Posts Tagged ‘pelvic floor dysfunction’

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)

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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.

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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. 

Your Pelvic Floor After Childbirth

May 21, 2016

Andrew Siegel MD 5/21/16

Pregnancy, labor and delivery are amazing experiences culminating in the birth of a precious human being. However, the process can be traumatic with possible untoward pelvic consequences. Today’s entry addresses some of the aftermaths and repercussions of the process of childbirth.

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 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

 

The pelvic floor muscles (PFM) take a genuine beating from pregnancy, labor and vaginal delivery. Pregnancy incurs maternal weight gain, a change in body posture, pregnancy-related hormonal changes and 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 you spend pushing and straining are often very unkind to the PFM. Elective Caesarian section avoids labor and affords protection to the PFM, but prolonged labor resulting in an emergency C-section is equally as potentially damaging to the PFM as is vaginal delivery.

Vaginal delivery is the ultimate traumatic event to the PFM. The soft tissues of the pelvis (including the PFM) get crushed in the “vise” between your baby’s bony skull and your own bony pelvis and are simply no match for the hardness and 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 obstetric “trauma” include altered PFM anatomy with loss of vaginal tone and function, a.k.a. birth-related laxity (looseness). This can give rise to a variety of pelvic floor dysfunctions including pelvic organ prolapse (pooching of one or more of the pelvic organs into the space of the vagina and in more severe cases, outside the vaginal opening), urinary and bowel control issues and sexual dysfunction.

Studies measuring PFM strength before and after first delivery show a decrease in PFM strength in about 50% of women.  Not surprisingly, following delivery, the larger the measured diameter of the vaginal opening, the weaker the vaginal strength.

Who Knew? After a vaginal delivery, things “down there” are often just not the same. The vagina becomes looser and more open, the vaginal lining becomes dryer and hormonal-related pigmentation changes often cause a darker appearance of the vulva.

Since birth trauma to the pelvic floor often gives rise to urinary, bowel, gynecological and sexual consequences, why not consider starting pelvic floor muscle training (PFMT) well before pregnancy? This runs counter to our repair-based medical culture that is not preventive-oriented and our patient population that often opts for fixing things as opposed to preventing them from occurring in the first place.

Realistically, PFMT prior to pregnancy will not prevent pelvic floor anatomical changes and dysfunction in everyone. Unquestionably, obstetrical trauma (9 months of pregnancy, hours of labor and vaginal delivery of a baby that can be plus or minus 9 pounds, repeated several times) can and will often cause some element of pelvic floor dysfunction, whether the PFM are fit or not! However, even if pelvic training does not prevent all forms of pelvic floor dysfunction, it will certainly impact it in a very positive way, lessening its degree and accelerating the healing process. Furthermore, mastering PFMT (a.k.a. Kegel exercises) before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery and the effortless resumption of the exercises in the after-delivery period, as the exercises were learned under ideal circumstances, prior to PFM injury.

Preventive health routines are commonly practiced with respect to general physical fitness. We work out not only to achieve better fitness, but also to maintain fitness and prevent losses in strength, flexibility, endurance, balance, etc. So why not apply this to the pelvic floor as well?

Bottom Line: Birth trauma can be detrimental to your pelvic health, resulting in a variety of pelvic floor issues.  Fortunately, these pelvic floor dysfunctions are treatable conditions. The best approach is a proactive and preventive, pursuing pelvic floor muscle training before pregnancy.  In fact, pelvic exercises can be beneficial to any woman, even if pregnancy is not a consideration. 

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– newly 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. 

 

The Pelvic (Kegel) Revolution

April 23, 2016

Andrew Siegel MD  4/23/16

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

A Brief Recap from Last Week

In the 1940s, the seminal work of Los Angeles gynecologist Dr. Arnold Kegel resulted in pelvic floor exercises achieving the stature and acclaim that they deserved. His legacy is the name that many use to refer to pelvic exercises—“Kegels” or “Kegel exercises.” Despite Kegel’s pelvic regimen proving effective for many female pelvic issues (pelvic relaxation, vaginal laxity and sexual issues, urinary leakage, etc.) what came to be referred to as Kegel exercises in the post-Kegel era had little resemblance to what he so brilliantly described in his classic series of medical articles sixty-five years ago. His regimen incorporated a critical focus and intensity that were unfortunately not upheld in most of the pelvic floor muscle training programs that followed his reign.

The Pelvic (Kegel) Revolution

After years of “stagnancy” following the transformative work of Dr. Arnold Kegel, there is a resurgence of interest in the pelvic floor and in the benefits of pelvic floor training. In 2016, we are in the midst of a pelvic floor “sea change” that is gaining momentum and traction. There is increasing recognition of pelvic floor dysfunction (when pelvic floor function goes awry) as the root cause for a variety of pelvic issues including pelvic organ prolapse, stress urinary incontinence, overactive bladder, sexual dysfunction and pelvic pain syndromes. There is an evolution in progress with respect to management of pelvic floor dysfunction, including “smart” pelvic floor muscle programs that are tailored to the specific pelvic floor dysfunction, the advent of a host of novel, high-technology pelvic floor training resistance devices and the expanding use of a specialty niche of physical therapy—pelvic floor physical therapy.  Of note, pelvic floor physical therapy has been popular in Europe for many years and it is only recently that its utility has been recognized in the USA. (I am grateful for the wonderful services provided by my pelvic physiotherapy colleagues who have been so helpful and beneficial for many of my patients with pelvic floor dysfunctions.)

It is my belief that the next few years will bear witness to continued advances in pelvic floor muscle training and focus that will restore pelvic training to the classic sense established by Arnold Kegel—a “renaissance” to a new era of “pelvic enlightenment.” Books such as The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health (www.TheKegelFix.com) introduce new-age, next-generation pelvic programs—progressive, home-based, tailored exercise programs consisting of strength, power and endurance training regimens—designed and customized for each specific pelvic floor dysfunction. 2016 will usher in the availability of high quality follow-along pelvic training programs, e.g., the PelvicRx (www.PelvicRx.com)—a comprehensive, interactive, FDA-registered training regimen accessible via DVD or streaming. Furthermore, based upon Dr. Kegel’s perineometer resistance device, technological advances have resulted in the emergence of numerous pelvic floor muscle training devices, many of which are sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. Although most provide the same basic functionality—insertion into the vagina, connection to a smartphone app, biofeedback and tracking—each has its own unique features. This market for resistance devices is evolving at a remarkably rapid pace.

Another major refinement is the concept of functional pelvic fitness—teaching patients how to put their pelvic knowledge and skills to real life use with practical and actionable means of applying pelvic muscle proficiency to daily tasks and common everyday activities, an area that has been sorely neglected in the past, with prior emphasis solely on achieving a conditioned pelvic floor.

An additional element of the pelvic revolution is the increasing awareness and acceptance by the urological-gynecological-gastrointestinal community of the concept that stress and other psychosocial factors can give rise to physical complaints such as pelvic floor tension myalgia, a condition in which the pelvic floor muscles exist in an over-contracted, painful state. At one time, this diagnostic entity was not even a consideration; however, an understanding of this condition is slowly gaining recognition and traction and there is a burgeoning understanding that many pelvic pain issues (interstitial cystitis/chronic pelvic pain syndrome, prostatitis, irritable bowel syndrome, fibromyalgia, endometriosis, etc.) can, in actuality, be manifestations of pelvic floor hyper-contractility and over-tensioning.

Pelvic floor physical therapy has become and will continue to be increasingly in vogue. This specialized branch of physical therapy that deals with pelvic floor issues treats a wide range of pelvic floor dysfunctions ranging the gamut from pelvic muscle weakness to pelvic muscle over-tensioning. Pelvic floor physical therapy sessions can be of great help for those with pelvic floor dysfunctions and it is clear that patients do better with supervised regimens than they do without. Pelvic physical therapy is particularly useful for pelvic pain syndromes. In France, the government subsidizes the cost of post-partum pelvic training (“La rééducation périnéale après accouchement”), including up to 20 sessions of pelvic PT intended to tone and “re-educate” the postnatal pelvic muscles.

The final piece of the pelvic revolution is the broadening appreciation that pelvic floor muscle training in males is no less important than in females, potentially beneficial in the management of stress urinary incontinence that follows prostatectomy, overactive bladder, post-void dribbling, erectile dysfunction, premature ejaculation and pelvic pain due to pelvic muscle spasm.

Future Considerations

Demand for the management of pelvic floor disorders will increase over the next decade. There is major growth opportunity for services that utilize non-physician providers (nurse practitioners, physician assistants and physical therapists) to teach patients pelvic muscle training and other behavioral treatments.

If Arnold Kegel were alive today, in all likelihood he would take great pleasure and pride in the breath of life being infused into his seminal work following decades of dormancy. His legacy and the fertile ground and transformative changes nurtured by his pioneering efforts will result in the continued empowerment of patients, with improvement in their pelvic health and quality of life.

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– newly available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo (paperback edition will be available May 2016).

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

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food   

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 code “UROLOGY10” at checkout for 10% discount. 

 

Kegel Exercises To PREVENT Pelvic Floor Dysfunction

August 29, 2015

Andrew Siegel MD   8/29/15

shutterstock_v162886

“Prepare and prevent, not repair and repent.”

Restoring function of injured muscles is a well-established principle in sports medicine, orthopedics, plastic surgery and physical medicine and rehabilitation. The premise is simple: a traumatized or injured muscle is treated with rehab and training to accelerate tissue healing and restore working order. Many of the “baby boomers” demographic (age 51-69)—striving to retain their fitness and youth through exercise and “weekend warrior” activities that promote cardiac health but at the same time, musculoskeletal injuries—understand this concept well.

Dr. Arnold Kegel applied this principle to the female pelvic floor muscles to improve muscle strength and function in women after childbirth. Obstetrical “trauma” (9 months of pregnancy, tough labor and delivery of a 9 lb. baby) can cause pelvic floor dysfunction—urinary and bowel control issues, looseness of the vagina and its support tissues with descent of the bladder, uterus and rectum, and altered sexual function.

This principle has also been applied to men with pelvic floor muscle issues to improve urinary, bowel, erectile and ejaculatory health. Obviously, men do not suffer the acute pelvic floor muscle trauma of childbirth that women do, but they can develop pelvic floor muscle dysfunction from aging, weight gain, pelvic surgery (radical prostatectomy, colon surgery, etc.), a sedentary lifestyle, disuse atrophy, participation in saddle sports including cycling, etc.

An Ounce Of Prevention Is Worth A Pound Of Cure

Why not a radically different approach and instead of fixing pelvic floor dysfunction, try to prevent it? Unfortunately, we have a “reactive” oriented medical culture in the USA that does not emphasize prevention, but “repair.”  Another hurdle is that many people prefer having broken things fixed as opposed to making the effort to avoid breaking them in the first place.

So, if obstetrical trauma to the pelvic floor often brings on pelvic floor muscle dysfunction and its urinary, gynecological, bowel and sexual consequences, why not consider starting pelvic floor muscle training well before pregnancy, perhaps at the time of the first gynecological visit? And if aging, surgery and other factors contribute to male pelvic floor muscle dysfunction and its urinary, bowel and sexual consequences, why wait for the system to malfunction? Why not strengthen and tone the pelvic floor muscles when a man is young and healthy to prevent the predictable age-related decline?

Did You Know? The concept of pelvic floor muscle training BEFORE radical prostatectomy for treatment of prostate cancer is rapidly gaining traction and implementation. Instead of waiting to “rehab” the pelvic muscles after the fact, the concept is to “prehab” them. 

Many of us apply wellness principles through regular exercise—aerobic pursuits for cardiovascular health and strength training to maintain muscle tone, integrity and function—so why neglect the pelvic floor? We work out in the gym not only to achieve better fitness, but also to maintain fitness and prevent age-related losses in strength, flexibility, endurance, etc.

Preventive Pelvic Health Paradigm

Why passively accept the seemingly inevitable, when one can be proactive instead of reactive and can address the future problem before it becomes a problem? Why wait until function becomes dysfunction? Whether male or female, the new paradigm is preventive pelvic health. The goal is to avoid, delay, or minimize the decline in pelvic function that accompanies aging and that is accelerated by pelvic muscle trauma and injury, surgery, obesity and disuse atrophy.

Bottom Line: You have the ability to positively influence your health destiny. Instead of being reactive and waiting for your pelvic health to go south, be proactive to ensure your continuing urinary, bowel and sexual health. If you wait for the onset of a dysfunction to motivate you to action, it may possibly be too late. Think about integrating a preventive pelvic floor muscle program into your exercise regimen. Much like a vaccine, it will help to prevent a disease that you hopefully will never get.

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 Male Pelvic Fitness: Optimizing Sexual and Urinary Health: Available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com.  In the works is The Kegel Fix: Recharging Female Sexual, Pelvic and Urinary Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon.

New Paradigm: Preventive Kegel Exercises (Pelvic Floor Muscle Training)

October 4, 2014

Andrew Siegel, M.D.

“To guard is better than to heal, the shield is nobler than the spear!”  Oliver Wendell Holmes

“Honor your pelvic floor–it has done a whole lot for you over the years.”

Restoration of the function of injured muscles is well established in the fields of sports medicine, orthopedics, plastic surgery and physical medicine and rehabilitation. A traumatized or injured muscle is treated with early active rehabilitation and muscle training to accelerate tissue healing and restore it back to working order.

Dr. Arnold Kegel popularized the application of this principle to the female pelvic floor muscles to improve muscle integrity and function in women after childbirth. Obstetrical trauma (9 months of pregnancy, labor and delivery of a 9 lb. baby out the vagina) can cause pelvic floor dysfunction. Pelvic floor dysfunction can cause incontinence (urinary and bowel control issues), pelvic relaxation (laxity of the vagina and its support tissues with descent of the pelvic organs including the bladder, uterus and rectum) and altered sexual function.

Likewise, this principle has been effectively applied to men with compromised pelvic floor muscle integrity and function in order to improve urinary, bowel, erectile, and ejaculatory health. Obviously, men do not suffer with the acute pelvic floor muscle trauma of childbirth that women do, but they can develop pelvic floor muscle dysfunction on the basis of aging, weight gain, a sedentary lifestyle, disuse atrophy, etc.

Don’t Allow Function to Become Dysfunction

Why not take a radically different approach and try to prevent pelvic floor dysfunction instead of fixing it? If you pardon the clichés, although “a stitch in time saves nine,” isn’t a better approach “an ounce of prevention is worth a pound of cure?”. Obstacles to implementing this paradigm are our very reactive and repair-oriented medical culture that does a poor job of being proactive and promoting prevention and our patient population that often prefers fixing things that go awry as opposed to making the effort to prevent them from occurring in the first place. The concept of promoting wellness as opposed to treating diseases is one that resonates powerfully with me.

So, if obstetrical trauma to the pelvic floor often brings on pelvic floor muscle dysfunction and its urinary, gynecological and sexual consequences, why not start pelvic floor muscle training well before pregnancy? And if aging and other factors contribute to male pelvic floor muscle dysfunction and its urinary, bowel and sexual consequences, why wait for the system to malfunction? Why not bolster and strengthen the pelvic floor muscles when one is young, hale and hearty to prevent the age-related decline that is so often predictable? Many of us do apply preventive and proactive means to our health through regular exercise—aerobic for cardiovascular health and strength training to maintain muscle tone, integrity and function.

Whether male or female, the new paradigm is preventive pelvic health. The goal is to preclude, delay, or mitigate the decline in pelvic function that accompanies aging and that is accelerated by pelvic muscle trauma and injury, obesity and disuse atrophy.

Maintaining healthy sexual functioning is important because it contributes to masculine and feminine identity and behavior and has an impact that extends way beyond the sexual domain, permeating positively into many areas of life. Sexual dysfunction—at least to some extent—will eventually surface in most of us and the prospect of this is unsettling.

So, why passively accept the seemingly inevitable, when one can be proactive instead of reactive and can address the future problem before it becomes a current problem? Why wait until function becomes dysfunction? This is a commonly practiced approach for general physical fitness. We work out in the gym not only to achieve better fitness, but also to maintain fitness and prevent age-related losses in strength, flexibility, endurance, etc.

In this spirit, I encourage men and women who are enjoying excellent sexual and urinary health to maintain their pelvic health via preventive PFMT. This preemptive strategy is an opportunity for those who are healthy-functioning to continue enjoying their healthy functioning and prevent, delay and/or mitigate the age-related changes as best as they can.

Bottom Line: You have the ability to affect your own health destiny. Don’t be reactive and wait for your pelvic health to go south. Be proactive to ensure your continuing sexual, urinary and bowel health. If you wait for the onset of a dysfunction to motivate you to action, it may possibly be too late. Think about integrating a preventive PFMT program into your exercise regimen—it’s like a vaccine to prevent a disease that you hopefully will never get. As the saying goes: “Prepare and prevent, not repair and repent.”

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

Note: As Arnold Kegel popularized pelvic floor muscle exercises in females in the late 1940’s, so I am working towards the goal of popularizing pelvic floor muscle exercises in males. This year I published a review article in the Gold Journal of Urology entitled Pelvic Floor Muscle Training in Men: Practical Applications to disseminate the importance and applications of these exercises to my urology colleagues. I wrote Male Pelvic Fitness: Optimizing Sexual and Urinary Health, a book intended to educate the non-medical population. I, along with my partner David Mandell and our superb pelvic floor team, co-created the Private Gym male pelvic floor exercise DVD and resistance program.

For more info on the book: www.MalePelvicFitness.com

For more info on the Private Gym: www.PrivateGym.com

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