation such that the vagina assumes a more upwards orientation as opposed to its normal downwards angulation towards the sacral bones.

“Loose lips” are not caused by an intrinsic problem with the vagina, but by the extrinsic weakened PFM that no longer provide optimal vaginal support.

Women with this issue who are sexually active may complain of a loose or gaping vagina, making intercourse less satisfying for themselves and their partners. This may lead to difficulty achieving climax, difficulty retaining tampons, difficulty retaining the penis with vaginal intercourse, the vagina filling up with water while bathing and vaginal flatulence (passage of air). The perception of having a loose vagina can lead to self-esteem issues.

 Women with “loose lips” often have difficulty in “accommodating” the penis properly, resulting in the vagina “surrounding” the penis rather than firmly “squeezing” it, with the end result being diminished sensation for both partners. Under normal circumstances, sexual intercourse results in indirect clitoral stimulation. The clitoral shaft moves rhythmically with penile thrusting by virtue of penile traction on the inner vaginal lips, which join together to form the hood of the clitoris. However, if the vaginal opening is too wide to permit the penis to put enough traction on the inner vaginal lips, there will be limited clitoral stimulation and less satisfaction in the bedroom.

Da Vinci made an interesting observation on perspectives: “Women’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.

Bottom Line: “Loose lips” (literally) can sink “ships” (figuratively), causing a number of pelvic floor dysfunctions including pelvic organ prolapse and urinary and bowel control issues. Furthermore, “loose lips” can sink your partner’s “ship,” making sexual intercourse challenging at times and less pleasurable for both parties. If your partner has compromised erections because of aging or other causes, “loose lips” can aggravate his problem by not providing sufficient stimulation to keep his penis erect. Help keep the anatomy and function of your female parts in good working order by participating in a PFM training program (Kegel pelvic exercises).

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

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

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

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

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

 

Who Is Arnold Kegel And What’s All That Fuss Over The Pelvic Floor?

June 25, 2016

Andrew Siegel MD 6/25/16

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(photo above: Dr. Arnold Kegel, Gladser Studio, 1953)

*Note: Much of this entry is excerpted from The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health (Author: Andrew Siegel, Rogue Wave Press, 2016)

Dr. Arnold Kegel (1894-1981) was a gynecologist who taught at the University of Southern California School of Medicine. In the late 1940s he was singularly responsible for popularizing pelvic floor muscle exercises in an effort to improve pelvic, sexual and urinary health in women following childbirth.  

It is a real measure of one’s significant impact on humanity to have a verb and noun derived from your name. I can think of only two physicians who fall into this category, Dr. Arnold Kegel and Dr. Henry Heimlich.

Kegel exercises: pelvic floor muscle exercises

Kegel: when one contracts the pelvic floor muscles

Heimlich maneuver: a means of dislodging a foreign object lodged in the upper airway using your fist to apply pressure to the upper abdomen

Heimlich: when one performs the Heimlich maneuver

 

Dr. Arnold Kegel capitalized on the principle of functional restoration of an isolated group of muscles—already well established in orthopedics, plastic surgery and physical medicine and rehabilitation—applying it to the pelvic floor muscles. His legacy is the pelvic floor exercises that bear his name, known as “Kegel exercises.” He invented a device called the perineometer that was placed in the vagina to create resistance and to measure the strength of pelvic floor muscle contractions, providing biofeedback.

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(Image above: Dr. Kegel’s perineometer, from Progressive Resistance Exercise in the Functional Restorati0n of the Perineal Muscles, Am J. Obst. Gyn., August 1948 56 (2) 238-248)

Kegel described pelvic exercises as an effort to “draw in” the perineum, the anatomical region between the vagina and anus. His goal was for “broader, thicker and firmer” pelvic muscles and a tighter muscular plane through which the urethra, vagina and rectum pass.

Kegel did not invent pelvic floor exercises, but was responsible for popularizing them in women. Pelvic floor exercises had actually been around for thousands of years before his era. Kegel came onto the scene in the 1940s and made the link between childbirth and pelvic floor issues resulting in loss of vaginal tone, pelvic organ prolapse, impaired sexual function and stress urinary incontinence.

Kegel observed that in women before childbirth the vaginal canal was typically tight, firm and closed to a high level, offering resistance to the examining finger in every direction. Oftentimes after delivery the vaginal canal became looser and flabbier, offering little resistance to the examining finger. Kegel questioned his patients about their sexual function after childbirth, concluding that sex felt different after delivery and that sexuality was closely related to vaginal muscle tone and was capable of being improved with proper exercises. Additionally, Kegel observed that about one in three new mothers suffered with stress urinary incontinence.

Factoid: In one of Kegel’s classic articles, he referred to a tribe of natives in Africa whose pelvic anatomy was observed to be unusually firm and intact. This was thought to be due to exercises of the vaginal muscles contracted upon the distended fingers of midwives starting several days after birth.

According to Kegel, the reasons for pursuing pelvic exercises were the following: vaginal looseness; weakened, poorly toned or poorly functional pelvic muscles; pelvic organ bulging and prolapse; stress urinary incontinence; impaired sexual function; and “pelvic fatigue.” He discovered that with his regimen a vagina initially admitting three fingers could be tightened to a snug, well-closed vagina admitting only one finger, with the results sustained over time.

Factoid: One of Kegel’s aims was to improve vaginal muscle tone so that a contraceptive diaphragm could be held in place without falling out.

Kegel wrote: “Muscles that have lost tone, texture and function can be restored to use by active exercise against progressive resistance since muscles increase in strength in direct proportion to the demands placed upon them.” He believed that a minimum of twenty hours of exercise were necessary to obtain maximal development of the pelvic muscles.

Dr. Kegel wrote a number of classic articles including: The Non-Surgical Treatment of Genital Relaxation; Progressive Resistance Exercise in the Functional Restoration of the Perineal Muscles; Sexual Functions of the Pubococcygeus Muscle; and The Physiologic Treatment of Poor Tone and Function of the Genital Muscles and of Urinary Stress Incontinence. Their content is summarized in the paragraphs that follow.

Since pregnancy, labor and delivery invariably inflict damage to pelvic anatomy—often resulting in flabby, weakened and poorly functional pelvic muscles—Kegel designed a pelvic training program that he used successfully on thousands of his patients. His objectives were a tighter, toned and firmer vaginal canal with improved urinary control, pelvic support and sexuality. He observed that the tricky thing about pelvic floor muscle injuries as opposed to injuries of external muscles is that the pelvic floor muscles are internal, hidden muscles that cannot be directly observed and thus their injuries are masked.

His program of pelvic rehabilitation incorporated four important principles. The first was that of muscle education—an understanding of pelvic anatomy and function. This enabled muscle memory—the development of the nerve pathway from the brain to the pelvic floor. The second principle was feedback to confirm to the exerciser that the proper muscles were being used, important since studies have shown that up to 50% of women who think they are doing pelvic exercises properly are actually squeezing other muscles, typically the rectus (abs), gluteal (butt) and adductor (thigh) muscles. Feedback served as a means of demonstrating that initial weak and irregular contractions became strong and sustained and a way of measuring and monitoring progress over time as pelvic strength increased. The feedback also provided motivation; by demonstrating improvement over time, the exerciser was incentivized and inspired to keep at the program. The third principle was resistance, which further challenged the pelvic muscles to work harder to increase their tone, texture and bulk. Resistance was capable of rapidly escalating pelvic strength and endurance since growth of muscles occurs in direct proportion to the demands placed upon them, a basic principle of muscle physiology. The final principle was progressive intensity, an escalation of exercise magnitude and degree of difficulty over time, key to increasing pelvic strength and endurance.

Bottom Line: Dr. Arnold Kegel was a champion of pelvic floor exercises, popularizing them in postpartum females. He established that pelvic health can be restored through education and focused pelvic floor muscle training using resistance and biofeedback. Restoration of pelvic health via exercise is simply a case of tapping into your body’s remarkable ability to adapt to the stresses and resistances placed upon it.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

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

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

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