Posts Tagged ‘preventive medicine’

“Preventive” Kegels: A Cutting-Edged Concept

August 25, 2018

Andrew Siegel MD  8/25/18

prevention                        Attribution: Alpha Stock Images –

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

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

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

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

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

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

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

If birth trauma to the pelvic floor often brings on pelvic floor dysfunction as well as urinary, bowel, gynecological and sexual consequences, why not start pelvic training well before pregnancy? This runs counter to both our repair-based medical culture that is not preventive-oriented and our patient population that often opts for fixing things as opposed to preventing them from occurring.

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

Preventive health is commonly practiced with respect to general physical fitness. We work out not only to achieve better fitness, but also to maintain fitness and prevent losses in strength, flexibility, endurance, balance, etc.  In this spirit, I encourage those of you who are enjoying excellent pelvic health to maintain this health with a preventive pelvic training program.  For those working to improve your pelvic health, continue forward on the journey.  Regardless of whether your goal is treatment or prevention, a pelvic training program will allow you to honor your pelvic floor and become empowered from within.

Bottom Line: You can positively affect your own pelvic health destiny.  It is better not to be reactive and wait for your pelvic health to go south, but to be proactive to ensure your continuing sexual, urinary and bowel health. If you wait for the onset of a dysfunction to motivate you to action, it may possibly be too late. Think about integrating a preventive pelvic floor training program into your exercise regimen—it’s like a vaccine to prevent a disease that hopefully you will never get.

Wishing you the best of health,

2014-04-23 20:16:29

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

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

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

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

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


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

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

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


New Paradigm: Preventive Kegel Exercises (Pelvic Floor Muscle Training)

October 4, 2014

Andrew Siegel, M.D.

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

“Honor your pelvic floor–it has done a whole lot for you over the years.”

Restoration of the function of injured muscles is well established in the fields of sports medicine, orthopedics, plastic surgery and physical medicine and rehabilitation. A traumatized or injured muscle is treated with early active rehabilitation and muscle training to accelerate tissue healing and restore it back to working order.

Dr. Arnold Kegel popularized the application of this principle to the female pelvic floor muscles to improve muscle integrity and function in women after childbirth. Obstetrical trauma (9 months of pregnancy, labor and delivery of a 9 lb. baby out the vagina) can cause pelvic floor dysfunction. Pelvic floor dysfunction can cause incontinence (urinary and bowel control issues), pelvic relaxation (laxity of the vagina and its support tissues with descent of the pelvic organs including the bladder, uterus and rectum) and altered sexual function.

Likewise, this principle has been effectively applied to men with compromised pelvic floor muscle integrity and function in order to improve urinary, bowel, erectile, and ejaculatory health. Obviously, men do not suffer with the acute pelvic floor muscle trauma of childbirth that women do, but they can develop pelvic floor muscle dysfunction on the basis of aging, weight gain, a sedentary lifestyle, disuse atrophy, etc.

Don’t Allow Function to Become Dysfunction

Why not take a radically different approach and try to prevent pelvic floor dysfunction instead of fixing it? If you pardon the clichés, although “a stitch in time saves nine,” isn’t a better approach “an ounce of prevention is worth a pound of cure?”. Obstacles to implementing this paradigm are our very reactive and repair-oriented medical culture that does a poor job of being proactive and promoting prevention and our patient population that often prefers fixing things that go awry as opposed to making the effort to prevent them from occurring in the first place. The concept of promoting wellness as opposed to treating diseases is one that resonates powerfully with me.

So, if obstetrical trauma to the pelvic floor often brings on pelvic floor muscle dysfunction and its urinary, gynecological and sexual consequences, why not start pelvic floor muscle training well before pregnancy? And if aging and other factors contribute to male pelvic floor muscle dysfunction and its urinary, bowel and sexual consequences, why wait for the system to malfunction? Why not bolster and strengthen the pelvic floor muscles when one is young, hale and hearty to prevent the age-related decline that is so often predictable? Many of us do apply preventive and proactive means to our health through regular exercise—aerobic for cardiovascular health and strength training to maintain muscle tone, integrity and function.

Whether male or female, the new paradigm is preventive pelvic health. The goal is to preclude, delay, or mitigate the decline in pelvic function that accompanies aging and that is accelerated by pelvic muscle trauma and injury, obesity and disuse atrophy.

Maintaining healthy sexual functioning is important because it contributes to masculine and feminine identity and behavior and has an impact that extends way beyond the sexual domain, permeating positively into many areas of life. Sexual dysfunction—at least to some extent—will eventually surface in most of us and the prospect of this is unsettling.

So, why passively accept the seemingly inevitable, when one can be proactive instead of reactive and can address the future problem before it becomes a current problem? Why wait until function becomes dysfunction? This is a commonly practiced approach for general physical fitness. We work out in the gym not only to achieve better fitness, but also to maintain fitness and prevent age-related losses in strength, flexibility, endurance, etc.

In this spirit, I encourage men and women who are enjoying excellent sexual and urinary health to maintain their pelvic health via preventive PFMT. This preemptive strategy is an opportunity for those who are healthy-functioning to continue enjoying their healthy functioning and prevent, delay and/or mitigate the age-related changes as best as they can.

Bottom Line: You have the ability to affect your own health destiny. Don’t be reactive and wait for your pelvic health to go south. Be proactive to ensure your continuing sexual, urinary and bowel health. If you wait for the onset of a dysfunction to motivate you to action, it may possibly be too late. Think about integrating a preventive PFMT program into your exercise regimen—it’s like a vaccine to prevent a disease that you hopefully will never get. As the saying goes: “Prepare and prevent, not repair and repent.”

Wishing you the best of health,

2014-04-23 20:16:29

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

Note: As Arnold Kegel popularized pelvic floor muscle exercises in females in the late 1940’s, so I am working towards the goal of popularizing pelvic floor muscle exercises in males. This year I published a review article in the Gold Journal of Urology entitled Pelvic Floor Muscle Training in Men: Practical Applications to disseminate the importance and applications of these exercises to my urology colleagues. I wrote Male Pelvic Fitness: Optimizing Sexual and Urinary Health, a book intended to educate the non-medical population. I, along with my partner David Mandell and our superb pelvic floor team, co-created the Private Gym male pelvic floor exercise DVD and resistance program.

For more info on the book:

For more info on the Private Gym:


Preventing Chronic Diseases

March 8, 2014

Blog # 144   Andrew Siegel and William Stewart

Bill Stewart, a 67 year-old friend of mine who has participated in countless full marathons and is passionate about living a healthy lifestyle, sent the following note to me that I want to disseminate because it is spot-on (it is edited to a very minimal extent):

“I got back from Boston this weekend after a very depressing week with my sister, whom I’ve always looked up to.  Just a few years ago she had language skills beyond most Americans; now she has skills at about age 5-6 level, but with significantly less recent memory than children those ages.  I toured an assisted care facility with my sister, which actually exceeded my expectations.  But this is certainly not a place I ever want to be in! 

I am now seeing most of my contemporaries having issues with chronic diseases to a greater or lesser degree, which, I believe could have been avoided or delayed to a later stage in life.  Most people work so hard and really look forward to the day they retire, but, unfortunately for most, retirement becomes one filled with chronic disease, accelerated physical decline, and endless visits to the doctor’s office, hospitalizations with surgical procedures, and gobs of drugs that may help alleviate their conditions, but often cause other conditions. 

I take the attitude that we’re given one period of up to 100 years of life on this earth, and with health it can be a joy, but without health the joy is diminished or gone.  I do believe that the majority of people, barring a particularly bad set of genes, can live an active and happy (or relatively happy) life to within a few years of their genetic clock expiring, whether it be at age 75, 80, 90 or 100 – but not in the prevailing culture of bad food and sedentary habits. 

There is a very vocal minority who are pointing the right way, such as Andy, Dr. Mark Hyman, Dr. Oz, Pastor Rick Warren (The Daniel Plan – an interesting motivator here, maybe not for everyone), etc.  But they are going against some very powerful special interests that make lots of money from the status quo – most physicians, health insurers, big pharma, big agriculture, food processors, fast food industry.  And unfortunately, the US government, for the most part, supports and encourages this. With heavyweight lobbyists representing these industries (many of whom were formerly gov’t officials regulating these industries!), it’s an uphill battle. I think at some point government will realize that Medicare and Medicaid can’t keep expanding because it will totally break the government budgets.  For example, the government now supports and encourages biotech drugs that cost $500,000 or more a year per patient; this is simply not sustainable. But currently it’s very difficult for the government to fund, support, or even encourage studies of preventive strategies because there is not much money to be made from these (but there could be huge savings!!!).

I looked up Dr. Robert Lustig and he had a great video on his web site about high fructose corn syrup and the damage that it does to the body (Sugar, The Bitter Truth). It is a bit technical and somewhat long (about an hour, but fascinating).  And the story he gives about Coca-Cola is really amazing.  I watched the winter Olympics and, of course, Coke presented itself as synonymous with 20th century American culture (this is really nauseating!). There is a Coca-Cola Beverage Institute for Health and Wellness, which I find particularly amusing. 

To my way of thinking, early 50 to mid 60 year-olds are at an age when most people’s health can be “saved”, so to speak, by modifying their habitual exercise and diet behavior before chronic illnesses take a firm hold; I’m really at the back end when, for the most part, the chronic illnesses are in firm command and people are really resistant to changing their habits.”

So what are the key elements for avoiding chronic diseases and living a long, healthy and happy life?  The following summary is excerpted from my first book: Finding Your Own Fountain of Youth: The Essential Guide to Maximizing Health, Wellness, Fitness & Longevity:

  • Maintain an active, purposeful, and meaningful existence—for many this means continuing to work in some capacity or involvement in other endeavors that create purpose—this allows one to structure one’s time effectively and maintain a sense of community.
  • Make a long-term commitment to ample exercise and physical activity.  Stay mentally engaged and passionate about interests and hobbies such as: reading, travel, games, art, music, crafts, pets, sports, etc., etc., etc.
  • Fuel yourself with the healthiest diet possible.
  • Avoid self-abusive behavior—junk food, obesity, tobacco, excessive alcohol, excessive sun exposure, undue risks—maintain an “everything in moderation” attitude.
  • Maintain close ties with family and friends—put great effort into your marriage/primary relationship, as it is a vital contributor to aging well.
  • Have an optimistic and grateful attitude—a cheery, happy, and upbeat disposition, a sense of hope about what the future will bring, and a good sense of humor.
  • Learn to deal positively with stress.
  • Counter life’s inevitable losses, changes, and vicissitudes with adaptation.
  • Practice preventive maintenance and avail yourself of all the advances medicine and technology have to offer.
  • Care about yourself, respect yourself, invest in yourself—LIVE and LIVE well!

Andrew Siegel, M.D.     Our Greatest Wealth Is Health

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in April 2014.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in Kindle edition

Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity  (free electronic download)


Amazon page:

For more info on Dr. Siegel: