Posts Tagged ‘pelvic floor muscle exercises’

DON’T Exercise Your Pelvic Muscles… TRAIN Them

April 1, 2017

Andrew Siegel MD  4/1/2017

“Exercise” is not the same as “training” and “pelvic floor exercises” (“Kegels”) are not the same as “pelvic floor training.”

1116_Muscle_of_the_Perineum (1)

Male (left) and female (right) pelvic floor muscles–By OpenStax [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)%5D, via Wikimedia Commons

To anybody interested in the nuances of exercise science, “exercising” and “training” are as different as apples and oranges. Don’t get me wrong—they are both healthy and admirable pursuits and doing any form of physical activity is far superior to being sedentary. However, exercise is more of being “in the moment,” a “here and now” physical activity– the short view. On the other hand, training is a well-planned and thought out process pursued towards the achievement of specific long-term goals– the long view. Every workout in a training program can be thought of as an incremental steppingstone in the process of muscle adaptation to achieve improvement or enhancement of function. The ultimate goal of a training program is being able to apply in a practical way the newly fit and toned muscles to daily activities—functional fitness—in order to achieve a better performance (and when it comes to the pelvic floor muscles, an improved quality of life.)

Muscle training is all about adaptation. Our muscles are remarkably adaptable to the stresses and loads placed upon them. Muscle growth will only occur in the presence of progressive overload, which causes compensatory structural and functional changes. That is 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–our muscles are “plastic,” meaning they are capable of growth or shrinkage depending on the environment to which they are exposed.

One obvious difference between pelvic floor muscles and other skeletal muscles is that the pelvic muscles are internal and hidden, which adds an element of challenge not present when training the visible arm, shoulder and chest muscles. However, the pelvic floor muscles are similar to other skeletal muscles in terms of their response to training. In accordance with the adaptation principle, incrementally increasing contraction intensity and duration, number of repetitions and resistance will build pelvic muscle strength, power and endurance.

The goal for pelvic floor muscle training is for fit pelvic muscles—strong yet flexible and equally capable of powerful contractions as well as full relaxation. The ultimate goal for pelvic floor muscle training—a goal that often goes unmentioned–is the achievement of “functional pelvic fitness.”  Pelvic floor muscle training really is the essence of functional fitness, training that develops pelvic floor muscle strength, power, stamina and the skill set that can be used to improve and/or prevent specific pelvic functional impairments including those of a sexual, urinary, or bowel nature and those that involve weakened pelvic support resulting in pelvic organ prolapse.

With occasional exceptions, most women and men are unable to perform a proper pelvic muscle contraction and have relatively weak pelvic floor strength. In my opinion, pelvic training programs should therefore initially focus on ensuring that the proper muscles are being contracted and on building muscle memory. It is fundamental to learn basic pelvic floor anatomy and function and how to isolate the pelvic muscles by contracting them independently of other muscles. Once this goal is achieved, pelvic training programs can be pursued.

Programs need to be able to address the specific area of pelvic weakness, e.g., if strength is the issue, emphasis on strength training is in order, whereas if stamina is the issue, focus on endurance training is appropriate. Furthermore, programs need to be designed for specific pelvic floor dysfunctions, with “tailored” training routines customized for the particular pelvic health issue at hand, whether it is stress urinary incontinence, overactive bladder, pelvic organ prolapse, sexual/orgasm issues, or pelvic pain. Aligning the specific pelvic floor dysfunction with the appropriate training program that focuses on improving the area of weakness and deficit is fundamental since each pelvic floor dysfunction is associated with unique and specific deficits in strength, power and/or endurance.

It is easiest to initially train the pelvic floor muscles in positions that remove gravity from the picture, then advancing to positions that incorporate gravity. It is sensible to begin with the simplest, easiest, briefest pelvic contractions, then advance to the more challenging, longer duration contractions, slowly and gradually increasing exercise intensity and degree of difficulty.

In my opinion, the initial training should not include resistance, which should be reserved for after achieving mastery of the basic training that provides the foundation for pelvic muscle proficiency.

Bottom Line: If you are serious about improving or preventing a pelvic floor dysfunction, you need to do pelvic floor muscle training as opposed to pelvic floor exercises. There are numerous differences including the following:

  • Training is motivated by specific goals and purposes while exercise is done for its own sake or for more general reasons
  • Training requires a level of focus and intensity not demanded by exercise
  • Training requires a plan
  • Training can be a highly effective means of improving and preventing pelvic floor dysfunction

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

Even More About Pelvic Prolapse: Diagnosis & Treatment

October 29, 2016

Andrew Siegel MD 10/29/2016

Note: This is the final entry in a 3-part series about pelvic organ prolapse.

 How is POP diagnosed and evaluated?

The diagnosis of POP can usually be made by listening to the patient’s narrative: The typical complaint is “Doc, I’ve got a bulge coming out of my vagina when I stand up or strain and at times I need to push it back in.”

After listening to the patient’s history of the problem, the next step is a pelvic examination in stirrups.  However, the problem with an exam in this position is that this is NOT the position in which POP typically manifests itself, since POP is a problem that is provoked by standing and exertion. For this reason, the exam must be performed with the patient straining forcefully enough to demonstrate the POP at its fullest extent.

A pelvic examination involves observation, a speculum exam, passage of a small catheter into the bladder and a digital exam. Each region of potential prolapse through the vagina—roof, apex, and floor—must be examined independently.

box

A useful analogy is to think of the vagina as an open box (see above), with the vaginal lips represented by the open flaps of the box.  A cystocele (bladder prolapse) occurs when there is weakness of the roof of the box, a rectocele (rectal prolapse) when there is weakness of the floor of the box, and uterine prolapse or enterocele (intestinal prolapse) when there is weakness of the deep inner wall of the box.

Inspection will determine tissue health and the presence of a vaginal bulge with straining. After menopause, typical changes include thinning of the vaginal skin, redness, irritation, etc. The ridges and folds within the vagina that are typical in younger women tend to disappear after menopause.

Useful analogy: The normal vulva is shut like a closed clam. POP often causes the vaginal lips to gape like an open clam.

Since the vagina has top and bottom walls and since the bulge-like appearance of POP of the bladder or rectum look virtually identical—like a red rubber ball—it is imperative to use a speculum to sort out which organ is prolapsing and determine its extent. A one-bladed speculum is used to pull down the bottom wall of the vagina to observe the top wall for the presence of urethral hypermobility and cystocele, and likewise, to pull up the top wall to inspect for the presence of rectocele and perineal laxity. To examine for uterine prolapse and enterocele, both top and bottom walls must be pulled up and down, respectively, using two single-blade specula. Once the speculum is placed, the patient is asked to strain vigorously and comparisons are made between the extent of POP resting and straining, since prolapse is dynamic and will change with position and activity.

 

exam-relaxed

Image above shows vaginal exam at rest (mild prolapse)

exam-minor-strain

Image above shows vaginal exam with straining (moderate prolapse)

exam-full-streain

Image above shows vaginal exam with more straining (more severe prolapse)

After the patient has emptied her bladder, a small catheter (a narrow hollow tube) is passed into the bladder to determine how much urine remains in the bladder, to submit a urine culture in the event that urinalysis suggests a urinary infection and to determine urethral angulation. With the catheter in place, the angle that the urethra makes with the horizontal is measured. The catheter is typically parallel with the horizontal at rest. The patient is asked to strain and the angulation is again measured, recording the change in urethral angulation that occurs between resting and straining. Urethral angulation with straining (hypermobility) is a sign of loss of urethral support, which often causes stress urinary incontinence (leakage with cough, strain and exercise).

Finally, a digital examination is performed to assess vaginal tone and pelvic muscle strength. A bimanual exam (combined internal and external exam in which the pelvic organs are felt between vaginal and external examining fingers) is done to check for the presence of pelvic masses. On pelvic exam it is usually fairly obvious whether or not a woman has had vaginal deliveries. With exception, the pelvic support and tone of the vagina in a woman who has not delivered vaginally can usually be described as “high and tight,” whereas support in a woman who has had multiple vaginal deliveries is generally “lower and looser.”

Depending upon circumstances, tests to further evaluate POP may be used, including an endoscopic inspection of the lining of the bladder and urethra (cystoscopy), sophisticated functional tests of bladder storage and emptying (urodynamics) and, on occasion, imaging tests (bladder fluoroscopy or pelvic MRI).

cystogram-normal

Image above is x-ray of bladder showing oval-shaped well-supported normal bladder.

cd-cystocele

                    Image above is x-ray of bladder showing tennis-racquet shaped bladder,                          which is high-grade cystocele.

How is POP treated?

First off, it is important to know that POP is a common condition and does not always need to be treated, particularly when it is minor and not causing symptoms that affect one’s quality of life.

There are three general options of managing POP: conservative; pessary and surgery (pelvic reconstruction).

Conservative treatment options for POP include pelvic floor muscle training Kegel); modification of activities that promote the POP (heavy lifting and high impact exercises); management of constipation and other circumstances that increase abdominal pressure; weight loss; smoking cessation; and consideration for hormone replacement since estrogen replacement can increase tissue integrity and suppleness.

A pessary is a mechanical device available in a variety of sizes and shapes that is inserted into the vagina where it acts as “strut” to help provide pelvic support.

512px-pessaries

Image above is an assortment of pessaries (Thank you Wikipedia, public domain)

The side effects of a pessary are vaginal infection and discharge, the inability to retain the pessary in proper position and stress urinary incontinence caused by the “unmasking” of the incontinence that occurs when the prolapsed bladder is splinted back into position by the pessary. Pessaries need to be removed periodically in order to clean them. Some are designed to permit sexual intercourse.

Studies comparing the use of pessaries with pelvic floor training in managing women with advanced POP have shown that both can significantly improve symptoms; however, pelvic floor muscle training has been shown to be more effective, specifically for bladder POP.

PFM Training (PFMT)

PFMT is useful under the circumstances of mild-moderate POP, for those who cannot or do not want to have surgery and for those whose minimal symptoms do not warrant more aggressive options. The goal of PFMT is to increase the strength, tone and endurance of the pelvic muscles that play a key role in the support of the pelvic organs. Weak pelvic muscles can be strengthened; however, if POP is due to connective tissue damage, PFMT will not remedy the injury, but will strengthen the pelvic muscles that can help compensate for the connective tissue impairment. PFMT is most effective in women with lesser degrees of POP and chances are that if your POP is moderate-severe, PFMT will be less effective. However, if not cured, the POP can still be improved, and that might be sufficient for you.

Numerous scientific studies have demonstrated the benefits of PFMT for POP, including improved pelvic muscle strength, pelvic support and a reduction in the severity and symptoms of POP. Improvements in pelvic support via PFMT are most notable with bladder POP as opposed to rectal or uterine POP. PFMT is also capable of preventing POP from developing when applied to a healthy female population without POP.

In symptomatic advanced POP, surgery is often necessary, particularly when quality of life has been significantly impacted. There are a number of considerations that go into the decision-making process regarding the specifics of the surgical procedure (pelvic reconstruction) to improve/cure the problem. These factors include which organ or organs are prolapsed; the extent and severity of the POP; the desire to have children in the future; the desire to be sexually active; age; and, if the POP involves a cystocele, the specific type of cystocele (since there are different approaches depending on the type). Surgery to repair POP can be performed vaginally or abdominally (open, laparoscopic or robotic), and can be done with or without mesh (synthetic netting or other biological materials used to reinforce the repair). The goal of surgery is restoration of normal anatomy with preservation of vaginal length, width and axis and improvement in symptoms with optimization of bladder, bowel and sexual function.

More than 300,000 surgical procedures for repair of POP are performed annually in the United States. An estimated 10-20% of women will undergo an operation for POP over the course of their lifetime.

Dr. Arnold Kegel—the gynecologist responsible for popularizing pelvic floor exercises—believed that surgical procedures for female incontinence and pelvic relaxation are facilitated by pre-operative and post-operative pelvic floor exercises. Like cardiac rehabilitation after cardiac surgery and physical rehabilitation after orthopedic procedures, PFMT after pelvic reconstruction surgery can help minimize recurrences. Pre-operative PFMT—as advocated by Kegel—can sometimes improve pelvic support to an extent such that surgery will not be necessary. At the very least, proficiency of the PFM learned pre-operatively (before surgical incisions are made and pelvic anatomy is altered) will make the process of post-operative rehabilitation that much easier.

Useful resource: Sherrie Palm is an advocate, champion and crusader for women’s pelvic health who has made great strides with respect to POP awareness, guidance and support. She is founder and director of the Association for Pelvic Organ Prolapse Support and author of “Pelvic Organ Prolapse: The Silent Epidemic.” Visit PelvicOrganProlapseSupport.org.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

 

“The Kegel Fix”: A New Twist On An Old Exercise

September 24, 2016

Andrew Siegel  MD  9/24/2016

Cover

I am a urologist with a strong interest in pelvic health, fitness and conditioning. Having first developed a curiosity with in this while in training as a urology resident at the Hospital of University of Pennsylvania, I became captivated with it at the time of my post-graduate fellowship training at UCLA. Since early adulthood, I have been passionate about the vitality of healthy living (“Our greatest wealth is health”) and I have come to recognize that pelvic health is an important component of a healthy lifestyle.

My philosophy of pelvic medicine embodies the principles that follow:  One of my key roles is as a patient educator in order to enable patients to have the wherewithal to make informed decisions about their health (In fact, the word doctor comes from the Latin docere, meaning “to teach”). I am a firm believer in trying simple and conservative solutions before complex and aggressive ones. Furthermore, I abide by the concept that if it isn’t broken, there is no purpose trying to fix it, expressed by the statement: “Primum non nocere,” meaning “First do no harm.”  I am an enthusiastic advocate of healthy lifestyle as critical to our wellbeing and enjoy the following quote: “Genes load the gun, but lifestyle pulls the trigger.”

After many years on the urology/gynecology front lines, I have concluded that pelvic health is a neglected area of women’s health, despite pelvic floor problems being incredibly common after childbirth. The notion of pelvic exercise (a.k.a. Kegels) is a vastly unexploited and misunderstood resource, despite great potential benefits to exercising these small muscles that can have such a large impact.  A strong pelvic floor has innumerable advantages, including helping one prepare for pregnancy, childbirth, aging and high impact sports.  I have found that most women have only a very cursory and superficial knowledge of pelvic anatomy and function.  I have also discovered that it is challenging to motivate women to exercise internal muscles that are not visible and are generally used subconsciously, ensure that the proper muscles are being exercised and avoid boredom so that the exercises are not given up prematurely.

Surprisingly, I have found that even health care personnel –those “in the know” including physical therapists, personal trainers and nurses–have difficulty becoming adept at pelvic conditioning. When asked to clench their pelvic muscles, many women squeeze their buttocks, thigh or abdominal muscles, others lift their bottom in the air as one would do the “bridge” maneuver in yoga class, and still others strain down as opposed to pull up and in.

The good news is that following decades of “stagnancy” following the transformative work of Dr. Arnold Kegel in the late 1940s–who was singularly responsible for popularizing pelvic floor exercises in women after childbirth–there has been a resurgence of interest in the pelvic floor and the benefits of pelvic floor training. I am pleased to be able to contribute to this pelvic renaissance with the publication of The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health. The book is a modern take on pelvic exercises that I was motivated to write because of my frustration with the existing means of educating women with respect to their pelvic floors and how to properly exercise them to reap the benefits that can accrue.

I thought carefully about the specific pelvic floor problems that Kegel exercises can potentially address—pelvic organ prolapse, sexual issues, stress urinary incontinence, overactive bladder/bowel, and pelvic pain due to pelvic muscle tension—and how each of these issues is underpinned by unique pelvic floor deficits not necessarily amenable to the one-size-fits-all approach that has been traditionally used. In The Kegel Fix I introduce home-based, progressive, tailored exercises consisting of strength, power and endurance training regimens—customized for each specific pelvic floor problem. The book is appropriate not only for women suffering with the aforementioned pelvic problems, but also for those who wish to maintain healthy pelvic functioning and prevent future problems.

I have found that most women who are taught Kegel exercises are uncertain about how to put them into practical use. This is by no fault of their own, but because they have not been taught “functional pelvic fitness”–what I call “Kegels-on-demand.” This concept—a major emphasis of the book—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—to condition these muscles and to apply them in such a way and at the indicated times so as to improve one’s quality of life—as opposed to static and isolated, out of context exercises.

Bottom Line: Conditioning one’s pelvic muscles and learning how to implement this conditioning is a first-line, non-invasive, safe, natural approach with the potential for empowering women and improving their pelvic health, with benefits from bedroom to the bathroom. Many women participate in exercise programs that include cardio and strength training of the external muscles including the chest, back, abdomen, arms and legs. It is equally important to exercise the pelvic floor muscles, perhaps one of the most vital groups of muscles in the body.

The Kegel Fix is available in e-book format on the Amazon Kindle, iPad (Apple iBooks), Barnes & Noble Nook and Kobo and in paperback: www.TheKegelFix.com. The e-book offers discretion, which some find advantageous for books about personal and private issues, as well as the fact that it is less expensive, is delivered immediately, saves the trees, and fonts can be adjusted to one’s comfort level. Furthermore, the e-book has numerous hyperlinks—links to other sites activated by clicking—that access many helpful resources.  The book was written for educated and discerning women who care about health, well being, nutrition and exercise and enjoy feeling confident, sexy and strong.

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

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

 

 

 

 

The Mystique Of The Pelvic Floor Muscles (PFM)

August 27, 2016

Andrew Siegel MD 8/27/16

1.core muscles

 Note that PFM form floor of the “barrel” of core muscles. Illustration by Ashley Halsey from THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Our bodies are comprised of a variety of muscle types: There are the glamour, overt, seen-and-be-witnessed muscles that offer no secrets, the “what you see is what you get” muscles. Then there are muscles that are shrouded in secrecy, hidden from view, veiled from sight, concealed and covert. The pelvic floor muscles (PFM) are in the latter category.

Strong puritanical cultural roots influence our thoughts and feelings about our nether regions. Consequently, the genital and anal zones often fail to command the respect and attention that other areas of our bodies command. Frequently ignored and/or neglected, this locale rarely sees the light of day and most people never think about exercising the important functional muscles in this anatomical sector.

Most women and men can probably point out their “bi’s” (biceps), “tri’s” (triceps), “quads” (quadriceps), “pecs” (pectorals), etc., but who really knows where their “pelvs” (PFM) are located? For that matter, who even knows what they are and how they contribute to pelvic health? Think for a moment about the PFM…How essential—yet taken for granted—are sphincter control, support of your pelvic organs and, of course, their key contribution to sexual function?

Unlike the glitzy, for show, external, mirror-appealing glamour muscles, the PFM are humble muscles that are unseen and behind the scenes, often unrecognized and misunderstood. Cloaking increases mystique, and so it is for these PFM, not only obscured from view by clothing, but also residing in that most curious of nether regions—the perineum—an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the PFM, which straddle the gamut of being vital for what may be considered the most pleasurable and refined of human pursuits—sex—but equally integral to what may be considered the basest of human activities—bowel and bladder function.

The PFM are hidden gems that work diligently behind the scenes and on a functional basis you would be much better off having “chiseled” PFM as opposed to having “ripped” external muscles.” Tapping into and harnessing the energy of the PFM—those that favor function over form, “go” rather than “show”—is capable of providing significant benefits. The PFM are the floor of the core muscles and seem to be the lowest caste of the core muscles; however, they deserve serious respect because they are responsible for very powerful functions, particularly so when intensified by training. The PFM are among the most versatile muscles in our body, contributing to the support of our pelvic organs, control of bladder and bowel, and sexual function. Although the PFM are not muscles of glamour, they are muscles of “amour.”

Bottom Line: You can’t see your PFM in the mirror. Because they are out of sight and out of mind, they are often neglected or ignored, but there is great merit in exercising vital hidden muscles, including the heart, diaphragm and PFM. This goes for men as much as it does for women, since in both genders these muscles provide vital functions and are capable of being enhanced with training.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

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

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

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

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

 

Urethral Bulking Agents: Alternative To Stress Incontinence Surgery

August 6, 2016

Andrew Siegel MD    8/6/2016

macroplastique

Illustration of bulking agent being injected into urethral tissues to plump up and compress the urethra

Stress Urinary Incontinence (SUI)

SUI is a common condition that affects one in three women during their lifetimes, most often young or middle-aged women, although it can happen at any age. An involuntary spurt of urine occurs at times of sudden increases in abdominal pressure.  This can happen with coughing, sneezing, laughing, jumping or exercise. It can even happen with walking, changing position from sitting to standing or during sex.

SUI most often occurs because the tissues that support the urethra (the channel that conducts urine from the bladder) have weakened and no longer provide an adequate “backboard.” This allows the urethra to be pushed down and out of position at times of sudden increases in abdominal pressure, a condition known as urethral hyper-mobility. The key inciting factors are pregnancy, labor and delivery, particularly traumatic vaginal deliveries of large babies.

Although the predominant cause of SUI is inadequate urethral support, it may also be caused by a weakened or damaged urethra itself, a condition known as sphincter dysfunction. Risk factors for this are menopause, prior pelvic surgery, nerve damage, radiation and pelvic trauma. A severely compromised urethral sphincter causes significant urinary leakage with minimal activities and typically results in “gravitational” incontinence, a profound urinary leakage that accompanies positional change. In this situation the sphincter does not provide sufficient closure to pinch the urethra closed.

Useful analogy: Sphincter dysfunction is similar to a situation in which a sink faucet is leaky because of a brittle washer that has lost the suppleness to provide closure.

First-line Treatment For SUI: Pelvic Floor Muscle (PFM) Training (Kegels)

It is important to know that you can tap into the powers of your PFM and harness the natural reflex that inhibits stress urinary incontinence. Combatting SUI demands that the PFM contract strongly, rapidly and ultimately, reflexively. The goal of Kegels is to increase PFM strength, power, endurance and coordination to improve the urethral support and closure mechanism. This has the potential to improve or cure SUI in those who suffer with the problem and prevent it in those who do not have it.

Kegel exercises are most effective in women with mild or mild-moderate SUI. Kegels increase PFM bulk and thickness, including the sphincter mechanism, reducing the number of SUI episodes. Additionally, Kegels improve urethral support at rest and with straining, diminishing the urethral hyper-mobility that is characteristic of SUI. It also permits earlier activation of the PFM when coughing, more rapid repeated PFM contractions and more durable PFM contractions between coughs. PFM training can cure or considerably improve 60-70% of women who suffer with SUI. The benefits persist for many years, as long as the exercises are adhered to on an ongoing basis.

Urethral Bulking Agents

The “gold standard” treatment of SUI that does not respond to conservative measures is a mid-urethral sling, a surgical procedure that provides support and a “backboard” to the urethra.  Cure or significant improvement is in the 85-90% range with sling surgery.  An alternative to the sling surgery is the injection of a urethral bulking agent.

Urethral bulking agents are typically used for SUI due to weakened or poorly functional sphincter muscles.  A special material—a bulking agent—is injected into the tissues around the urethra in an effort to “plump” up the urethra to help provide closure to it, with the goal of improving urinary control. The material works by bulking up the layer of the urethra immediately under the inner urethral lining, providing closure of the urethra via compression. This outpatient procedure is simple to perform and generally takes only a few minutes. In theory, it is similar to the lip injections that are used by plastic surgeon in order to plump up the lips and make them appear fuller, suppler and more sensuous.

The urethral bulking agent procedure is done under direct visual control using a small, lighted scope (cystoscope) that is inserted into the urethra. The bulking material is injected into the tissue immediately under the urethral lining while the plumping and closure of the urethra is observed. Several treatments may be necessary for lasting results.

There are three materials that are FDA-approved bulking agents: carbon-coated beads suspended in a water gel (Durasphere); calcium hydroxylapatite (Coaptite); and silicone microparticles (Macroplastique).

For whom are bulking agents appropriate?

  • Women with SUI primarily due to sphincter dysfunction
  • Women who are too elderly or frail or have too many medical issues to undergo anesthesia and standard mid-urethral sling surgery
  • Women who have had unsuccessful or incompletely successful sling surgery
  • Women who wish to avoid surgery for SUI
  • Women who have SUI and wish to have more children
  • Women with mild SUI
  • Women with SUI who are anti-coagulated with “blood thinners” and whose anti-coagulation status cannot safely be reversed

How effective are bulking agents?

Generally, bulking agents result in a 75% improved or cure rate, including about 30% who are cured and 25% who fail to improve.  It is important to understand that the effectiveness of urethral bulking agents is inferior to that of sling surgery, the duration is limited and multiple repeat injections may be required. Improvement rather than cure is the goal.

Can urethral bulking agents be used for men as well as women?

Yes, they have been used in men with SUI after prostatectomy, but the results are less favorable than the results in women.

Bottom Line: Injection of urethral bulking agents is a reasonable alternative to mid-urethral sling surgery in certain populations of women who either are not medically fit for sling surgery, have failed sling surgery, or wish to defer or avoid sling surgery.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

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

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

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

Arnold Kegel’s Device—The Perineometer: Prototype Resistance Device

July 23, 2016

Andrew Siegel MD 7/23/16

perineometer

Image above: Arnold Kegel’s perineometer

 

The pelvic floor muscles and vagina often become traumatized with the process of pregnancy, labor and vaginal delivery.  Pelvic floor dysfunctions may result, including pelvic organ prolapse and vaginal laxity, stress urinary incontinence and sexual issues.

In the 1940s, Dr. Arnold Kegel created a special apparatus called a perineometer to help restore pelvic function and vaginal tone in women who had recently delivered babies.  The term is derived from perineum–the anatomical region between the vagina and anus (where many of the pelvic floor muscles are located) and  meter–to measure.  The device was placed in the vagina and provided resistance to contract the pelvic floor muscles upon and feedback as to pelvic floor muscle strength.

The perineometer is a pneumatic chamber about three inches in length and less than one inch in width. It is attached by tubing to a pressure measuring tool (similar to a blood pressure gadget) that is capable of measuring pressures ranging from 0-100 millimeters (mm). The patient inserted the device into her vagina and then contracted her pelvic muscles. The device provided resistance to clench down upon, similar to contracting one’s biceps against the resistance of the weight of a dumbbell as opposed to doing arm flexes with no weights. The perineometer allowed the user to observe the magnitude of each contraction of her pelvic muscles.

Who Knew? In terms of feedback, the perineometer device is not unlike the “ring the bell” strongman game at an amusement park where one swings a mallet as hard as they can in an effort to ring a bell mounted at the top.

The feedback element was of vital importance to the pelvic floor muscle training process, serving as a visual aid and confirming to the patient that the proper muscles were being contracted. It also served the purpose of showing day-to-day improvement, helping to encourage the participant to complete the program. Kegel recommended recording the maximal contraction at each exercise session, the written documentation providing further encouragement.

 Who Knew? Tracking one’s performance is fundamental to the success of pelvic training. By being able to observe forward progress over time, the process is enabled.

Kegel observed that when the vaginal muscles were well developed and had a contractile strength of 20 mm or more, sexual complaints were infrequent. However, when the vaginal muscles were inelastic, thin, poorly toned and had a weak contractile strength, sexual dissatisfaction was commonplace. Kegel observed that younger patients progressed more rapidly through pelvic training than older ones.

Who Knew? Patients vary greatly in their ability to contract their vaginal muscles. Some women are incapable of clenching down on an examining finger in the vagina, whereas others can squeeze so hard that the finger hurts!

Kegel recognized that pelvic muscle reconditioning proceeded in a sequence of stages. The initial phase was awareness and coordination. The next phase was transitional, the adaptive phase when the body learns how to properly execute the exercises; this was followed by regeneration, when the pelvic muscles respond to the exercises and increase their mass, strength, power and coordination. The final stage was restoration, in which there was a leveling out of the maximal pelvic muscle contractions.

Who Knew? Kegel observed that following restoration of pelvic floor muscle function in women with incontinence or pelvic laxity, many patients had increased sexual feelings—including more readily achieved and better quality orgasms.

Kegel’s PFMT regimen was rigorous, requiring a significant investment of time: 20 minutes three times daily for a total of 20-40 hours of progressive resistance exercise over a 20-60 day period. He emphasized the importance of not only pursuing pelvic training after pregnancy, but also prophylactically during pregnancy.

Bottom Line: In the 1940s, Dr. Arnold Kegel developed the prototype pelvic training device used to provide feedback to the user as well as create resistance to contract down upon. After many years of quiescence following Dr. Kegel’s seminal work, we have recently witnessed the availability of numerous resistance devices available in a rapidly changing, competitive and evolving market, all of which are based on Kegel’s perineometer. Most of the sophisticated training devices provide similar basic functionality—insertion into the vagina, connection to a smartphone app, and biofeedback and tracking—although each device has its own special features. An upcoming blog will review the current devices that are available. 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

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

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

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

 

 

What You Don’t Know About Your Pelvic Floor Muscles, But Should

June 18, 2016

Andrew Siegel, M.D. 6/18/16

* Please note that although this entry is written for women, it is equally applicable to men.

In dogs, the pelvic floor muscles (PFM) play an important role with respect to tail position and movement. They are responsible for tail wagging in circumstances when dogs are happy and for the tail being held down between the legs when dogs are frightened or anxious. Weak PFM are virtually unheard of in the canine population, suggesting that with constant tail movement, the PFM are exercised sufficiently to maintain tone and vitality.

 

foot in water bowl

Photo above is Charley, my English Springer Spaniel.  Note her happy, erect tail and her curious habit of eating with her foot in her water bowl.

For better or worse, humans do not have tails to wag or place between our legs.  Tails became extinct with the evolutionary process (with the exception of the character played by Jason Alexander in the movie “Shallow Hal”). If we did have tails, our PFM would likely get a great deal more exercise than they typically do.

Sadly, the PFM don’t get the respect that the glitzy, for-show, mirror-appealing, external glamour muscles do. However, the PFM are hidden gems that work diligently behind the scenes–muscles of major function and not so much form-offering numerous powers and benefits, particularly so when intensified by training. Although not muscles of glamour, they are muscles of “amour,” and have a profoundly important role in sexual, urinary, and bowel function as well as in supporting our pelvic organs.

What are the PFM?

The PFM—commonly known as the “Kegel muscles”—are a muscular hammock that form the bottom of the pelvis. They are also referred to as the “saddle” muscles because you sit on them when seated on a bicycle. They are part of the “core” group of muscles.

What are the “core” muscles?

The core muscles are the “barrel” of muscles comprising the torso, consisting of the abdominal muscles in front, the lumbar muscles in back, the diaphragm muscle on top and the PFM on the bottom. The core muscles are responsible for stabilizing the pelvis and holding the spine erect.

1.core muscles

                              Illustration of core muscles by Ashley Halsey from                                            The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health

Where are the PFM?

The deep PFM (pubococcygeus, iliococcygeus, coccygeus) span from the pubic bone in front to the tailbone in the back, and from pelvic sidewall to pelvic sidewall, between the “sit” bones.

2.deep PFM              Illustration of deep PFM muscles by Ashley Halsey

The superficial PFM (ischiocavernosus, bulbocavernosus, transverse perineal, anal sphincter) are situated under the surface of the external genitals and anus.

3. superficial and deep PFM

            Illustration of superficial and deep PFM muscles by Ashley Halsey

 

What is the function of the PFM?                                                                      

The PFM muscles intertwine with the muscles of the vagina, bladder and rectum,  provide support for the pelvic organs, play a vital role in sexual function and contribute to the control mechanism of the urinary and intestinal tracts.

What is PFM dysfunction?

PFM “dysfunction” is a common condition referring to when the PFM are not functioning properly. PFM dysfunction ranges from “low tone” to “high tone.” Low tone occurs when the PFM lack in strength and endurance and is often associated with stress urinary incontinence (urinary leakage with coughing, sneezing, laughing, exercising and other physical activities), pelvic organ prolapse (when one or more of the pelvic organs fall into the space of the vagina and at times outside the vagina) and altered sexual function (decreased sensation, difficulty accommodating a penis because of looseness, difficulty achieving climax, etc.). High tone occurs when the PFM are too tense and unable to relax, giving rise to a pain syndrome known as pelvic floor tension myalgia (this situation is entirely analogous to the high-strung dog with its tail between its legs).

Trivia: PFM dysfunction often causes symptoms in several domains, e.g., women with urinary control issues often have trouble achieving orgasm, both problems contributed to by weak PFM.

What causes PFM dysfunction?

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

Why are the PFM so vital to your health?

The PFM are perhaps the most versatile yet under-appreciated muscle group in your body. They provide vaginal tone, support to the pelvic organs, a healthy sexual response–enhancing arousal and orgasm–and urinary and bowel sphincter control. They play a key role in your ability to carry and deliver a baby as well as contributing to the mobility and stability of your torso.

A simplified way of thinking of the female pelvic organs–bladder, uterus and bowel–is as “storage containers” for urine, fetuses, and stool, respectively. Each organ is connected to the outside world by tubular structures, the urethra, vagina and anal canal, respectively, through which flow the contents of the organs. The PFM play a strong role in compressing the tubes for storage and relaxing them for emptying.

What Is the muscle function of the PFM?

Whereas most skeletal muscles function as movers (joint movement and locomotion), the PFM are unique in that they function as stabilizers—helping to keep the pelvic organs in proper position—and compressors—helping to tighten the vagina, urethra and rectum—important to urinary and bowel control as well as to sexual function. During sex the PFM activate, causing a surge of genital blood flow that helps lubrication and clitoral engorgement; at the time of orgasm, the PFM contract rhythmically.

Why bother exercising your PFM?                                                        

The PFM are out of sight and out of mind; however, they have vital functions, so are muscles that you should be exercising. PFM training is based upon solid exercise science and can help maintain PFM integrity and optimal function into old age. The PFM are capable of making adaptive changes when targeted exercise is applied to them. Pelvic training involves gaining facility with both the contracting and the relaxing phases of PFM function. Their structure and function can be enhanced, resulting in broader, thicker and firmer PFM with a stronger resting tone and the ability to generate a powerful contraction at will. PFM training can be effective in stabilizing, relieving, improving and even preventing issues with pelvic support, sexual function, and urinary and bowel control. In addition to the muscle-training benefit of PFM training, it also supports tissue healing by stimulating the flow of oxygenated, nutritionally-rich blood to the vagina and other pelvic organs.

Because of pregnancy, labor and delivery, the PFM get stretched more than any other muscle group in the body. Through pelvic training, the PFM have the capacity of rebounding from this obstetrical “trauma,” recovering tone and function. Prenatal pelvic training can help fortify the PFM in preparation for pregnancy, labor and delivery.

Bottom Line: The PFM may literally be at the bottom of the barrel of our core muscles, but in terms of their important functions, they are figuratively furthermost from the “bottom of the barrel.” Without functioning PFM, your organs would dangle out of your pelvis, you would be wearing adult diapers and your sexual function would be non-existent. It behooves you to keep these vital muscles in tip-top shape. 

Please check out the following 3 minute video entitled “Why Kegel?”:

https://www.youtube.com/watch?v=kclY1vY3wG8

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

Author page on Amazon: 

http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook:

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

The Kegel Fix trailer: 

https://www.youtube.com/watch?v=uHZxoiQb1Cc  

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

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

Vaginal Tone: How Tight Is Right?

June 11, 2016

Andrew Siegel, M.D.   6/10/16

IMG_1544

The strength and firmness of the vagina is largely determined by the strength and tone of the pelvic floor muscles .  As a urologist who treats many female pelvic problems, questions about vaginal tightness and tone are not infrequently raised by concerned patients.  It is important to distinguish strength from tone.  A condition exists in which the pelvic floor muscles are tight and over-toned (“hypertonic”), yet weak, inflexible and with an impaired ability to relax after a contraction.  This is a pathological condition of the pelvic floor muscles which can give rise to pelvic pain, sexual dysfunction and numerous other symptoms.

The Effect of Vaginal Delivery

The most compelling factor affecting vaginal form is vaginal childbirth.  A recent article from the British Journal of Obstetrics and Gynecology (Kamisian et al, 2015; 122:867-872) studied the relationship between childbirth and vaginal dimensions in women presenting with urinary control issues and pelvic organ prolapse. The average measurement of the vaginal opening (obtained upon abdominal straining) was 29 cm² in women who had vaginal deliveries versus 21.5 cm² in women who had not delivered vaginally. Having more than one child did not further increase the size of the vaginal opening in a significant way. Bottom Line: The researchers concluded that there are clearly anatomical differences present in women who have delivered vaginally versus those who have not and that most of the stretching effect of vaginal childbirth is related to the first delivery.

 The Vagina: A Mysterious But Amazing Place

Trivia: The word “vagina” derives from the Latin word for “sheath,” a cover for the blade of a knife or sword. The word “penis” derives from the Latin word for “tail.”

Although for many people–both women and men–the vagina is a dark and mysterious place, it is impressive how versatile and multifunctional an organ it is. The vagina wears many “hats,” functioning as an entryway for the penis during sexual intercourse, an inflow pathway and receptacle for semen, an outflow pathway for menstruation and a birth canal. The elasticity of the vagina is extraordinary, with an astonishing ability to stretch to accommodate a baby’s head and then return to a relatively normal caliber. That stated, pregnancy, labor and delivery–particularly vaginal deliveries of large babies–has the potential to profoundly affect the anatomy and function of the vagina and its supportive pelvic muscles.  Although not inevitable, this can result in vaginal laxity (looseness) and other pelvic floor dysfunctions including pelvic organ prolapse (dropped bladder and other pelvic organs), stress urinary incontinence (urinary leakage with coughing, sneezing and physical exertion) and sexual issues.

Trivia: Elective C-section (no labor) is generally protective against vaginal laxity, whereas emergency C-section (after prolonged labor) is equally as potentially damaging to the vaginal support system as is vaginal delivery.

Is Your Vagina Toned/Tight Enough?

If you have ever wondered if your vagina is toned enough and how it might compare with others, you are by no means alone. Like penis size for men, this can be a source of concern and anxiety for many women. A “fit” vagina and pelvic floor is a desirable physical attribute, correlating with youthful vitality, better sexual function for women and their partners and less risk for pelvic organ prolapse and stress urinary incontinence.

Trivia: Leonardo Da Vinci observed that while women generally desire the size of a man’s genitals to be as large as possible, men typically desire the opposite for a woman’s genitals.

Vaginal tone is strongly impacted by the strength and tone of the pelvic floor (Kegel) muscles, but is also influenced by the strength and tone of the muscle layers of the vagina itself. Vaginas come in all sizes and shapes and run the gamut from being very snug to very loose. The vast majority of vaginas are between these too extremes,  “toned sufficiently.” On one extreme, the vagina and pelvic muscles can be so snug that the vagina cannot be penetrated, a medical condition known as vaginismus, which can be a devastating physical and emotional problem. It is an extreme form of pelvic floor tension myalgia, a pelvic pain syndrome referred to earlier resulting from pelvic floor muscles that are chronically over-tensioned. Extremely narrow and tight vaginas are also common in the elderly population that is not sexually active, on the basis of disuse atrophy and the lack of hormone stimulation that accompanies menopause.

On the other hand, the vagina, pelvic floor muscles and other connective tissue support can be so lax that the vagina gapes open, allowing one or more of the pelvic organs to fall into the space of the vagina and at times, outside of the vagina. This can also give rise to other pelvic issues having to do with sexual function and urinary/bowel control. Laxity can lead to difficulties with retaining the penis with vaginal intercourse, retaining tampons and in achieving orgasm.  Vaginal laxity can also result in the vagina filling up with water while bathing and vaginal passage of air (vaginal flatulence). The perception of having a loose vagina can lead to self-esteem issues.

 The Role of Vaginal Tone In Sexual Function

To reiterate, vaginal fitness is an important factor in terms of sexual function and is largely determined by pelvic floor muscle strength and tone. Vaginal laxity is caused by weakened pelvic muscles, vaginal muscles and connective tissue that no longer provide optimal vaginal support. Women with a lax vagina who are sexually active may complain of less satisfying sexual intercourse with diminished sensation for themselves and their partners with an impairment in “accommodating” the penis, with the vagina “surrounding” the penis rather than firmly “squeezing” it.

Under normal circumstances, sexual intercourse results in indirect clitoral stimulation. The clitoral shaft moves rhythmically with penile thrusting by virtue of penile traction on the inner vaginal lips, which join together to form the hood of the clitoris. However, if the vaginal opening is too wide to permit the penis to put sufficient traction on the inner vaginal lips, there can be decreased clitoral stimulation and less satisfaction in the bedroom.

Trivia: George Carlin did a routine about women who have a special gift with the strength, tone and finesse of their vaginas and pelvic floor muscles that I will attempt to paraphrase. He referred to the vaginas of these women as “snapping,” which he defined as “quick muscular control and vaginal elasticity that can grab ahold of you.”  What he was actually describing was women with excellent command of their pelvic floor muscles. 

 So How Tight Is Right?

Dr. Arnold Kegel in the 1940s invented a device called a perineometer that was inserted into the vagina to record the pelvic floor muscle contractile strength.  There are numerous sophisticated measurement devices that exist today.

A simple means is the digital method (a finger in the vagina) to assess your pelvic muscle strength. Do so supine (lying down, face up) with knees bent and slightly parted. Use a hand-held mirror to get a visual of your vulva. The inner vaginal lips should be closed and touching, appearing like a shut clamshell. A sign of vaginal laxity is when the lips are parted like an open clamshell. Another sign of laxity is a reduction in the distance from the bottom part of the vaginal opening to the anus (the perineum). A more severe sign of vaginal laxity is gaping lips with a pink bulge (pelvic organ prolapse) emerging between the lips. Take a look while pushing and straining your abdominal muscles—as if you are pushing out a baby—as a “vaginal stress test.”

Gently place a lubricated finger of one hand in the vagina and contract your pelvic muscles, squeezing around the finger and trying to lift it upwards and inwards, ensuring 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.

Grade your strength using the modified Oxford grading scale, giving yourself a number between 0-5. Note that the Oxford system is what physicians use and it is relatively simple when done regularly by those with experience performing pelvic exams. It is granted that since this assessment is subjective and is not your specialty, you may find it challenging, but do your best, as your goal is to get a general sense of your pelvic strength.

Oxford Grading of Pelvic Strength

0—complete lack of contraction

1—minor flicker

2—weak squeeze (without a circular contraction or inner and upward movement)

3—moderate squeeze (with some inner and upward movement)

4—good squeeze (with moderate inner and upward movement)

5—strong squeeze (with significant inner and upward movement)

What To Do About Vaginal Laxity

If you are unhappy with your vaginal tone, do not despair. Pelvic floor exercises (a.k.a. Kegels) can and will often help improve the situation. Achieving a well-conditioned pelvic floor will optimize vaginal tone, pelvic organ support and sexual, urinary and bowel function as well as positively impact core strength and stability, posture and spinal alignment.

Bottom Line:  A firm and fit vagina is desirable from the standpoint of pelvic, sexual and general health.  Having well-conditioned pelvic floor muscles can help prevent and treat vaginal laxity, pelvic organ prolapse, urinary and bowel control issues as well as contribute to a healthy and enjoyable sex life. Just as you make an effort to keep your external muscles in good shape, It makes sense to apply a similar effort to these important internal muscles.

Please check out the following 3 minute video entitled “Why Kegel?”:

https://www.youtube.com/watch?v=kclY1vY3wG8

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

Author page on Amazon: 

http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook:

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

The Kegel Fix trailer: 

https://www.youtube.com/watch?v=uHZxoiQb1Cc  

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

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

 

10 Reasons For Men To Kegel

June 4, 2016

Andrew Siegel, M.D. 6/4/16

The pelvic floor muscles—a.k.a. the Kegel muscles—are internal, hidden and behind-the-scenes muscles, yet they are vital to a healthy life. There are numerous advantages to keeping them fit and robust with pelvic floor exercises.  Last week’s entry detailed why this is the case for females and today’s will explain how and why are equally beneficial for males.  As the saying goes: “What’s good for the goose is good for the gander,” and when it comes to the pelvic floor, this is an absolute truth.  Kegel popularized these exercises for females and it is my intent to do the same for men!   If you would like more information on pelvic floor muscle training in men, visit AndrewSiegelMD.com, the opening page of which has the link to a review article I wrote for the Gold Journal of Urology on the topic. 

 

pixabay image

  10 REASONS FOR MEN TO DO KEGEL EXERCISES 

  1. To improve/prevent erectile dysfunction.
  1. To improve/prevent premature ejaculation.
  1. To improve/prevent ejaculatory dysfunction (skimpy ejaculation volumes, weak ejaculation force and arc, diminished ejaculatory sensation).
  1. To improve/prevent post-void dribbling (that annoying after-dribble of urine that occurs after finishing urinating).
  1. To improve/prevent stress urinary incontinence (leakage with coughing, sneezing, exercise, etc.) that may occur following prostate surgery.
  1. To improve/prevent urinary and bowel urgency (“gotta go”) and urinary and bowel urgency incontinence (inability to get to the bathroom on time to prevent an accident).
  1. To improve/prevent pelvic pain due to pelvic floor tension myalgia by learning how to relax your pelvic floor muscles.
  1. To help prevent pelvic impairments from high impact sports and saddle sports (e.g., cycling, motorcycling and horseback riding).
  1. To improve core strength, posture, lumbar stability, alignment and balance.
  1. To maintain good health and youthful vitality.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

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

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

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

Female Sex-Related Urinary Leakage

April 29, 2016

Andrew Siegel MD 4/30/16

shutterstock_femalebluepelvic

 

 

 

 

 

I have previously written on the topic of male urinary leakage during sexual excitement and climax: https://healthdoc13.wordpress.com/tag/climacturia/.  This entry covers the issue in females.

“Coital incontinence” is the medical term for leakage of urine that occurs during sexual intercourse. This involuntary loss of urine can occur either at the time of vaginal penetration, during the act of intercourse itself or during orgasm. It can be a devastating problem that affects one’s emotional, psychological, and social well being. This is not a topic that many women feel comfortable discussing with their physicians and therefore is under-reported and under-studied. It is important to know that coital incontinence is a manageable situation. 

A healthy sexual response involves being “in the moment,” free of concerns and worries. Women who develop coital incontinence often become mentally distracted during sexual activity, preoccupied with their lack of control over their problem, fear of leakage during intercourse and concerns about what consequences this might have on their partner’s sexual experience. This can cause a feeling of being unattractive and unsexy and an overall negative perception of body image, which can affect sex drive, arousal, sexual fulfillment and ability to orgasm. In addition to being embarrassing, it often results in women withdrawing from participating in sexually intimate situations, which can have a harmful effect on relationships.

There are two distinct forms of coital incontinence: leakage with penetration/intercourse and leakage with climax.

Leakage With Vaginal Penetration or During Intercourse

Leakage with penetration typically occurs in women with weakened pelvic support, often in women with a condition known as a cystocele (a.k.a. dropped bladder), in which the bladder sags to a variable extent through a weakness in its structural support such that the it enters into the vaginal space and at times can emerge outside the vaginal opening. This condition often causes an anatomical kink, resulting in symptoms of urinary obstruction including a weak, slow, intermittent stream and incomplete bladder emptying. Many women with dropped bladders need to use their fingers to manually push the bladder back into its normal anatomical position in order to straighten out the kink to be able to urinate effectively. What happens at the time of penetration is that the penis displaces the bladder back into its normal anatomic position and “unkinks” the urethra, resulting in a gush of urinary leakage.  Urinary leakage can also occur for the same underlying reason after penetration–during the act of intercourse itself– as penile thrusting shifts the bladder position and straightens out the urethra.  Either situation does not make for a happy couple.

Leakage With Sexual Climax

Leakage with sexual climax usually happens because of an involuntary contraction of the bladder that occurs along with the contraction of the other pelvic muscles during orgasm. With climax, there is a rhythmic contraction of the pelvic floor muscles, anal sphincter, urethral sphincter and several of the core muscles. This form of urinary leakage–often with large volumes of urinary incontinence– in many cases is due to an overactive bladder, a bladder that “contracts without its owner’s permission” causing symptoms including urinary urgency, frequent urinating and urgency incontinence.

Who Knew? “Squirting.” At the time of climax, some women are capable of “ejaculating” fluid. The nature of this fluid has been controversial, thought by some to be excess lubrication and others to be  glandular secretions (from Bartholin’s and/or Skene’s glands). There are certain women who “ejaculate” very large volumes of fluid at climax and scientific studies have shown this to be urine released because of an involuntary bladder contraction that accompanies orgasm.

How To Prevent Coital Incontinence:

  • Empty your bladder as completely as possible before sex.
  • If you have a dropped bladder, manually push the bladder back in to optimize your bladder emptying before sex.
  • Decrease fluid and caffeine intake for several hours prior to sex.
  • Experiment with sexual positions that put less pressure on the bladder.
  • Do pelvic floor muscle exercises (Kegels) on a regular basis to strengthen the voluntary urethral sphincter muscle; additionally, pelvic floor training can benefit cystoceles and overactive bladders.
  • Get in the best physical shape possible and exercise regularly (Pilates and yoga emphasize core strength and can be particularly helpful).
  • Medications: two classes of bladder relaxant medications used for overactive bladder can be helpful for incontinence that occurs with climax.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– newly available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo (paperback edition will be available May 2016).

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

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

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

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

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