Posts Tagged ‘pelvic floor muscles’

Rectoceles And Perineal Laxity: What You Need To Know

May 20, 2017

Andrew Siegel MD  5/20/17

recto copy

Image above: protrusion of the rectum into the floor of the vagina, a.k.a. rectocele (blue arrow); also note catheter in urethra (red arrow) and gaping vagina with scarring of tissues between vagina and anus, a.k.a. perineum (white arrow)

A rectocele is a specific type of pelvic organ prolapse in which the pelvic floor muscles and connective supporting tissue between the lower vaginal wall and rectum weaken, allowing protrusion of the rectum into the floor of the vagina and at times outside the vaginal opening. This not uncommonly follows vaginal childbirth, which places tremendous stresses on the tissues that provide to support of the pelvic organs. Other risk factors for the occurrence of a rectocele are chronic straining, menopause and weight gain.

Rectoceles are also known by the terms “dropped rectum,” “prolapsed rectum,” and “rectal hernia.” The most common symptom is an annoying vaginal bulge that worsens with assuming the upright position and being active and tends to improve with sitting, lying down and being sedentary. It is often quite noticeable when straining to move one’s bowels. It can give rise to bowel difficulties—most notably what is referred to as “obstructed defecation”—including constipation, incomplete bowel emptying, diarrhea and fecal incontinence. The prolapsed rectum often needs to be manipulated back into position in order to be able to effectively move one’s bowels. Rectoceles can also cause vaginal pressure, vaginal pain and painful sexual intercourse.

Relevant trivia: The word “rectum” derives from the Latin word meaning “straight,” because under normal circumstances the rectum is a straight chute, facilitating bowel movements. The presence of a rectocele causes kinking of the rectum to occur, destroying this anatomical arrangement and making bowel movements difficult without “splinting” the rectum (straightening it out) using one or more fingers placed in the vagina.

Often accompanying a rectocele is laxity of the perineal muscles, a condition in which the superficial pelvic floor muscles (those located in the region between the vagina and anus) become flabby. This causes a widened vaginal opening, decreased distance between the vagina and anus, and a change in the vaginal angle. Women who are sexually active may complain of a loose or gaping vagina. This may lead to difficulty keeping a tampon in position without it falling out, the vagina filling with water while bathing, vaginal flatulence (the embarrassing passage of air) and sexual issues including difficulty retaining the penis with vaginal intercourse and difficulty achieving orgasm. Perineal laxity may result in the vagina “surrounding” the penis rather than firmly “squeezing” it during sexual intercourse, with the end result diminished pleasurable sensation for both partners. The perception of having a loose vagina and altered anatomy can lead to self-esteem and other psychological issues.

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

Management of Rectoceles

Rectoceles can be managed conservatively with pelvic floor exercises, behavioral modifications and consideration for using a pessary. Alternatively, surgical treatment, a.k.a. pelvic reconstruction, is often necessary for more extensive rectoceles or for those that do not respond to conservative measures.

Pelvic floor muscle training (PFMT) is useful under the circumstances of mild-moderate rectocele, 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 muscles that play a key role in the support of the rectum and perineum. Weak pelvic muscles can undoubtedly be strengthened; however, if there is connective tissue damage, pelvic training will not remedy the injury, but does serve to strengthen the muscles that can help compensate for the connective tissue impairment. If not completely cured with PFMT, the rectocele and perineal laxity can still be improved, and that might be sufficient.  Chapter 5 in The Kegel Fix book  (www.TheKegelFix.com) is devoted to a specific PFMT regimen for rectoceles and other forms of pelvic organ prolapse.  Note that if the pelvic floor muscles are torn or widely separated, PFMT will not be productive until surgical repair is performed.

Another component of conservative management is modification of activities that promote the rectocele (heavy lifting and high impact exercises), management of constipation and other circumstances that increase abdominal pressure, weight loss, smoking cessation and consideration for estrogen hormone replacement, since estrogen replacement can increase tissue integrity and suppleness.

A pessary is a mechanical device that is available in a variety of sizes and shapes and is inserted into the vagina where it acts as a “strut” to help provide pelvic support and keep the rectum in proper position. Pessaries need to be removed periodically in order to clean them. Some are designed to permit sexual intercourse.

Surgery is often necessary in the case of a symptomatic moderate-severe rectocele, particularly when quality of life has been significantly impacted. This type of surgery is most often done vaginally, typically on an outpatient basis. Both the rectocele and the perineal laxity are addressed.  The goal of surgery is restoration of normal anatomy with preservation of vaginal dimensions and improvement in symptoms with optimization of bowel and sexual function.  With improvement of anatomy, function often significantly improves, since function often follows form. Difficulties with evacuation, constipation, straining, incomplete emptying and fecal incontinence should improve, if not resolve. There should no longer be a need to splint the rectum and sexual function (for both patient and partner) should dramatically improve with the rebuilding of the perineum.

Marietta S pre-PP

Pre-operative photo–note gaping vulva, exposed vagina, rectocele and perineal laxity; (c) Michael P Goodman, MD. Used with permission

 

Mariette S 6 wk p.o. PP

Post-operative photo–note closed vulva, unexposed vagina and restored perineum after levatorplasty, vaginoplasty, perineorrhaphy and aesthetic perineoplasty; (c) Michael P Goodman, MD. Used with permission

 

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  

Much of the content of this entry was excerpted from Dr. Siegel’s The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health (Chapter 5. Pelvic Organ Prolapse)

Pessaries To Treat Pelvic Organ Prolapse: What You Need To Know

April 15, 2017

Andrew Siegel MD    4 /15 /17

A pessary is a vaginal insert that is used to help provide pelvic support in women with vaginal prolapse of the urogenital organs, a.k.a. pelvic organ prolapse (POP). Pessaries are available in a variety of sizes and shapes and when positioned in place within the vagina, function as “struts” to help keep the prolapsing pelvic organ(s) in proper anatomical position. They are ideal for older patients who have medical issues that preclude surgical treatment and for women who opt for non-surgical management.  Pessaries need to be removed periodically in order to clean them.  Some are designed to permit sexual intercourse.

A Few Words on POP

POP is a common condition in which there is weakness of the pelvic muscles and connective tissues that provide pelvic support, allowing one or more of the pelvic organs to move from their normal positions into the potential space of the vaginal canal and, at its most severe degree, outside the vaginal opening. POP is an important issue in women’s health, with an increasing prevalence correlating with extended longevity. Two-thirds of women who have delivered children vaginally have anatomical evidence of POP (although many are not symptomatic) and 10-20% will need to undergo a corrective surgical procedure. The true prevalence of POP is not known because of the large number of women who do not seek medical care for the problem.

POP is not life threatening, but can be a distressing and disruptive problem that negatively impacts quality of life. Despite how common an issue it is, many women are reluctant to seek help because they are too embarrassed to discuss it with anyone or have the misconception that there are no treatment options available or fear that surgery will be the only solution.

POP may involve any pelvic organ including the urinary, intestinal and gynecological tracts. The bladder is the organ that is most commonly involved in POP. POP can vary from minimal descent—causing few, if any, symptoms—to major descent—in which one or more of the pelvic organs prolapse outside the vagina at all times, causing significant symptoms. The degree of descent varies with position and activity level, increasing with the upright position and/or exertion and decreasing with lying down and resting, as is the case for any hernia.

POP can give cause a variety of symptoms, depending on which organ is involved and the extent of the prolapse.  The most common complaints are the following: a vaginal bulge or lump, the perception that one’s insides are falling outside, and vaginal “pressure.”  Because POP often causes vaginal looseness in addition to one or more organs falling into the space of the vaginal canal, sexual complaints are common, including painful intercourse, altered sexual feeling and difficulty achieving orgasm as well as less partner satisfaction.

3 Options to Manage POP

  1. Conservative
  2. Pessaries
  3. Surgery (Pelvic Reconstruction) 

Conservative treatment options for POP include pelvic floor muscle training (for details on pelvic muscle training for POP see http://www.TheKegelFix.com), 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.

Pessary Basics

A pessary is a non-surgical option for treating POP, used with the goal of improving quality of life, body image, and bladder, bowel and sexual function. Pessaries are made of soft and pliable hypoallergenic plastic or silicone and can successfully alleviate symptoms of POP in 85% of those who use them.  About 50% or so of women who trial pessaries continue to use them for the long term, with discontinuation typically occurring in those who cannot retain the pessary, those experiencing discomfort or pain, those who desire surgery, and those who are incapable of inserting and removing them.

It is important to know that pessaries are not successful in all women with POP.  They tend to fail in women with significantly enlarged vaginal openings, in which case the pessary can fall out with effort and exertion. Factors associated with a higher risk for failure are younger age, obesity, and weak pelvic floor muscles.

For Whom is a Pessary Appropriate?

  • Older women who are not candidates for surgery
  • Anyone who desires non-surgical management of their POP
  • For those who need to delay surgery, wish to defer surgery or simply desire to trial one prior to surgery

1-Pessary Image

Image Above: A Potpourri of Pessaries

What Types of Pessaries Are Available?

For Mild-Moderate POP

The ring pessary (7:00 position of image above) is the simplest and most commonly used pessary that has the least side effects.  It is widely employed because of its ease of insertion, good vaginal fit and allowance for sexual intercourse without removing it.  A variation of the ring pessary is one with central support. The oval pessary is a variation of the ring used in narrow vaginas.  The Shaatz pessary (4:00 position of image above) is another variation. The incontinence dish pessary (5:00 position of image above) is used for stress urinary incontinence and mild POP.  A variation of this comes with a central support.

For Moderate-Severe POP

The Gellhorn pessary (3:00 position of image above) is used for greater degrees of POP than the pessaries described in the paragraph above, which are typically used for mild-moderate POP.  It tends to produce the greatest degree of vaginal discharge because of its shape.   The Hodge pessary has wires that can be manually shaped to fit the nuances of one’s anatomy. The Gehrung pessary (10:00 position of image above) also has wires that allow it to be manually shaped.  The donut pessary (center position of image above) is soft allowing it to be compressed for insertion, even with its bulk.  The cube pessary (9:00 position of image above) comes with a tie to help with its removal.

What Are Side Effects Of Pessaries?

The most common side effects are vaginal discharge and vaginitis (vaginal irritation or infection).  Occasionally, vaginal ulcerations can occur because of abrasive contact of the pessary with the delicate lining of the vagina.

How Does One Get Fitted For A Pessary?

A pelvic exam is performed prior to the fitting in order to help determine the proper size and type.  A properly fitted pessary should be large enough to function optimally, but not so large that it causes pressure or discomfort. It should be possible to insert a finger between the pessary’s outer rim and the wall of the vagina.

Usually a ring pessary (size 2, 3, or 4) is initially trialled.  It comes in 9 sizes, ranging from 2.00-4.00 in 0.25 increments.  If unsuccessful, a Gellhorn (size 2, 2.25, 2.5, or 2.75), cube or other model is utilized, depending upon particular circumstances. The largest pessary that is comfortable is placed and the patient is asked to walk and strain to ensure that it remains in proper position.  Motivated patients can be taught how to remove, clean and reinsert it. Typically, removal is done once weekly prior to sleeping, with reinsertion the following morning.  For the less motivated patient, the gynecologist can remove, clean and replace the device every three months or so.

Bottom Line: Pessaries are a non-surgical alternative to help provide pelvic support in women with pelvic organ prolapse.  They are available in a variety of sizes and shapes and need to be fitted and sized to the particulars of one’s anatomy.  They fold and compress to facilitate insertion and removal.  They are ideal for older patients who have medical issues that preclude surgical treatment.  If pessaries fail to improve the POP or cannot be retained or are poorly tolerated, a surgical procedure–pelvic reconstruction–can be performed to remedy the problem.  

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 

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

Leaking Havoc: Diagnosing And Treating Female Stress Urinary Incontinence

March 4, 2017

Andrew Siegel, MD  3/4/17

This is the completion of a blog entry uploaded last week entitled “Leaking Havoc: Female Stress Incontinence.”

How is Stress Urinary Incontinence (SUI) diagnosed and evaluated?

Listening carefully to the patient is usually sufficient to make the diagnosis of SUI, the typical complaint being: “Doc, I leak urine when I sneeze, cough and exercise.”

After hearing the details of the patient’s problem, the next step is a pelvic examination. The issue with an exam with legs-up-in-stirrups is that this is NOT the position in which SUI typically occurs, since SUI is usually provoked by standing, exertion and physical activities. For this reason, the exam must be performed using straining or coughing forcefully enough to demonstrate the SUI.

The pelvic examination is done after the patient empties her bladder. The exam involves observation, passage of a small catheter (a narrow hollow tube) into the bladder, a speculum exam and a digital exam.

Inspection determines tissue health and the presence of urethral movement with straining. After menopause, typical changes include thinning of the vaginal skin, redness, irritation, etc. The ridges and folds within the vagina that are present in younger women (rugae) tend to disappear.

A small catheter is passed into the bladder to determine how much urine remains, to obtain a urine culture in the event that urinalysis suggests 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 (hyper-mobility) is a sign of loss of urethral support, which often is seen with SUI. The vagina is carefully inspected for other manifestations of pelvic organ prolapse (dropped bladder, rectum, uterus) that can accompany the SUI.

urethra-rest

                                     Image above: female urethra (woman in stirrups)–note that urethra points straight ahead, like the barrel of a rifle

urethra-strain

                             Image above: female urethra (woman in stirrups)– because of urethral hyper-mobility the urethra leaks at the moment she is asked to strain or cough

Finally, a digital examination is performed to assess vaginal tone and pelvic muscle strength (rated on a scale from 0-5). A bimanual exam (combined internal and external exam in which the pelvic organs are felt between internal and external examining fingers) checks for the presence of pelvic masses.

Depending on circumstances, tests to further evaluate SUI 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).                   

How is SUI managed?

There are a variety of treatment options for SUI, ranging from non-invasive strategies to surgery. There are no effective medications for SUI. If there is not an adequate response to first-line, non-invasive, conservative measures, surgery becomes an appropriate consideration. However, it is always sensible to initially use a conservative approach that is cost-effective, natural, uses few resources and is free from side effects.

Kegel Exercises for SUI

Kegels have emerged from obscure to mainstream…In fact the 2017 Oscar “swag bag” included a pelvic floor device called “The Elvie,” reviewed in my book THE KEGEL FIX.

 

one-sheet-poster

Combating SUI demands contracting one’s pelvic floor muscles (PFMs) strongly, rapidly and ultimately, reflexively. The goal of Kegels, a.k.a. pelvic floor muscle training (PFMT) is to increase PFM strength, power, endurance and coordination to improve urethral support and closure.

Who Knew? PFMT 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.

The cough reflex is an automatic contraction of the PFMs above and beyond their resting tone when one coughs. This squeezes the urethra shut to help prevent leakage. This is nature’s way of protection against incontinence with a sudden increase in abdominal pressure, a defense against cough-related SUI. An extension of this principle is to exercise the PFMs to amplify strength and power to allow earlier activation and more robust contraction.

PFMT increases PFM bulk and thickness, reducing the number of SUI episodes. Additionally, PFMT improves urethral support at rest and with straining, diminishing the urethral hyper-mobility that is characteristic of SUI. It also permits earlier activation of the PFMs when coughing, more rapid repeated PFM contractions and more durable PFM contractions between coughs.

Who Knew? PFMT 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. PFMT is equally effective for pre-menopausal and post-menopausal women with SUI.

Who Knew? PFMT is most effective in women with mild or mild-moderate SUI. Chances are that if the SUI is moderate-severe, PFMT will be less effective. However, if not cured, the SUI can be improved, and that might be sufficient.

Once the PFMs are conditioned via PFMT, it is vital to apply the improved conditioning on a practical basis. The cough reflex can be replicated—voluntarily—when one is in situations other than actual coughing that induce SUI. In order to do so, one needs to be attentive to the triggers that provoke the SUI. By actively contracting the PFMs immediately prior to the trigger exposure, the SUI can be improved or prevented. For example, if changing position from sitting to standing results in SUI, consciously performing a brisk PFM contraction—an intense contraction for 2-5 seconds prior to and during transitioning from sitting to standing—should “clamp the urethra” and help control the problem. Such bracing of the PFMs can be a highly effective means of managing SUI and when practiced diligently can become automatic (a reflex behavior).

More Non-Invasive Strategies to Improve SUI

Manage the condition that provokes the SUI: Since discrete triggers often provoke SUI (e.g., when asthma causes wheezing, seasonal allergies cause sneezing, or when tobacco use, bronchitis, sinusitis, or post-nasal drip cause coughing), by managing the underlying condition, the SUI can be avoided.

Moderate fluid intake: With a sudden increase in abdominal pressure, there will tend to be more SUI when there are larger volumes in the bladder (although SUI can occur even immediately after urinating). Since there is a direct relationship between fluid intake and urine production, any moderation in fluid intake will decrease the volume of urine in the bladder and potentially improve the SUI. The key is to find the right balance to diminish the SUI, yet avoid dehydration. Since caffeinated beverages and alcohol increase urine volume, it is best to limit exposure (caffeine is present in coffee, tea, cola and even chocolate has a caffeine-like ingredient).

Urinate regularly: Based on the premise that there tends to be more SUI when there are greater volumes in the bladder, by emptying the bladder more frequently, SUI can be better controlled. Urinating on a two-hour basis is usually effective, although the specific timetable needs to be individually tailored. Voluntary urinary frequency is more desirable than involuntary SUI. An extension of this principle is to empty one’s bladder immediately before any activity that is likely to induce the SUI.

Maintain a healthy weight: Extra pounds can worsen SUI by increasing abdominal pressure and placing a greater load on the pelvic floor and bladder. Even a modest weight loss may improve SUI.

Who Knew? Bearing the burden of unnecessary pounds adversely affects many body parts. As much as obesity puts a great strain on the knees that support the body’s weight, so it does on the PFM.

Exercise: Being physically active can go a long way towards maintaining general fitness and helping improve SUI. In general, exercises that emphasize the core muscles—particularly Pilates and yoga—are most helpful for SUI. Unfortunately, and ironically, it is exercise that often provokes SUI.

Tobacco cessation: Tobacco causes bronchial irritation and coughing that provoke SUI. Additionally, chemical constituents of tobacco constrict blood vessels, impair blood flow, decrease tissue oxygenation and promote inflammation, negatively affecting function of the bladder, urethra and PFMs. By eliminating tobacco, SUI can be significantly improved.

Maintain bowel regularity: Achieving bowel regularity may improve SUI and prevent it from progressing. A rectum full of stool can adversely affect urinary control by putting internal pressure on the bladder and urethra. Additionally, chronic straining with bowel movements—similar in many ways to being in “labor” every day—can have a cumulative effect in weakening PFMs and can be a key factor in the development of SUI. To promote healthy bowel function, exercise daily and increase fiber intake by eating whole grains, fruits and vegetables.

The tampon trick: If SUI occurs under very predictable circumstances—e.g., during tennis, golf or jogging—a strategically placed tampon can be a friend. The tampon is not used for absorption purposes, but to support the urethra. By positioning the tampon in the vagina directly under the urethra, it acts as a space-occupying backboard. The tampon does not need to be positioned as deeply as it would be for menstruation, but just within the vagina. This may allow one to pursue activities without the need for a pad. Poise has come out with “Impressa,” a tampon available in three sizes designed specifically for SUI. It is placed via an applicator and can be worn for up to eight hours. In Australia and the UK, “Contiform,” a self-inserted, foldable intra-vaginal device that is shaped like a hollow tampon, is often used to help manage SUI.

Surgical Management of SUI: Mid-urethral sling

sling

Image above is of a mid-urethral sling in place under the urethra to provide the support necessary to cure/substantially improve the stress urinary incontinence

If conservative measures fail to sufficiently improve SUI, there are solutions. A relatively simple outpatient procedure—the mid-urethral sling—is the implantation of a synthetic tape between the urethra and vagina to recreate the “backboard” of urethral support that is defective. This creates a “hammock” to provide support and to allow compression and pinching of the urethra with any activity that increases abdominal pressure.

The sling procedure is performed via a small vaginal incision. The permanent material used for the sling is polypropylene tape, the same material as used by general surgeons to repair groin hernias. Mid-urethral refers to the placement of the sling beneath the mid-urethra, the channel that leads from the bladder to the urinary opening. Sling refers to the configuration created when the tape is firmly anchored to the soft tissues of the pelvis after being placed underneath the urethra. The sling procedure has a 85-90% cure rate for SUI.

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. Much of the content of this entry was excerpted from this book.  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 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.

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

February 26, 2017

Andrew Siegel MD  2/26/17

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

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

And the Oscar goes to….

arnold-kegel-gladser-studio-1953

Arnold Kegel MD (Gladser Studio, 1953)

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

ben-wa

 Ben Wa Balls

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

elvie

Elvie Pelvic Training Device 

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

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

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

Benefits of Pelvic Floor Muscle Training

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

Love Balls 101

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

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

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

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

vaginal-conesVaginal Cones

 

Sophisticated Pelvic Training Devices Like Elvie

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

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

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

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

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

The Female Love Muscles

January 7, 2017

Andrew Siegel MD 1/7/16

Optimal muscle functioning is integral to sexual activity. There would be no “jump” in the term “jump one’s bones” without fit muscles that permit the coordinated movements and muscle contractions that are necessary to engage in sexual coupling.

The following is a short poem I have composed about the muscles of love:

 Limber hip rotators,

A powerful cardio-core,

But forget not

The oft neglected pelvic floor.

Sex is a physical activity involving numerous muscles that coordinate with seamless efficiency. Sexual activity demands movement, a synchronized kinetic chain integrating core muscles and external hip rotators in which both pelvic thrusting and outward rotation of the hips work effectively together to forge a choreographed motion. It is a given that cardiac (aerobic) conditioning is a prerequisite for any endurance athletic endeavor, including SEX-ercise.

Three muscle groups are vital for optimal sexual function—core muscles, which maintain stability and provide a solid platform to enable pelvic thrusting; external hip rotators, which rotate the thighs outward and are the motor behind pelvic thrusting; and the floor of the core muscles—pelvic floor muscles (PFM), which provide pelvic tone and support, permit tightening and relaxing of the vagina, support clitoral erection, and contract rhythmically at the time of climax. When these three groups of muscles are in tiptop shape, sexual function is optimized.

The core muscles are a cylinder of torso muscles that surround the innermost layer of the abdomen. They function as an internal corset and shock absorber. In Pilates they are aptly referred to as the “powerhouse,” providing stability, alignment and balance, but also allowing the extremity muscles a springboard from which to push off and work effectively. It is impossible to use your limbs without engaging a solid core and, likewise, it is not possible to use your genitals effectively during sex without engaging the core muscles.

Who Knew? According to the book “The Coregasm Workout,” 10% of women are capable of achieving sexual climax while doing core exercises. It most often occurs when challenging core exercises are pursued immediately after cardio exercises, resulting in core muscle fatigue. 

Rotation of your hips is a vital element of sexual movement. The external rotators are a group of muscles responsible for lateral (side) rotation of your femur (thigh) bone in the hip joint. My medical school anatomy professor referred to this group of muscles as the “muscles of copulation.” Included in this group are the powerful gluteal muscles of your buttocks.

Who Knew? Not only do your gluteal muscles give your bottom a nice shape, but they also are vital for pelvic thrusting power.

The PFM make up the floor of the core. The deep layer is the levator ani (“lift anus”), consisting of the pubococcygeus, puborectalis, and iliococcygeus muscles. These muscles stretch from pubic bone to tailbone, encircling the base of the vagina, the urethra and the rectum. The superficial layer is the bulbocavernosus, ischiocavernosus, transverse perineal muscles and the anal sphincter muscle.

The following two illustrations are by Ashley Halsey from The Kegel Fix:

2.deep PFM 3. superficial and deep PFM

The PFM are critical to sexual function. The other core muscles and hip rotators are important with respect to the movements required for sexual intercourse, but the PFM are unique as they directly involve the genitals. During arousal they help increase pelvic blood flow, contributing to vaginal lubrication, genital engorgement and the transformation of the clitoris from flaccid to softly swollen to rigidly engorged. The PFM enable tightening the vagina at will and function to compress the deep roots of the clitoris, elevating blood pressure within the clitoris to maintain clitoral erection. An orgasm would not be an orgasm without the contribution of PFM contractions.

Who Knew? Pilates—emphasizing core strength, stability and flexibility—is a great source of PFM strength and endurance training. By increasing range of motion, loosening tight hips and spines and improving one’s ability to rock and gyrate the hips, Pilates is an ideal exercise for improving sexual function.

PFM Training to Enhance Sexual Function: The Ultimate Sex-ercise

The PFM are intimately involved with all aspects of sexuality from arousal to climax. They are highly responsive to sexual stimulation and react by contracting and increasing blood flow to the entire pelvic region, enhancing arousal. Upon clitoral stimulation, the PFM reflexively contract. When the PFM are voluntarily engaged, pelvic blood flow and sexual response are further intensified. During climax, the PFM contract involuntarily in a rhythmic fashion and provide the muscle power behind the physical aspect of an orgasm. The bottom line is that the pleasurable sensation that one perceives during sex is directly related to PFM function and weakened PFM are clearly associated with sexual and orgasmic dysfunction.

PFM training improves PFM awareness, strength, endurance, tone and flexibility and can enhance sexual function in women with desire, arousal, orgasm and pain issues, as well as in women without sexual issues. PFM training helps sculpt a fit and firm vagina, which can positively influence sexual arousal and help one achieve an orgasm. PFM training results in increased muscle mass and more powerful PFM contractions and better PFM stamina, heightening the capacity for enhancing orgasm intensity and experiencing more orgasms as well as increasing “his” pleasure. PFM training is an excellent means of counteracting the adverse sexual effects of obstetrical trauma. Furthermore, PFM training can help prevent sexual problems that may emerge in the future.  Tapping into and harnessing the energy of the PFM is capable of improving one’s sexual experience. If the core muscles are the “powerhouse” of the body, the PFM are the “powerhouse” of the vagina.

Bottom Line: Strong PFM = Strong climax. The PFM are more responsive when better toned and PFM training can revitalize the PFM and instill the capacity to activate the PFM with less effort. PFM training can lead to increased sexual desire, sensation, and sexual pleasure, intensify and produce more orgasms and help one become multi-orgasmic. Women capable of achieving “seismic” orgasms most often have very strong, toned, supple and flexible PFM. Having fit PFM in conjunction with the other core muscles and the external hip rotators translates to increased self-confidence.

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. Much of the content of this entry was excerpted from his recently published book The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health: http://www.TheKegelFix.com

He is also the author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

 

 

The Ins And Outs Of The Vagina

November 19, 2016

Andrew Siegel MD 11/19/16

Chances are that you may be clueless about female genital anatomy and for good reason, as you had no formal instruction…no “vagina-ology” class exists. Education often involves knowledge imparted from friends and schoolmates and perhaps a talk from a parent on the “birds and the bees,” generally less than adequate means. “Sex Ed” classes in junior high school (a.k.a. middle school) were cursory and insufficient. Your dad’s Playboy, your mom’s Cosmo and other magazines may have provided some insight, but were certainly not the gospel. Pornography offers a totally skewed perspective. As a consequence, most people have been educated through practical experience with their own vagina or with those of sexual partners. Although there is no substitute for “hands on” experience, a bit of vaginal academics is certainly a good addition to practical experience.

For many men—and women for that matter—the vagina is a dark and mysterious place, a “black hole” of human anatomy, hidden in the deep recesses of the body. This landscape is complex terrain and unfortunately does not come with a topographical map explaining its intricate subterranean geography.

The following are quotes about the vagina from Tom Hickman’s book: “God’s Doodle: The Life and Times of the Penis”:

“A place of procreative darkness, a sinister place from which blood periodically seeped as if from a wound.”

“Even when made safe, men feared the vagina, already attributed mysterious sexual power – did it not conjure up a man’s organ, absorb it, milk it, spit it out limp?”

The objective of this entry is to explore and demystify the vagina to help you comprehend and navigate its complexities. Knowledge is power and whether female or male, a greater understanding and appreciation of the anatomy, function and nuances of this curious and special female body part will most certainly prove useful.

Female Genital Anatomy 101

The hidden female nether parts and their inner workings are a mystery zone to a surprising number of women. Many falsely believe that the “pee hole” and the “vagina hole” are one and the same…not surprising given that lady parts are much more unexposed, subtle and complex than the more obviously exposed man parts. However, what lies between the thighs is more complicated and intricate than one might think…. three openings, two sets of lips, swellings, glands, erectile tissue, muscles and more.

Let’s first set the record straight on the difference between the vagina and vulva, geography that is often confused. When referring to external visible “girly” anatomy, most people incorrectly speak of the “vagina”—this is actually the “vulva,” divided in half by a midline slit known in medical jargon as the pudendal cleft or cleft of Venus or in slang terms, “camel toe.” The “vagina,” on the other hand, is the internal, flexible, cylindrical, muscular passageway that extends from vulva to cervix (neck of the uterus). The vaginal opening on the vulva is known in medical terms as the vaginal introitus. Further down south is the landscape between the vulva and the anus known in medical jargon as the perineum or in slang terms, “taint.”

vulva

(Anatomy of the vulva by OpenStax College – Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=30148635, no changes made to original)

Bottom Line: The vulva is external, the vagina internal. Good to remember.

Fact: The word “vulva” derives from the Latin “cunnus” (hence the derivation of the slang C-word. The word “vagina” derives from the Latin word for “sheath,” a cover for the blade of a knife or sword, an apt term.

vagina-collage-public-domain

Above image (public domain) entitled “Vagina Collage”…note that it should be entitled  “Vulva Collage”

Many Functions Of The Vagina

The vagina is an amazingly versatile and multifunctional organ that is truly a “cave of wonders.” Beyond being a sexual organ, it is an inflow pathway and receptacle for semen, an exit pathway for menstrual blood, and a birth canal. It is not simply a passive channel, but an active and dynamic, highly responsive passageway that has the capacity for voluntary muscular contraction.

Anatomy Of The Vagina

The average depth of the vagina (without sexual stimulation) is 3-4 inches or so, but with sexual stimulation and arousal, the vagina is capable of considerable expansion and distension to a much greater potential. The elasticity of the vagina is truly impressive (perhaps the most elastic and stretchable organ in the body), with the ability to stretch to accommodate a full-term infant and then return to a relatively normal caliber. The width of the vagina varies throughout its length, narrowest at the vaginal opening and increasing in diameter throughout its depth. It is typically about 1 inch in diameter at the external opening.

Joke from Maxim.com:

  1. Just how deep is the average vagina?
  2. Deep enough for a man to lose his house, his car, his dog and half of all his savings and assets…

All vaginas are unique with a great variety in shape, size and even color, similar to variations in penile anatomy. The vagina is a banana-shaped structure and when a woman lies down on her back, the more external part of the vagina (closest to the vaginal opening) is straight, and the inner, deeper part angles/curves downwards towards the sacral bones (the lower part of the vertebral column that forms the back bony part of the pelvis). This vaginal “axis” often changes with aging and childbirth.

banana-25239_960_720

Banana representing vaginal axis, with inner portion curved towards sacrum and outer portion straight (Thank you Pixabay for image)

Fact: Although the vagina recovers remarkably well after childbirth, anatomy does generally change to some extent. Pelvic examination is usually easily able to distinguish between women who have and have not had children vaginally. Of note, elective C-section (no labor) preserves vaginal anatomy. Women who have an enlarged vaginal outlet due to childbirth may have difficulty in satisfactorily “accommodating” the penis, resulting in the vagina merely “surrounding” the penis rather than firmly “squeezing” it, with the end result being diminished sensation for both partners.

The vagina has pleats and corrugations called rugae that maximize the elasticity and stretchiness of the vagina. They are accordion-like ruffles and ridges that supply texture, which increase friction for the penis during sexual intercourse. In a young woman they are prominent, but with aging they tend to disappear.

Fact: Vaginal rugae are like tread on a tire…in young women they appear like deep grooves on a new snow tire, whereas in older women they appear like thinning tire tread, completely bald at their most extreme…aging can be cruel.

The vaginal wall has an inner lining of “skin” known as epithelium, which is surrounded by connective tissues and a muscular coat. The vaginal muscle is comprised of an inner layer that is circular in orientation and an outer layer that is oriented longitudinally. Contraction of the inner muscle tightens the vagina. Contraction of the outer muscle shortens and widens the vagina. The vagina is secured within a “bed” of powerful pelvic floor muscles.

To better understand  vaginal anatomy, it is useful to divide it arbitrarily into thirds: outer, inner and middle. The outer and inner thirds are where “all the action is,” the outer third being the hub of sexuality, the inner third the hub of reproduction and the middle third essentially a connection between the inner and outer thirds.

Outer third: The outer third of the vagina is rich in nerve fibers and is the most sensitive part of the vagina. The “orgasmic platform” is the Masters and Johnson term for the anatomical “base” that responds to sexual arousal and stimulation with pelvic blood congestion. It consists of the outer third of the vagina and the engorged inner lips.

Middle third: The middle third is a conduit connecting the outer and inner thirds.

Inner third: The cervix (opening to the uterus) sits in the inner third of the vagina. Its presence within the deep vagina defines the deepest recesses of the vagina, which are referred to as the fornices (singular fornix), derived from the Latin word for “arches.” The largest fornix is the one behind the cervix (posterior fornix) with the two smaller fornices above and to the sides of the cervix (anterior and lateral fornices).

Question: What do you think is the origin of the word “fornicate”?

sobo_1906_508

Image above:  Uterus, Cervix and Inner Third Vagina from Dr. Johannes SobottaSobotta’s Atlas and Text-book of Human Anatomy 1906, note the vaginal rugae and the relationship of the cervix with the inner vagina

Fact: In the man-on top sexual intercourse position, the penis reaches the anterior fornix, while in the rear-entry position it reaches the posterior fornix.

The Pelvic Floor Muscles And The Vagina

The pelvic floor muscles play a pivotal role with respect to vaginal and sexual function, their contractions facilitating and enhancing sexual response. They contribute to arousal, sensation during intercourse and the ability to clench the vagina and firmly “grip” the penis. The strength and durability of their contractions are directly related to orgasmic potential since the pelvic muscles are the “motor” that drives sexual climax and can be thought of as the powerhouse of the vagina. During orgasm, the pelvic floor muscles “shudder.”

There is great variety in the bulk, strength, power and voluntary control of the pelvic floor muscles that support the vagina. Some women are capable of powerfully “snapping” their vaginas, whereas others cannot generate even a weak flicker.

3-superficial-and-deep-pfm

Image above: Female pelvic floor muscles, illustration by Ashley Halsey from The Kegel Fix

Fact: “Pompoir” is a sexual technique in which a woman contracts her pelvic floor and vaginal muscles rhythmically to stimulate the penis without the need for pelvic motion or thrusting. Women who diligently practice Kegel exercises can develop powerful pelvic floor muscles and become particularly adept at this technique resulting in extreme vaginal “dexterity” and the ability to refine pulling, pushing, locking, gripping, pulsing, squeezing and twisting motions, which can provide enough stimulation to bring a male to climax.  

Fact: “Penis Captivus” is a rare condition in which a male’s erect penis becomes stuck within a female’s vagina. It is thought to be on the basis of intense contractions of the pelvic floor muscles, causing the vaginal walls to clamp down and entrap the penis. It usually is a brief event and after female orgasm and/or male ejaculation, withdrawal becomes possible. However, it sometimes requires medical attention with a couple showing up in the emergency room tightly connected, like Siamese twins. Not a good call to 911!

Sexual Function And The Vagina

Under normal circumstances, the vagina is not “primed” for sex and is little more prepared for intercourse than is a flaccid penis. The un-stimulated vagina is essentially a closed “potential space” in which the vaginal roof and floor are in contact. With sexual stimulation, the vagina expands with lengthening and widening of its inner two-thirds and flattening of the rugae. The cervix and uterus pull up and back. Pelvic blood flow increases and the vaginal walls undergo a “sweating-like” reaction as a result of pelvic blood congestion, creating a slippery and glistening film. Most of the lubrication is based upon seepage from this increased blood flow, but some comes from Bartholin’s and Skene’s glands. Bartholin’s glands are paired, pea-size glands that drain just below and to each side of the vagina. During sexual arousal they secrete small drops of fluid, resulting in moistening of the opening of the vagina. Skene’s glands are paired glands that drain just above and to each side of the urethral opening. They are the female equivalent of the male prostate gland and secrete fluid with arousal.

With sexual excitement and stimulation, in addition to vaginal lubrication from increased pelvic blood flow, there is congestion and engorgement of the vulva, vagina and clitoris.

Fact: The profound vaginal changes that occur during sexual arousal and stimulation are entirely analogous to the changes that occur during male arousal: expansion of penis length and girth, retraction of the testicles towards the groin, and the release of pre-ejaculate fluid.

With increasing stimulation and arousal, physical tension within the genitals gradually builds and once sufficient intensity and duration of sexual stimulation surpass a threshold, involuntary rhythmic muscular contractions occur of the vagina, uterus, anus and pelvic floor muscles, followed by the release of accumulated erotic tension (a.k.a. orgasm) and a euphoric state. Thereafter, the genital engorgement and congestion subside, muscle relaxation occurs and a peaceful state of physical and emotional bliss and afterglow become apparent.

Fact: Anatomy can affect potential for experiencing sexual climax.

Sexual intercourse results in indirect clitoral stimulation. The clitoral shaft moves rhythmically with penile thrusting by virtue of penile traction on the inner lips, which join together to form the hood of the clitoris. However, if the vaginal opening is too wide to permit the penis to put enough traction on the inner lips, there will be limited clitoral stimulation and less satisfaction in the bedroom. Furthermore, studies have suggested that a larger clitoris that is closer to the vaginal opening is more likely to be stimulated during penetrative sexual intercourse.

At the time of sexual climax, some women are capable of “ejaculating” fluid. The nature of this fluid has been controversial, thought by some to be hyper-lubrication and others to be Bartholin’s and/or Skene’s gland secretions. There are certain women who “ejaculate” very large volumes of fluid at climax and studies have shown this to be urine released because of an involuntary bladder contraction that can accompany orgasm.

Fact: “Persistent genital arousal disorder” is a rare sexual problem characterized by unwanted, unremitting and intrusive arousal, genital engorgement and multiple orgasms without sexual interest or stimulation. It causes great distress to those suffering with it and there are no known effective treatments. It typically does not resolve after orgasm.

The G-Spot—named after German gynecologist Ernst Grafenberg—was first described in 1950 and was believed to be an erogenous zone located on the upper wall of the vagina, anatomically situated between the vagina and the urethra (urinary channel). Stimulation of this spot was thought to promote arousal and vaginal orgasm.

Fact: There is little scientific support for the existence of the G-spot as a discrete anatomical entity; however, many women feel that they possess an area on the roof of the vagina that is a particularly sensitive pleasure zone. Although its existence remains controversial, the G-spot is certainly a powerful social phenomenon.

Regular sexual activity is vital for maintaining the ability to have ongoing satisfactory sexual intercourse with the vagina staying fit and healthy if one remains sexually active, as nature intended. Vaginal penetration increases pelvic and vaginal blood flow, optimizing lubrication and elasticity, while orgasms tone and strengthen the pelvic floor muscles that support vaginal function. “Disuse atrophy” is a condition when the vagina adapts to not being used, with thinning and fragility of the vaginal walls and weakness of the pelvic floor muscles. Use it or lose it!

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 Little Muscles That Could: The Mysterious Muscles You Should Be Exercising

November 5, 2016

Andrew Siegel MD 11/5/2016

This entry was a feature article in the Fall 2016 edition of BC The Magazine: Health, Beauty & Fitness.

(A new blog is posted weekly. To receive the blogs via email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com)

3-superficial-and-deep-pfm

Image above: female pelvic floor muscles, illustration by Ashley Halsey from The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health

00001

Image above: male pelvic floor muscles, illustration by Christine Vecchione from Male Pelvic Fitness: Optimizing Sexual and Urinary Health

There are over 600 muscles in the human body and they all are there for good reasons. However, some are more critical to health and survival than others. In the class rank it is a no-brainer that the heart muscle is valedictorian, followed by the diaphragm. What may surprise you is that the pelvic floor muscles (a.k.a. Kegel muscles) rank in the top ten of the hierarchy.

The pelvic floor muscles are a muscular hammock that make up the floor of the “core” muscles. They are located in the nether regions and form the bottom of the pelvis. They are among the most versatile muscles in the body, equally essential in both women and men for the support of the pelvic organs, bladder and bowel control and sexual function. Because they are out of sight they are frequently out of mind and often not considered when it comes to exercise and fitness. However, without functional pelvic muscles, our pelvic organs would dangle and we would be diapered and asexual.

Our bodies are comprised of a variety of muscle types: There are the glamour, for show, mirror-appeal, overt, seen and be witnessed muscles that offer no secrets—“what you see is what you get”—the biceps, triceps, pectorals, latissimus, quadriceps, etc. Then there are muscles including the pelvic floor muscles that are shrouded in secrecy, hidden from view, concealed and covert, unseen and behind the scenes, unrecognized and misunderstood, favoring function over form, “go” rather than “show.” Most of us can probably point out our “bi’s” (biceps), “tri’s” (triceps), “quads” (quadriceps), “pecs” (pectorals), etc., but who really knows where their “pelvs” (pelvic floor muscles) are located? For that matter, who even knows what they are and how they contribute to pelvic health?

Strong puritanical cultural roots influence our thoughts and feelings about our nether regions. Consequently, this “saddle” region of our bodies (the part in contact with a bicycle seat)—often fails to attain the respect and attention that other zones of our bodies command. Cloaking increases mystique, and so it is for these pelvic muscles, not only obscured by clothing, but also residing in that most curious of regions–an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the pelvic floor muscles, which straddle the gamut of being critical for what may be considered the most pleasurable and refined of human pursuits—sex—but equally integral to what may be considered the basest of human activities—bowel and bladder function.

The deep pelvic floor muscles span from the pubic bone in front to the tailbone in the back, and from pelvic sidewall to pelvic sidewall, between the “sit” bones. The superficial pelvic floor muscles are situated under the surface of the external genitals and anus. The pelvic floor muscles are stabilizers and compressors rather than movers (joint movement and locomotion), the more typical role that skeletal muscles such as these play. Stabilizers support the pelvic organs, keeping them in proper position. Compressors act as sphincters—enveloping the urinary, gynecological and intestinal tracts, opening and closing to provide valve-like control. The superficial pelvic floor muscles act to compress the deep roots of the genitals, trapping blood within these structures and preparing the male and female sexual organs for sexual intercourse; additionally, they contract rhythmically at the time of sexual climax. Although the pelvic floor muscles are not muscles of glamour, they are certainly muscles of “amour”!

Pelvic floor muscle “dysfunction” is a common condition referring to when the pelvic floor muscles are not functioning properly. It affects both women and men and can seriously impact the quality of one’s life. The condition can range from “low tone” to “high tone.” Low tone occurs when the pelvic muscles lack in strength and endurance and is often associated with stress urinary incontinence (urinary leakage with coughing, sneezing, laughing, exercising and other physical activities); pelvic organ prolapse (when one or more of the female pelvic organs falls into the space of the vagina and at times outside the vagina); and altered sexual function, e.g., erectile dysfunction or vaginal looseness.  High tone occurs when the pelvic floor muscles are over-tensioned and unable to relax, giving rise to a pain syndrome known as pelvic floor tension myalgia.

A first-line means of dealing with pelvic floor dysfunction is getting these muscles in tip-top shape. Tapping into and harnessing their energy can help optimize pelvic, sexual and urinary health in both genders. Like other skeletal muscles, the pelvic muscles are capable of making adaptive changes when targeted exercise is applied to them. Pelvic floor training involves gaining facility with both the contracting and the relaxing phases of pelvic muscle function. Their structure and function can be enhanced, resulting in broader, thicker and firmer muscles and the ability to generate a powerful contraction at will—necessary for pelvic wellbeing.

Pelvic floor muscle training can be effective in stabilizing, improving and even preventing issues with pelvic support, sexual function, and urinary and bowel control. Pursuing pelvic floor muscle training before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery; it will also allow for the effortless resumption of the exercises in the post-partum period in order to re-tone the vagina, as the exercises were learned under ideal circumstances, prior to childbirth. Similarly, engaging in pelvic training before prostate cancer surgery will facilitate the resumption of urinary control and sexual function after surgery. Based upon solid exercise science, pelvic floor muscle training can help maintain pelvic integrity and optimal function well into old age.

Bottom Line: Although concealed from view, the pelvic floor muscles are extremely important muscles that deserve serious respect. These muscles are responsible for powerful and vital functions that can be significantly improved/enhanced when intensified by training. It is never too late to begin pelvic floor muscle training exercises—so start now to optimize your pelvic, sexual, urinary, and bowel health.

Wishing you the best of health,

2014-04-23 20:16:29

www.AndrewSiegelMD.com

Andrew Siegel MD practices in Maywood, NJ. He is dual board-certified in urology and female pelvic medicine/reconstructive surgery and is Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and attending urologist at Hackensack University Medical Center. He is a Castle Connolly Top Doctor New York Metro area and Top Doctor New Jersey. He is the author ofTHE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health (www.TheKegelFix.com) and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health (www.MalePelvicFitness.com). He is co-creator of PelvicRx, an interactive, FDA-registered pelvic floor muscle-training program that empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance, this program helps improve sexual function and urinary function. In the works is the female PelvicRx pelvic floor muscle training for women. Visit: http://www.UrologyHealthStore.com to obtain PelvicRx. Use promo code “UROLOGY10” at checkout for 10% discount.

What’s That Bulge Coming Out Of My Vagina?

October 15, 2016

Andrew Siegel MD   10/15/2016

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Photo above: typical appearance of  a vaginal bulge (in this case a dropped bladder)

“The thought was delivered just after my newborn’s placenta: A sneaking suspicion that things were not quite the same down there, and they might never be again…my daughter had finished using my vagina as a giant elastic waterslide.”

-Alissa Walker, Gizmodo.com, April 2, 2015

Between A Rock And A Hard Place

The bony pelvis provides the infrastructure to support the pelvic organs and to allow childbirth. Adequate “closure” is needed for pelvic organ support, yet sufficient “opening” is necessary to permit vaginal delivery. The female pelvis evolved as a compromise between these two important, but opposing functions.

The pelvic floor muscles (PFM) divide the abdominal and pelvic cavities above from the perineum below, forming an important structural support system that keeps the pelvic organs in place. Many physical activities result in significant increases in abdominal pressure, the force of which is largely exerted downwards towards the pelvic floor, especially when upright. This pelvic floor “loading” puts the PFM at particular risk for damage with the potential for pelvic organ prolapse, a.k.a. pelvic relaxation or pelvic organ hernia.

Pelvic Organ Prolapse (POP)

POP is a common condition in which there is weakness of the PFM and other connective tissues that provide pelvic support, allowing the pelvic organs to move from their normal positions into the space of the vaginal canal and, at its most severe degree, outside the vaginal opening. It is a situation in which the pelvic organs go wayward, literally “popping” out of place. POP often causes a bulge outside the vaginal opening, appearing like a man’s scrotum…little wonder why most women are disturbed by this condition.

Two-thirds of women who have delivered children have anatomical evidence of POP (although most are not symptomatic) and 10-20% will need to undergo a corrective surgical procedure. POP is not life threatening, but can be a distressing and disruptive problem that negatively impacts quality of life. Despite how common an issue it is, many women are reluctant to seek help because they are too embarrassed to discuss it with anyone or have the misconception that there are no treatment options available or fear that surgery will be the only solution.

POP may involve any of the pelvic organs including those of the urinary, intestinal and gynecological tracts. The bladder is the organ that is most commonly involved in POP. POP can vary from minimal descent—causing few, if any, symptoms—to major descent—in which one or more of the pelvic organs prolapse outside the vagina at all times, causing significant symptoms. The degree of descent varies with position and activity level, increasing with the upright position and exertion and decreasing with lying down and resting, as is the case for any hernia.

POP can give rise to a variety of symptoms, depending on which organ is involved and the extent of the prolapse. The most common complaints are the following: a vaginal bulge or lump, the perception that one’s insides are falling outside, and vaginal “pressure.” Because POP often causes vaginal looseness in addition to one or more organs falling into the space of the vaginal canal, sexual complaints are common, including painful intercourse, altered sexual feeling and difficulty achieving orgasm as well as less partner satisfaction.

When one’s bladder or rectum descends into the vaginal space, there can be an obstruction to the passage of urine or stool, respectively. This often requires placing one or more fingers in the vagina to manually push back the prolapsed organ. Doing so will straighten the “kink” in order to facilitate emptying one’s bladder or bowels. Pushing (and holding in place) a prolapsed organ back into position with one’s finger(s) is called “splinting.”

Why Do I Have A Bulge Coming Out Of My Vagina?

POP results from a combination of factors including multiple pregnancies and vaginal deliveries (especially deliveries of large babies), menopause, hysterectomy, aging and weight gain. Additionally, conditions that give rise to chronic increases in abdominal pressure contribute to POP. These include chronic constipation, asthma, bronchitis and emphysema (chronic wheezing and coughing), seasonal allergies (chronic sneezing), high-impact sports, and repetitive heavy lifting, whether work-associated or due to weight training. Other causes are genetic predispositions to POP and connective tissue disorders.

Childbirth is one of the most traumatic events that the female body experiences and vaginal delivery is the single most important factor in the development of POP. Passage of the large human head through the female pelvis causes intense mechanical pressure and tissue trauma (stretching, tearing, compression and crushing) to the PFM and PFM nerve supply. This results in separation or weakness of connective tissue attachments and alterations and damage to the integrity of the pelvis. POP that occurs because of a difficult vaginal delivery may not manifest until decades later. It is unusual for women who have not had children or who have delivered by elective caesarian section to develop significant POP.

To be continued…

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

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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