Posts Tagged ‘pelvic floor exercises’

Integrating Kegels With Other Exercises

March 17, 2018

Andrew Siegel MD     3/17/2018

Initially, it is important to isolate the pelvic floor muscles (PFM) and exercise them while not actively contracting any other muscle groups. Once PFM mastery is achieved, PFM exercises can then be integrated into other exercise routines, workouts and daily activities.

No Muscle is an Island

In real life, muscles do not work in isolation, but rather as part of a team. The PFM are no exception, often contracting in conjunction with the other core muscles in a mutually supportive way, co-activating to maintain lumbar-pelvic stability, help prevent back pain and contribute to pelvic tone and strength.

The core muscles—including the PFM—stabilize the trunk when the limbs are active, enabling powerful limb movements. It is impossible to use arm and leg muscles effectively in any athletic endeavor without engaging a solid core as a “platform” from which to push off. Normally this happens without conscious effort; however, with focus and engagement, the core and PFM involvement can be optimized. The stronger the core platform, the more powerful the potential push off that platform will be, resulting in more forceful arm and leg movements. Thus, maximizing PFM strength has the benefit of optimizing limb power.  Core training that exercises the abdominal/lumbar/pelvic muscles as a unit improves the PFM response. Many Pilates and yoga exercises involve consciously contracting the PFM together with other core muscles during exercise routines.

Integrating PFMT with Other Exercises

Dynamic exercises in which complex body movements are coupled with core and PFM engagement provide optimal support and “lift” of the PFM, enhance non-core as well as core strength and heighten the mind-body connection. When walking, gently contract your PFM to engage them in the supportive role for which they were designed, which will also contribute to good posture. Consciously contract the PFM when standing up, climbing steps, doing squats and lunges, marching, skipping, jumping, jogging, and dancing.  When cycling, periodically get up out of the saddle and contract your PFM to get blood flowing to the compressed pelvic muscles and perineum.

Integrating PFMT with Weight Training: “Compensatory” Pelvic Contractions

Weight training and other forms of high impact exercise result in tremendous increases in abdominal pressure. This force is largely exerted downwards towards the pelvic floor, particularly when exercising in the standing position, when gravity comes into play, potentially harmful to the integrity of the PFM.  Engaging the PFM during such efforts will help counteract the downward forces exerted on the pelvic floor.  “Compensatory” PFM contractions, in which the PFM are contracted in proportion to the increased abdominal pressure, are effective in balancing out the forces exerted upon the pelvic floor.

Wishing you the best of health!

2014-04-23 20:16:29

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

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

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

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

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

 

 

 

 

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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

 

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 2

February 10, 2018

Andrew Siegel MD    2/10/18

This is a continuation of last week’s entry.  Remember, PFMT is equally appropriate for males as well as females –both genders have these important muscles that can benefit from whipping them into shape.

3 screw icon square

 

The basic PFMT programs that follow are “low tech” exercises of the PFM without added resistance.  They can be thought of as PFMT 101, the goal of which is to provide the foundation for pelvic muscle proficiency. After mastery of basic PFMT, progression to the next phase of conditioning—resistance training—is in order.

PFMT is the essence of “functional fitness,” exercises that develop PFM strength, power, stamina and the skillset that can be used to improve and/or prevent specific pelvic functional impairments. PFMT regimens must be flexible and nuanced, designed and customized with particular functional needs in mind, i.e., issues of pelvic support, urinary control, sexual function, pain, etc., as opposed to a one-size-fits-all approach.  An additional consideration is baseline PFM strength and stamina.  After determining an area of weakness, focused effort should be applied to this deficit.

Time to Begin

You do not need to go to a gym, wear athletic clothing, have any special equipment, or dedicate a great deal of time to PFMT. It is vital to do properly performed, quality PFM contractions with the goal of slow and steady progress. Experiencing some aching and soreness as you begin is not uncommon.

If you are pursuing PFMT for specific pelvic issues, expect that it may take a number of weeks or more to see an improvement in your symptoms.  After you have noticed a beneficial effect, the exercise regimen must be maintained, because regression can occur if the pelvic muscles are not consistently exercised…”use it or lose it” applies here.

Basic PFMT exercises can be performed lying down, sitting upright in a comfortable chair with your back straight, or standing. It is best to begin lying down, to minimize gravity, which makes the exercises more challenging. Regardless of position, it is essential to maintain good form, posture and body alignment while doing PFMT. It is important to relax your abdomen, buttocks and thighs. Breathe slowly and do not hold your breath. Even though no muscle group works alone, by trying to isolate the PFM and focusing on squeezing only the PFM, you will make more rapid progress. You should not be grimacing, grunting or sweating, as PFMT is, in part, a meditative pursuit that employs awareness, focus, mindfulness and intention while performing deliberate contractions of the PFM.

Helpful metaphor: “Snap” describes a brief, vigorous, well-executed contraction of the PFM. With increasing PFM command, these pelvic muscles can be “snapped” like your fingers.

There are six variables with respect to PFM contractions:

  1. contraction intensity
  2. contraction duration
  3. relaxation duration
  4. power
  5. repetitions
  6. sets

Contraction intensity refers to the extent that the PFM are squeezed, ranging from a weak flick of the muscles to a robust and vigorous contraction. The contraction duration is the amount of time that the squeeze is sustained, ranging from a “snap”—a rapid pulsing of the PFM, to a “sustained hold”—a long duration contraction. The relaxation duration is the amount of time the PFM are unclenched until the next contraction is performed. Power is a measure of contraction strength and speed, the ability to rapidly achieve a full intensity contraction. Repetitions (reps) are the number of contractions performed in a single set (one unit of exercise).

It is relatively easy to intensively contract your PFM for a brief period, but difficult to maintain that intensity for a longer duration contraction. It is unlikely that you will be able to maintain the intensity of contraction of a sustained hold as you would for a snap.

The better PFMT regimens utilize a combination of snaps, few-second contractions and sustained duration contractions to reap the benefits of both strength and endurance training.

Fact: Short duration, high intensity contractions build strength and power, whereas longer duration, less intense contractions will build endurance, both vital elements of fit PFM.

Incremental change—the gradual and progressive increase in the intensity of contraction, duration of contraction, number of reps and number of sets performed—is the goal.  Performing the program 3-4 times weekly is desirable since recovery days are important for skeletal muscles.

PFMT is not an extreme program; nonetheless, it is by no means an undemanding program, and certainly requires effort and perseverance.  Depending on your level of baseline PFM fitness, you may find the exercises anywhere in the range from relatively easy to quite challenging. Your PFM are unique in terms of their shape, size and strength and consequently expectations regarding results will vary from individual to individual.

After a month or so, you should be on your way to achieving basic conditioning of the PFM. Reassessing the PFM by repeating the Oxford grading and the PFM endurance tests that you measured at baseline should demonstrate objective evidence of progress. More importantly, you should start noticing subjective improvement in many of the domains that PFM fitness can influence.  Once you have mastered non-resistance training, it is time to move on to resistance training, in which you squeeze your PFM against the opposing force of resistance in an effort to accelerate the PFMT.

If you are challenged by the non-resistance PFMT or cannot or prefer not to use resistance—which for women requires the placement of a device in your vagina and for men the ability to achieve a rigid erection—you can continue with the non-resistance training using it as a “maintenance” program.  PFM maintenance training typically requires continuing with the PFMT program, but performing it less frequently, twice weekly usually being sufficient.

To be continued next week…

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

 

Preparing For Pelvic Floor Muscle Training (PFMT): What You Need To Know (Part 3)

January 20, 2018

Andrew Siegel MD  1/20/18

This entry, written for both women as well as men, is intended to enable one to do a proper contraction of  the pelvic floor muscles (PFM), a task easier said than done.  A means of self-assessment of PFM strength and stamina is offered. 

Image Below: The Pelvic Floor Muscles (Male left; Female right)

1116_Muscle_of_the_Perineum

Attribution: URL: https://cnx.org/contents/FPtK1zmh@8.108:b3YG6PIp@6/Axial-Muscles-of-the-Abdominal
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016 

Do It Right

PFM exercises (Kegel exercises) must be done properly to reap benefits. Many think they are doing these pelvic contractions correctly, but actually are contracting the wrong muscles, an explanation of why their efforts may have failed to improve their clinical situation. In both women and men, PFM exercises involve pulling inwards and upwards, lifting and elevating.  In females, this will result in tightening the urethral, vaginal and anal openings and in males tightening the anus and if done at the time of an erection, elevating the erect penis.  Proper pelvic contractions are the very opposite of straining. One strains to move their bowels, whereas one “Kegels” to accomplish the opposite—to tighten up the sphincters to NOT move their bowels; in fact, PFM contractions are a means of suppressing bowel urgency (as well as urinary urgency).

How do you know if you are contracting your PFM properly?

For the Ladies: 6 Ways to Know That You Are Properly Contracting Your PFM

  1. When you see the base of your clitoris retract and move inwards towards your pubic bone.
  2. When you see your perineum (area between vagina and anus) move up and in.
  3. When you see the anus contract (“anal wink”) and feel it tighten and pull up and in.
  4. When you can stop your urinary stream completely.
  5. When you place your index and middle fingers on your perineum and you feel the contraction.
  6. When you place a finger in your vagina, you feel the vaginal “grip” tighten.

 

 

For the Gentlemen: 6 Ways to Know That You Are Properly Contracting Your PFM

  1. When you see the base of your penis retract inwards towards the pubic bone and the testes rise up towards the groin.
  2. When you place your index and middle fingers in the midline between the scrotum and anus and you feel the PFM contractions.
  3. When you see the anus contract (“anal wink”) and feel it tighten and pull up and in.
  4. When you get the same feeling as you do when you are ejaculating.
  5. When you touch your erect penis and feel the penile erectile chambers surge with blood and you can make the penis lift upwards when you are in the standing position.
  6. When you can stop your urinary stream completely.

Fact:  Vince Lombardi stated: “Practice doesn’t make perfect, perfect practice makes perfect.”  This is wholly applicable to PFM training. Do it right or don’t do it!

Assessing Your PFM: Note that this is used primarily for women

There are many fancy ways of testing your PFM, but the simplest is by using tools that everyone owns—their fingers.  Digital palpation (a finger in the vagina, or alternatively the anal canal) is the standard means of testing the contraction strength of the PFM. The other methods are visual inspection, electromyography (measuring electrical activity of the PFM), perineometry (measuring PFM contractile strength via a device that is inserted into the vagina or anus) and imaging tests that assess the lifting aspects of the PFM, such as ultrasound and magnetic resonance imaging.

Assessment of your PFM evaluates PFM strength and endurance.  PFM strength can be self-assessed in the supine position (lying down, face up) with your knees bent and parted. Gently place a lubricated finger of one hand in the vagina (or alternatively the anal canal) and contract your PFM, lifting upwards and inwards and squeezing around the finger. Keep your buttocks down in contact with the surface you are lying on. Ensure that you are not contracting your gluteal (butt), rectus (abdomen) or adductor (inner thigh) muscles. Do this by placing your other hand on each of these other muscle groups, in turn, to prove to yourself that these muscles remain relaxed during the PFM contraction.

Rate your PFM strength using the modified Oxford grading scale, giving yourself a grade ranging from 0-5.  Note that the Oxford system is what many physicians use and it is relatively simple when done regularly by those who are experienced performing pelvic exams. Granted that this is not your area of expertise, so you may find this challenging. However, do your best to get a general sense of your baseline PFM strength.

Oxford Grading of PFM Strength

0—complete lack of contraction

1—minor flicker

2—weak squeeze

3—moderate squeeze

4—good squeeze

5—strong squeeze

Next test your PFM endurance. Do as many PFM contractions as possible, pulsing the PFM rapidly until fatigue sets in (the failure point where you cannot do any more contractions).  After you have recovered, contract the PFM for several seconds followed by relaxing them for several seconds, doing as many repetitions until fatigue occurs. Finally, do a single PFM contraction and hold it for as long as you can.

Record your Oxford grade and the maximum number of pulses, maximum number of several second contractions and the duration of the sustained hold as baseline measurements. These will be useful to help assess your progress. Initially, it is likely that your PFM will be weak and lack endurance capacity.

Coming soon…The Nuts and Bolts of Pelvic Floor Muscle Training.

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 pelvic floor health 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 

 

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

 

 

 

 

 

Preparing For Pelvic Floor Muscle Training (PFMT): What You Need To Know (Part 2)

January 13, 2018

Andrew Siegel MD    1/13/2018

This entry, written for both males and females, will help you develop pelvic floor muscle (PFM) awareness and build PFM muscle memory.  

Image below: Male PFM (left); Female PFM (right)

 

1116_Muscle_of_the_Perineum

Attribution: URL: https://cnx.org/contents/FPtK1zmh@8.108:b3YG6PIp@6/Axial-Muscles-of-the-Abdominal
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016

PFM Education and Awareness

Fact: Studies have clearly shown that most women with pelvic issues referred for PFM training are unable to perform a proper PFM contraction. Almost all demonstrate weak PFM strength regardless of age, ethnicity or diagnosis. Most males are clueless about PFM training, many not even realizing that they have this set of important muscles. 

Physical therapists and physical medicine and rehabilitation experts have used functional restoration to effectively manage injured skeletal muscles. This strategy can likewise be applied to weakened and poorly functional PFM. The principles involve segregation, guidance and progression.  Segregation is an awareness of PFM anatomy and function with the ability to isolate the PFM by contracting them independently of other muscles. Guidance refers to the instructions necessary to learn how to properly engage and train the PFM.  Progression refers to the incrementally more challenging exercises over the course of the PFM training regimen that result in PFM growth and improvement.  Again, exercise is about adaptation, so increasing repetitions and intensity is mandatory to achieve results. The goal is for fit PFM—strong, yet flexible, equally capable of powerful contractions as well as full relaxation.

Initially, one must become aware and mindful of the presence, location and nature of the PFM.  A good starting point is what the PFM are not: they are NOT the muscles of the abdomen, thighs or buttocks, but are the saddle of muscles that run from the pubic bone in front to the tailbone in back.

The PFM have a resting tone, even though you are not typically aware of it. They can be contracted and relaxed at will: a voluntary contraction of the PFM will enable interruption of the urinary stream and tightening of the anal canal and an involuntary (reflex) contraction of the PFM occurs, for example, at the time of a cough. Relaxation of the PFM occurs during urination or a bowel movement.

Dr. Arnold Kegel described a PFM contraction as “a squeeze around the pelvic opening with an inward lift.” With a proper PFM contraction, the perineum (the area between vagina and anus in females and scrotum and anus in males) pulls in and lifts in an upwards direction.  This is a “drawing in and up,” which is the very opposite feeling of “bearing down” to move one’s bowels.  For females, one method of getting the feel for doing a proper PFM contraction is to initially tighten the vagina, secondly the anus, and thirdly lift up the perineum.

Fact: Kay Crotty, a pelvic floor physiotherapist in the UK, feels that it is initially easier to learn to contract your PFM by concentrating on just the back PFM (anal sphincter).  She discovered that women who tighten their PFM while focused on both the front PFM (vaginal) and back PFM do better quality PFM contractions than those who tighten their PFM focused on just the front PFM. 

There are many mental images that can be useful in understanding PFM contractions. One is to think of the pubic bone and tailbone moving towards each other. Another helpful picture is to imagine the PFM as an elevator—when the PFM are engaged, the elevator rises upwards to the first floor from the ground floor; with continued training, the elevator rises to the second floor.  Alternatively, for females, envision that you are lifting a ping pong ball with your vagina and pulling it deep inside you. Another means is to mentally visualize that you are removing a tampon from your vagina and as you pull on the string you try to resist and hold the tampon in.

There are simple “biofeedback” techniques that can be helpful as well. After emptying your bladder about halfway, try to interrupt your urinary stream for a few seconds while you focus on the PFM that allow you to do so. Then resume and complete urination.  The feeling should be that of clenching and unclenching the vagina, urethra and anus in females and the anus and urethra in males.  Another method for females is to place a finger in your vagina and contract your PFM: the feeling should be of your vagina having a firm grip around your finger; alternatively, in either gender one can place a finger in the anus and when the PFM are contracted, the feeling should be of the anus having a firm grip around your finger.

Building Muscle Memory

It is important to understand how one becomes adept at using muscles.  This is relevant to gaining competence in any new physical activity and will be applied specifically to acquiring the skills to perform well-executed PFM contractions.

There are four stages of motor learning.  (I learned this as it pertained to the mechanics of a golf swing, but it is equally relevant to mastering contracting the PFM.)

Stage 1. Unconscious/incompetent

There is no awareness of the motion and it cannot be capably performed. It is challenging to make the connection between your brain and your PFM because the PFM under most circumstances are used involuntarily (without conscious awareness). This connection is not intuitive and must be taught.

Fact: The connections between brain and PFM consist of sensory and motor nerves. The PFM contain sensors known as “proprioceptors” that detect stretch, position and motion and convey this information to the brain via sensory nerves. Motor nerves originate in the brain and enable the PFM to contract.

Stage 2. Conscious/incompetent

Awareness of the motion is learned, but the motion cannot be competently performed.

Stage 3. Conscious/competent

Awareness of the motion is established and with sufficient practice the motion can be competently performed.

Stage 4. Unconscious/competent

With continued practice, the brain-PFM connection and muscle memory become well established and the motion can be performed reflexively (without conscious thought or effort).

…To be continued next week with a discussion on the execution of a proper PFM contraction and self-assessment of  your PFM strength and stamina.

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

 

 

 

 

 

Preparing For Pelvic Floor Muscle Training (PFMT): What You Need To Know

January 6, 2018

Andrew Siegel MD  1/6/2017

Happy New Year!  At this time, many of us are trying to execute New Year’s resolutions.  Topping the list of most resolutions is getting into good physical shape.  A vital piece of this is pelvic floor fitness; in fact, pelvic floor muscle training was among the top five exercises recommended for general health and fitness in a recent Harvard Medical School report.

The next series of blog entries, written for both men and women, will enable you to achieve pelvic floor fitness.  Remember, Kegels are not just for the ladies!  This first entry discusses the fast and slow twitch muscle fibers that determine pelvic floor muscle (PFM) function, the adaptation principle and the distinction between strength, power and stability.  

Image below: Male PFM (left) and female PFM (right); notice their similarity.

1116_Muscle_of_the_PerineumAttribution: URL: https://cnx.org/contents/FPtK1zmh@8.108:b3YG6PIp@6/Axial-Muscles-of-the-Abdominal  Version 8.25 from the Textbook, OpenStax Anatomy and Physiology, 
Published May 18, 2016

Muscles 101

Muscles provide shape to our bodies and allow for movement, stability and maintenance of posture.  Most skeletal muscles come in pairs and cross bony joints—when one group contracts, it causes bending of that joint and when the opposing group contracts, it causes straightening of that joint (e.g., biceps/triceps).  When each contract equally, the joint is in a neutral position. The human body has three types of muscles—skeletal muscles that provide mobility and stability, smooth muscles that line the arteries, bladder, intestine, etc., and the unique cardiac muscle of the heart.  Muscles are composed of fibers that contract (shorten and tighten) and relax (lengthen and loosen).

The PFM are skeletal muscles that are comprised of fast twitch and slow twitch muscle fibers. Fast twitch fibers predominate in high contractile muscles that fatigue rapidly and are used for fast-paced muscle action, e.g., sprinting.  Slow twitch fibers predominate in endurance muscles, e.g., marathon running. The PFM have a constant tone (low level of involuntary contraction) because of the presence of slow twitch fibers. The fast twitch fibers allow for voluntary contraction. The PFM fibers are 70% slow twitch, fatigue-resistant, endurance muscles to maintain constant muscle tone (e.g., sphincter function and pelvic support) and 30% fast twitch, capable of rapid and powerful contractions (e.g., sexual climax, interrupting the urinary stream and tightening the anus).

Fact:  Aging causes a decline in the function of the fast twitch fibers, but tends to spare the slow twitch fibers.   

Muscle mass is in a dynamic state, a constant balance between growth and breakdown. With aging, muscle fiber wasting occurs as muscle breakdown exceeds muscle growth, adversely affecting function. Strength training reduces muscle wasting by increasing muscle bulk through enlargement of muscle fibers. This is true of all skeletal muscles, the PFM being no exception.

Adaptation Principle

Muscles are remarkably responsive to the stresses placed upon them.  Muscle growth only occurs in the presence of progressive overload, which causes compensatory structural and functional changes, a.k.a. adaptation. This explains why exercises get progressively easier in proportion to the effort put into doing them.  As muscles adapt to the stresses placed upon them, a “new normal” level of fitness is achieved.  Another term for adaptation is plasticity. Skeletal muscles are “plastic,” capable of growth or shrinkage depending on the environment to which they are exposed.

The PFM behave similarly to other skeletal muscles in terms of their response to exercise or lack thereof.  In accordance with the adaptation principle, it is advisable to increase number of repetitions and contraction intensity to build muscle PFM strength, power and endurance.  As much as our muscles adapt positively to resistance, so they will adapt to the absence of stress and resistance, resulting in smaller, weaker and less durable muscles.

Fact: Use It or Lose It. With a conditioning regimen, the PFM will thrive, optimizing their function.  When the PFM are neglected, they will weaken, impairing their function.   

Strength, Power and Stability

The goal of PFM training is to maximize the trio of PFM strength, power and stability. Strength is the maximum amount of force that a muscle can exert. With time and effort, PFM contractions become more robust, helping sexual function and improving one’s ability to neutralize stress urinary incontinence, overactive bladder and pelvic organ prolapse in females.  In males, command of one’s pelvic floor muscles can improve sexual, urinary and prostate health.  Power is a gauge of strength and speed (muscle force multiplied by the contraction speed), a measure of how rapidly strength can be expressed, of great benefit to sexual health and the ability to react rapidly to urinary/bowel urgency and stress urinary incontinence. Stability helps maintain vaginal tone, urinary and bowel sphincter function and pelvic organ support as well as contributing to the “backboard” that helps prevent stress urinary incontinence.

To be continued… Next week’s entry provides information on the process of building muscle PFM memory and how to develop PFM awareness.

Wishing you the best of health!

2014-04-23 20:16:29

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

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

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

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

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

 

 

 

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.

 

Kegels Go Hollywood: From Ben Wa Balls To The Elvie Pelvic Trainer

February 26, 2017

Andrew Siegel MD  2/26/17

I do not ordinarily compose more than one blog entry per week, but Kegels Go Hollywood presented itself and is worthy of a timely discussion.

Photo below by Ivan Bandura [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commonsoscars_for_sale_6952722855

And the Oscar goes to….

arnold-kegel-gladser-studio-1953

Arnold Kegel MD (Gladser Studio, 1953)

“Fifty Shades of Grey” and “Fifty Shades of Darker” are not my cup of tea, although I confess to having read the first book to see what all the fuss was about.  According to The New Yorker reviewer Anthony Lane, the current “Fifty Shades of Darker” movie is lacking in thrills, “unless you count the nicely polished performance from a pair of love balls.” The movie popularizes the use of Ben Wa Balls, which apparently spend most of their time settled deeply in the vagina of female character Anastasia Steele (Dakota Johnson).

ben-wa

 Ben Wa Balls

Included in the swag bag of high-end gifts at tonight’s Oscars is a pelvic floor training device called the “Elvie.” Manufactured in the UK, Elvie is a sophisticated wearable, egg-shaped, waterproof, flexible device inserted vaginally. Pelvic floor muscle contraction strength is measured and sent via Bluetooth to a companion mobile app on a smartphone that provides biofeedback to track progress. Five-minute workouts are designed to lift and tone the pelvic floor muscles. The app includes a game designed to keep users engaged by trying to bouncing a ball above a line by clenching their pelvic floor muscles. The carrying case also serves as a charging device. Cost is $199 (Elvie.com).

elvie

Elvie Pelvic Training Device 

I have worked with the company that manufactures Elvie and recently wrote a blog for the Elvie website on the topic of “Myths about the pelvic floor.” To access, go to:

https://www.elvie.com/blog/12-myths-about-the-pelvic-floor-with-dr-siegel

As a physician, urologist, author and pelvic floor muscle training advocate, I am quite pleased by the newfound awareness and popularity accorded pelvic floor muscle training, a highly beneficial means of improving/maintaining pelvic, sexual, urinary and bowel health–despite its popularization in Hollywood.

Benefits of Pelvic Floor Muscle Training

The vagina has its own set of intrinsic muscles (within its wall), which are further layered with the pelvic floor muscles (external to the vaginal wall). An intense pelvic floor muscle workout—albeit a pleasurable one made possible through devices like Ben Wa Balls or the Elvie—accords some real advantages to the participant. A stronger and better toned pelvic floor increases vaginal blood flow, lubrication, orgasm potential and intensity, the ability to clench the vagina as well as partner pleasure, overall increasing the potential for sexual gratification.  Of no less importance, a powerful pelvic floor also improves urinary and bowel control. Keeping the pelvic floor fit can prevent the onset of many sexual, urinary, bowel and other pelvic issues that may emerge with the aging process.

Love Balls 101

Motion-induced friction applied to the vaginal wall is one of the key factors leading to sexual pleasure.  Ben Wa Balls provide such friction and can be thought of as erotic toys as well as medical devices that are used to train the pelvic floor and vaginal muscles. When exercise can be made pleasurable—not unlike playing tennis as opposed to working out in the gym—it unquestionably provides significant advantages.

There are numerous variations in terms of Ben Wa ball size (usually one to two inches in diameter), weight, shape, composition and number of balls. Some are attached to a string, allowing tugging on the balls to add more resistance. Another type has a compressible elastic covering that can be contracted down upon. Still others vibrate. There are some upscale varieties that are carved into egg shapes from minerals such as jade and obsidian.

Ben Wall Balls are classified under the general heading of vaginal weights, devices that are placed in the vagina and require pelvic floor muscle engagement in order that they remain in position and not fall out when the user is upright, providing resistance to contract down upon.

Ben Wa balls are not unlike vaginal cones, which consist of a set of weights that are of identical shape but vary in their actual weight. Initially, one places a light cone in the vagina and stands up and walks about, allowing gravity to come into play. Pelvic floor contractions are required to prevent the cone from falling out. The intent is to retain the weighted cone for fifteen minutes twice daily to improve pelvic strength.  Gradual progression to heavier cones challenges the pelvic floor and vaginal muscles to improve strength and tone. Ben Wa balls can be thought of as sexy versions of the vaginal cones.

vaginal-conesVaginal Cones

 

Sophisticated Pelvic Training Devices Like Elvie

There are many pelvic resistance devices on the market—some basic and simple, like Ben Wa balls and vaginal cones—but many newer ones are a “high tech” and sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. More information will follow about these complex devices in future blog entries.

Bottom Line: Pelvic floor muscle training can be done with or without resistance devices like Ben Wa balls, vaginal cones, and the more sophisticated devices such as the Elvie.  The use of resistance devices adds a dimension beyond what is achievable by contracting one’s pelvic muscles without resistance (against air).  From a medical and exercise physiology perspective, muscles increase in strength in direct proportion to the demands placed upon them and resistance exercise is one of the most efficient ways to stimulate muscular and metabolic adaptation.

The slang term “pussy” is often used to connote “weak” and “ineffectual.”  Anastasia Steele’s “vagina of steel” fashioned by using Ben Wa Balls as a vaginal resistance device clearly shows that this does not have to be the case!

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

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 such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health http://www.TheKegelFix.com.  This book is written for educated and discerning women who care about health, well being, nutrition and exercise and enjoy feeling confident, sexy and strong.

The Kegel Fix is available in e-book format on the Amazon Kindle, iPad (Apple iBooks), Barnes & Noble Nook and Kobo and in paperback, all accessible via the following website: www.TheKegelFix.com. The e-book offers discretion, is less expensive, is delivered immediately, saves the trees, has adjustable fonts, as well as numerous hyperlinks—links to other sites activated by clicking—that access many helpful resources. Enjoy!