Posts Tagged ‘pelvic floor muscle’

5 Kegel Exercise Mistakes You Are Probably Making

October 21, 2017

Andrew Siegel MD 10/21/17

Do it right or don't do it

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

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

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

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

  The Kegel problem is threefold:

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

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

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

5 Common Kegel Exercise Mistakes

Mistake # 1: Holding Your Breath

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

Mistake # 2: Contracting the Wrong Muscles

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

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

Sadly, there is a device on the market (see below) called the “Kegel Pelvic Muscle Thigh Exerciser,” a Y-shaped plastic device that fits between your inner thighs such that when you squeeze your thighs together, the gadget squeezes closed. This exerciser has NOTHING to do with pelvic floor muscles (as it strengthens the adductor muscles of the thigh), serving only to reinforce doing the wrong exercise and it is shameful that the manufacturer mentions the terms “Kegel” and “pelvic muscle” in the description of this product.

kegeler

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

Mistake # 3: Not Using a Kegel Program

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

Mistake # 4: Impatience

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

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

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

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

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

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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

Cover

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

 

 

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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.

 

5 Things You Can Do To Cure Post-Void Dribbling (PVD)

March 20, 2015

Andrew Siegel MD 3/21/15

“No matter how much you shake and dance,

The last few drops end up in your pants.

PVD

PVD is “after-dribbling” of urine that is more annoying and embarrassing than serious. Although it commonly occurs after age forty, it can happen to men at any age.  Immediately or shortly after completing urination, urine that remains pooled in the urethra (tubular channel that conducts urine) drips out, aided by gravity and movement.

One specific pelvic floor muscle (PFM) is responsible for ejecting the contents of the urethra, whether it is urine after completing urination or semen at the time of sexual climax. With aging and loss of PFM strength and tone, both PVD and ejaculatory dysfunction may occur. The specific muscle responsible for ejecting the contents of the urethra is the bulbocavernosus muscle, which compresses the deep, inner portion of the urethra to function as the “urethral stripper.” In fact, the 1909 Gray’s Anatomy textbook referred to this muscle as the “ejaculator urine.”

Factoid: Dr. Grace Dorey published the landmark article in the British Journal of Urology that proved the effectiveness of PFM exercises for erectile dysfunction (ED), but also demonstrated an association between the occurrence of ED and PVD. She essentially showed that ED and PVD are linked and parallel issues, one sexual and the other urinary—both manifestations of PFM weakness, and both treatable by PFM exercises.

Factoid: Dr. Grace Dorey wrote the foreword to my book, Male Pelvic Fitness: Optimizing Sexual and Urinary Health. She also serves as a board member at Private Gym and helped design the Private Gym male pelvic floor training program for men.

What To Do About PVD?

  • PFM training has been proven to be an effective remedy for PVD, with the premise that a more powerful BC muscle will help the process of ejecting the contents of the urethra. Not only will PFM training optimize emptying the urethra, but it also has collateral benefits of improving erections and ejaculation.
  • Try not to rush urination. Urologists interpret “Haste makes waste” as “Haste makes PVD.”
  • When you are finished urinating, vigorously contract your PFMs to displace the inner urethra’s contents. By actively squeezing the PFM by using the Private Gym “rapid flex” technique—3-5 quick pulsations—the last few drops will be directed into the toilet and not your pants.
  • If necessary, PFM contractions can be supplemented with manually compressing and stripping the urethra, but this is usually unnecessary since the PFM—particularly when conditioned—are eminently capable of expelling the urethral contents. To strip the urethra, starting where the penis meets the scrotum, compress the urethra between your thumb on top of the penis and index and middle fingers on the undersurface and draw your fingers towards the penile tip, “milking” out any remaining urine.
  • Gently shake the penis until no more urine drips from the urethra. Apply a tissue to the tip of the penis to soak up any residual urine.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Co-creator of Private Gym pelvic floor muscle training program for menhttp://www.PrivateGym.com Gym-available on Amazon as well as Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.

Penile Rehabilitation (Penile “Rehab”)

March 13, 2015

Andrew Siegel MD   3/13/15

shutterstock_side view manjpeg

Penile rehab is probably not what you think. It is not a place where “misbehaved” penises go to get reformed and restored to normalcy. 

Although the term “rehab” has a bit of a negative connotation–a place and a process by which one attempts to reclaim their lives from the grip of a drug, alcohol or other addiction–it should, however, be thought of in a positive sense as a means of regaining strength, skills and normalcy after not only an addiction, but also an injury, illness, or surgery.

Rehab can take many forms: physical (physical therapy to treat an injury or help recover mobility and strength after surgery), occupational (to recover the ability to perform daily activities), speech (to recover comprehension of language, speaking, reading and writing), cardiac (after a serious cardiac event or surgery) and pulmonary (to improve breathing).

What Does This Have To Do With The Penis?

Some abdominal and pelvic surgical procedures—including removal of the prostate, the bladder, and the colon—can result in a penile dysfunction in which it becomes difficult to obtain or maintain an erection. Similarly, pelvic radiation therapy and pelvic injuries can negatively affect one’s sexual function.

The problem is that if you go for too long without an erection, penile smooth muscle and other tissues may be damaged, resulting in a loss of penile length and girth and further compounding the ED. Like every other body part, your penis needs to be used the way nature intended. A marvel of engineering, the penis is uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge of blood flow happening within seconds and accomplished by relaxation of the smooth muscle within the penile arteries and erectile tissues. An erect penis not only gives you the capacity for penetrative sex, but also serves to keep the penile muscles and tissues richly oxygenated, elastic and functioning well.

Interestingly, studies have demonstrated that sex on a regular basis protects against ED and the risk of ED is inversely related to the frequency of intercourse. Men reporting intercourse less than once weekly had a two-fold higher incidence of ED as compared to men reporting intercourse once weekly. (Am J Med 2008 July; 121(7): 592-596).

In the absence of regular erections, disuse atrophy (wasting away with a decline in anatomy and function) can occur. In a vicious cycle, the poor blood flow resulting from disuse produces a state of poor oxygen levels in the penile tissues, that, in turn, can induce scarring, which further decreases sexual function. This is where the concept of penile rehab comes into play. Rehab the penis after surgical, radiation or physical trauma to get it back into a functional state.

So What Is Penile Rehab?

Penile rehab is a process by which you attempt to recover erectile function after surgery, radiation or injury that compromises your sexual function. This is most commonly used after surgery or radiation for prostate cancer, but is also relevant for other major pelvic surgeries as well as pelvic injuries. There are numerous techniques for penile rehab (in order of least invasive to most invasive): exercises, vacuum, pills and injections.

Pelvic Floor Muscle (PFM) Exercises

This is physical therapy for the penis, which should be a first-line approach because of its safety, non-invasiveness, and minimal expense.

When the pelvic floor muscles contract, they increase blood flow to the penis, specifically by the actions of the two superficial pelvic floor muscles—the bulbocavernosus (BC) and ischiocavernosus (IC) muscles that become engaged at the time of an erection. Contractions of these PFMs prevent the exit of blood from the penis, enhancing penile rigidity. With every contraction of the BC and IC muscles, a surge of blood flows into the penis. Additionally, these muscles act as powerful struts to support the roots of the penis, the foundational support that allows a more “skyward” angling erection. Increasing the strength, tone and conditioning of these muscles will enhance their function, resulting in more powerful contractions and more penile rigidity and stamina. PFM exercises can serve as a powerful tool to help reignite erectile function.

Vacuum Suction Device

This is a mechanical means of producing an erection in which the penis is placed in a plastic cylinder that is connected to a manual or battery-powered vacuum. The negative pressure created by the vacuum literally sucks blood into the penis, creating a state of engorgement.

PDE5 inhibitors: Viagra, Levitra, Cialis, Stendra

Viagra (Sildenefil). Available in three doses—25, 50, and 100 mg—it is taken on demand and will produce an erection in most men within 30-60 minutes if they are sexually stimulated, and will remain active for up to 8 hours.

Levitra (Vardenefil). Available in 5, 10, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra.

Cialis (Tadalafil). Available in 2.5, 5 mg, 10mg, and 20 mg doses, its effectiveness and side effect profile is similar to Viagra. It has duration of about 36 hours that has earned it the nickname “the weekender.” In 2012, daily lower doses of Cialis were FDA approved for the management of urinary symptoms due to benign prostate enlargement.

Stendra (Avanafil). Similar to Viagra, it is available in 50, 100 and 200 mg doses. It has the advantage of a rapid onset.

Penile Injections

Injections of these vasodilators (medicines that increase blood flow) directly into the erectile chambers of the penis induce an erection. Caverject and Edex (Prostaglandin E1) are commonly used for this purpose.  Side effects can be pain, bruising, scarring and prolonged erections. At times, a combination of medications needs to be used to obtain optimal results; this combination is known as Trimix and consists of Papaverine, Phentolamine, and Alprostadil.

Thinking Forward

Adaptation of skeletal muscle is an accepted scientific precept and if you have ever had your arm or leg in a cast, you can understand the detrimental effect of disuse on muscle tone and strength. The corollary is that if you have ever done weight training, you understand the beneficial effect of resistance training on muscle tone and strength.

So, instead of thinking of penile rehab as a means of getting back function after surgery, radiation or injury, how about thinking of it as a means of preventing the inevitable decline in function that accompanies aging? Or to take it another level, think of rehab as a means of optimizing the blue-ribbon function that you may be fortunate enough to already have.  I’m not suggesting using invasive methods such as the vacuum, pills, or injections, but about pursuing exercises that can improve dysfunction, optimize current function and maintain future function.

 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Co-creator of Private Gym pelvic floor muscle training program for menhttp://www.PrivateGym.com Gym-available on Amazon as well as Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.

Penile Attention Deficit Disorder (PADD)

February 14, 2015

Andrew Siegel MD  2/14/15

heart-24011_1280

(Thank you Pixabay for above image)

 

“It is like a firstborn son—you spend your life working for him, sacrificing everything for him, and at the moment of truth he does just as he pleases.”

 Gabriel Garcia Marquez

(from Love In The Time of Cholera)

 

“The penis does not obey the order of its master, who tries to erect or

shrink it at will. Instead, the penis erects freely while its master is asleep.

The penis must be said to have its own mind, by any stretch of the imagination.”

Leonardo da Vinci

PADD

In the vast range between flawless erectile functioning and defeated phallus syndrome, there are a variety of forms, dimensions and magnitudes of impairments in the working order of the penis.  You may be able to achieve a fabulous erection—a proud soldier standing tall at attention, saluting, noble, confident, majestic, and readily capable of penetration, but then, much to you and your partner’s bewilderment and dismay, it decides to display its short “attention” span and deflate before business is fully conducted. I like to refer to this as penile attention deficit disorder (PADD).

Erection Hydraulics

Our circulatory system consists of arteries that supply oxygenated blood to our organs and tissues and veins that return blood back to the heart. Since erections are all about blood filling the penis, being able to achieve proud soldier status infers that your inflow of blood is excellent and uncompromised, with blood surging into the penis through arterial vessels unclogged by the ravages of time and poor lifestyle. The attention deficit occurs when the blood that is stored in the erection chambers leaks, similar to air hissing out from a flat tire and slowly deflating. This often implies a venous leak, in which the veins are unable to close off effectively

Erections are a matter of simple hydraulics—maximizing inflow of blood while minimizing outflow. There are two stages of erectile hydraulics: tumescence and rigidity. In the tumescence stage the penis becomes plump and full; in the rigidity stage, the penis becomes rock hard. The penis consists of 3 erection chambers that fill with blood. The erection chambers are composed of sinuses—virtually identical to our nasal sinuses—and when the sinuses become congested with blood, an erection results. When you are in a sexually stimulating situation, blood surges into your erection chambers by virtue of smooth muscle relaxation in both the penile arteries and in the sinuses, permitting inflow. It is this ability for smooth muscle relaxation that is critical for the initial penile erection hydraulics. As the sinuses fill up with blood, they compress the penile veins to block the outflow of blood, resulting in a tumescent penis, plump and full, but not yet rigid.

Fact: To get a good quality erection, relaxation is key, as it is in so many other physical activities.

Role Of Pelvic Floor Muscle…From Tumescence To Rigidity

The pelvic floor muscles are critical in the transformation of your tumescent penis to a rigid penis. By compressing the deep, inner part of your penis (the root of the penis), the pelvic floor muscles foster rigidity by aiding closure of veins and by elevating the blood pressure within your penis to levels well above systolic blood pressure (an erect penis being a hypertensive penis…the only hypertension you desire!), causing bone-like rigidity. You can think of the role of the pelvic floor muscles in trapping blood within the penis like that of a tourniquet placed around your arm by a phlebotomist in order to block venous return to make your arm veins full and easy to draw blood from.

Effect Of Aging On Muscle

With aging, the smooth muscle of our arteries tends to become stiffer (less able to relax and permit inflow of blood), resulting in high blood pressure for many of us. Your penis is not spared, as the smooth muscle of your penile arteries and sinuses stiffens and becomes less able to relax. This muscle stiffness does NOT result in penile stiffness. No, unfortunately the consequence of stiff smooth muscle in the penis and the sinuses is less arterial inflow and poor venous trapping. Additionally, your pelvic floor muscles tend to weaken with age. With the smooth muscle stiffening and the weakened pelvic floor muscles, you have the perfect storm for your proud soldier to falter, causing weakened erections and not uncommonly PADD.

Fact: With aging, your arteries get stiffer and your penis gets less stiff.

So, What To Do?

How do you maintain proud soldier status? What can you do to keep the proud soldier from becoming a wounded warrior?

You must keep that soldier in tip-top shape, well fed, well exercised, and well utilized for the role for which he was intended. And don’t forget that for a soldier to stand tall and proud at attention, he needs to engage in training exercises and drills.

To reiterate, the pelvic floor muscles play a critical role during erections, activating and engaging to help maintain penile rigidity and a skyward angling erection. There is good reason that the 1909 Gray’s Anatomy labeled one of the key pelvic floor muscles the “erector penis.”  Numerous studies have shown the benefits of pelvic floor muscle exercises in the management of erectile dysfunction, with particular benefit to those with venous leakage. So, the first line of defense against the onset of PADD and other forms of erectile dysfunction is keeping your pelvic floor muscles fit.  Enhancing pelvic floor muscle strength, tone, durability and responsiveness results in stronger pelvic floor muscles and consequently more rigid and durable erections .

Fact: Exercising the pelvic floor muscles can help prevent or improve PADD and other forms of ED.

 

Wishing you the best of health and a wonderful, romantic and sexy Valentine’s Day,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Private Gym: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use.  The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.