Posts Tagged ‘pelvic floor exercises’

“Preventive” Kegels: A Cutting-Edged Concept

August 25, 2018

Andrew Siegel MD  8/25/18

prevention                        Attribution: Alpha Stock Images – http://alphastockimages.com/

“People whose diseases are prevented as opposed to cured may never really appreciate what has been done for them. Zimmerman’s law: Nobody notices when things go right.” …Walter M. Bortz II, M.D.

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

Achieving a fit pelvic floor by strengthening and toning the pelvic muscles is a first line approach that can improve a variety of pelvic maladies in a way that is natural, easily accessible and free from harmful side effects. Although it is always desirable to treat the symptoms of pelvic floor dysfunction, it is another dimension entirely to take a proactive approach by strengthening the pelvic muscles to prevent pelvic floor dysfunction.

Pregnancy, labor, childbirth, aging, menopause, weight gain, gravity, straining and chronic increases in abdominal pressure take a toll on pelvic anatomy and function and can adversely affect vaginal tone, pelvic organ support, urinary and bowel control and sexual function.  Humans have a remarkable capacity for self-repair and pelvic issues can be dealt with after the fact, but why be reactive instead of being proactive?  Why not attend to future problems before they actually become problems? Isn’t a better approach “an ounce of prevention is worth a pound of cure”? Why not pursue a strategy to prevent pelvic floor dysfunction instead of fixing it, not allowing function to become dysfunction in the first place?

To be the “devil’s advocate,” the answers to the aforementioned questions posed may be:

  1. Why bother at all, since pelvic issues may never surface.
  2. Being proactive takes work and effort and many humans do not have the motivation and determination required to pursue and stick with any exercise program.
  3. If I put in the effort and pelvic issues never surface, how do I even know that it was my efforts that prevented the problem.

In the USA, over 350,000 surgical procedures are performed annually to treat two of the most common pelvic floor dysfunctions—stress urinary incontinence and pelvic organ prolapse.  Estimates are that by the year 2050, this number will rise to more than 600,000.  These sobering statistics provide the incentive for changing the current treatment paradigm to a preventive pelvic health paradigm with the goal of avoiding, delaying or diminishing deterioration in pelvic floor function.

If birth trauma to the pelvic floor often brings on pelvic floor dysfunction as well as urinary, bowel, gynecological and sexual consequences, why not start pelvic training well before pregnancy? This runs counter to both 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.

Realistically, pelvic training prior to pregnancy will not prevent pelvic floor dysfunction in everyone.  Unquestionably, obstetrical trauma (9 months of pregnancy, labor and vaginal delivery of a baby that is about half the size of a Butterball turkey, repeated several times) can and will often cause pelvic floor dysfunction, whether the pelvic muscles 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 the degree of the dysfunction and accelerating the healing process. Furthermore, mastering pelvic exercises before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery and the effortless resumption of the exercises in the post-partum period, as the exercises were learned under ideal circumstances, prior to pelvic injury. Since there are other risk factors for pelvic muscle dysfunction aside from obstetric considerations, this preventive model is equally applicable to women who are not pregnant or never wish to become pregnant.

Preventive health is 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.  In this spirit, I encourage those of you who are enjoying excellent pelvic health to maintain this health with a preventive pelvic training program.  For those working to improve your pelvic health, continue forward on the journey.  Regardless of whether your goal is treatment or prevention, a pelvic training program will allow you to honor your pelvic floor and become empowered from within.

Bottom Line: You can positively affect your own pelvic health destiny.  It is better not to be reactive and wait for your pelvic health to go south, but to 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 pelvic floor training program into your exercise regimen—it’s like a vaccine to prevent a disease that hopefully you will never get.

Wishing you the best of health,

2014-04-23 20:16:29

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

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

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

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

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

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

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

July 28, 2018

Andrew Siegel MD  7/28/2018

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

 

elvie

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

 

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

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

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

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

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

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

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

Do you really need to use a resistance device? 

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

Which resistance device will work best for you?

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

Wishing you the best of health,

2014-04-23 20:16:29

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

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

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

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

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

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

 

 

 

 

 

 

Ladies, If You Leak When You Exercise

June 30, 2018

Andrew Siegel MD  6/30/18

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

image above, Creative Commons

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

What physical activities cause leakage?

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

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

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

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

 So, what to do?

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

There is a better solution

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

New video on pelvic floor exercises.

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

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

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

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

2014-04-23 20:16:29

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

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

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

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

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

 

 

Try This First Before Seeing A Urologist

June 9, 2018

Andrew Siegel MD  6/9/2018

Picture1

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

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

What happens under normal circumstances

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

What happens to the frequent urinator

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

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

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

Fixing it

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

  1. FLUID AND CAFFEINE IN MODERATION

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

  1. ASSESS MEDICATIONS

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

  1. AVOID BLADDER IRRITANTS

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

Tobacco

Alcoholic beverages

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

Chocolate

Carbonated beverages

Tomatoes and tomato products

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

Spicy foods

Sugar and artificial sweeteners

Vinegar

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

Dairy products

  1. URGENCY INHIBITION

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

  1. INTERVAL TRAINING

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

  1. BOWEL REGULARITY

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

  1. PELVIC FLOOR MUSCLE TRAINING (PFMT)

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

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

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

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

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

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

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

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

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD: PelvicRx

Female version in the works: Female PelvicRx

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

 

 

 

 

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

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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

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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