Posts Tagged ‘urinary health’’

Men’s Health: Holistic Urology Approach

August 19, 2017

Andrew Siegel MD   8/19/17

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Thank you, Pixabay, for image above

Men Don’t Ask For Directions, Etc…

With respect to their health, women are usually adept at preventive care and commonly see an internist or gynecologist regularly.  On the other hand, men—who could certainly take a lesson from the fairer sex—are generally not good at seeing doctors for routine checkups. Not only has our culture indoctrinated in men the philosophy of “playing through pain,” but also the lack of necessity of seeking medical care when not having a specific problem or pain (and even when men do develop dangerous health warning signs, many choose to ignore them.). Consequently, many men have missed out on some vital opportunities: To be screened for risks that can lead to future medical issues; be diagnosed with problems that cause no symptoms (such as high blood pressure, glaucoma and prostate cancer); and counseled regarding means of modifying risk factors and optimizing health.

Many Men Don’t Have A Doc

Urologists evaluate and treat a large roster of male patients, a surprising number of whom have not sought healthcare elsewhere and do not have a primary physician. Urological visits offer an opportunity to not only focus on the specific urological complaint that drives the visit (usually urinary or sexual problems), but also to take a more encompassing holistic health approach, emphasizing modifications in diet, physical activity, and other lifestyle factors that can prevent many untoward consequences and maximize health. By getting men engaged in the healthcare system on a timely basis, they can be helped to minimize those risk factors that typically cause the illnesses that afflict men as they age.

Identifying and modifying risk factors can mitigate, if not prevent, a number of common maladies.  Modifiable risk factors for the primary killer of men—cardiovascular disease—include poor diet, obesity, physical inactivity, excessive alcohol, tobacco consumption, stress, high blood pressure, high blood glucose and diabetes, high cholesterol, obstructive sleep apnea, low testosterone and depression. The bottom line is that every patient contact provides an opportunity for so much more than merely treating the sexual or urinary complaint that brought the patient into the office. Furthermore, many systemic disease processes—including diabetes, obstructive sleep apnea, cardiovascular diseases, etc.—have urological manifestations and symptoms that can be identified by the urologist who in turn can make a referral to the appropriate health care provider.

Erections are an Indicator of Health

Many men may not cherish seeing doctors on a routine basis, but a tipping point occurs when it comes to their penises not functioning!  Erectile dysfunction (ED) is a common reason for men to “bite the bullet” and call their friendly urologist for a consultation. The holistic approach by the consultant urologist is to not only manage the ED, but to diagnose the underlying risk factors that can be a sign of broader health issues than simply poor quality erections. Importantly, ED can be a warning sign of an underlying medical problem, since the quality of erections serves as a barometer of cardiovascular health.

    “A man with ED and no known cardiovascular disease                                                                      is a cardiac patient until proven otherwise.”

Graham Jackson, M.D., cardiologist from the U.K.

Since the penile arteries are small in diameter and the coronary (heart) arteries larger, it stands to reason that if vascular disease—generally a systemic process that is diffuse and not localized—is affecting the tiny penile arteries, it may affect the larger coronary arteries as well, if not now, then at some time in the future. In other words, the fatty deposits that compromise blood flow to the smaller vessels of the penis may also do so to the larger vessels of the heart and thus ED may be considered a “stress test.” In fact, the presence of ED is as much of a predictor of cardiovascular disease as is a strong family history of cardiac problems, tobacco smoking, or elevated cholesterol.

Dr. Jackson cleverly expanded the initials ED to mean: Endothelial dysfunction (endothelial cells line the insides of arteries); early detection (of heart disease); and early death (if missed). For this reason, men with ED should undergo a medical evaluation seeking arterial disease elsewhere in the body (heart, brain, aorta, and peripheral blood vessels).

Urologists have a broad network of colleagues (including internists, cardiologists, pulmonologists, gastroenterologists, medical oncologists, radiologists, radiation oncologists, general surgeons, etc.) that can be collaborated with and to whom patients can be referred to if and when their expertise is needed.

Urine is Golden

Of all the bodily secretions that humans produce, urine uniquely provides one of the best “tells” regarding health.  A simple and inexpensive urinary dipstick can diagnose diabetes, kidney disease, urinary tract infection, the presence of blood and hydration status, in a matter of moments.

What a dipstick can reveal:

specific gravity… hydration status

pH…acidity of urine

leukocytes…urinary infection

blood…many urological disorders including kidney and bladder cancer

nitrite…urinary infection

bilirubin…a yellow pigment found in bile, a substance made by the liver; its presence may be indicative of jaundice

protein…kidney disease

glucose…diabetes

Case report of a recent patient

54-year-old male with six-month history of frequent daytime urination as well as awakening 3-4 times during sleep hours to urinate. Additionally, he has difficulty maintaining erections and premature ejaculation. Physical examination of the abdomen, genitalia and prostate was unremarkable. Urinalysis showed large glucose. Lab studies showed glucose 204 (normally < 100); HbA1c 10.6% (normally < 5.6); testosterone 202 (normally > 300) and PSA 4.2 (elevated for his age). 

He was referred to an internist for management of diabetes that manifested with urinary frequency, elevated urine and blood glucose and elevated HbA1c (a measure of blood glucose levels over the past 6 weeks).  With appropriate management of the diabetes, the urinary frequency resolved. Because of the PSA elevation he is scheduled for an MRI of the prostate, and because of the low testosterone, he is undergoing additional endocrine testing to see if the problem is testicular or pituitary in origin and certainly will be a candidate for medical therapy if improved lifestyle measures fail to sufficiently elevate the testosterone.

Bottom Line: Preventive and proactive care—as many pursue regularly for their prized automobiles (e.g., lubrication and oil changes, replacing worn belts before they snap while on the road, etc.)—provides numerous advantages.  The same strategy should be applied to the human machine!  Since contact with a urologist may be a man’s only connection with the healthcare system, a vital opportunity exists for the urologist to offer holistic care in addition to specialty genital and urinary care.  The goal is to empower men by getting them invested in their own health in order to minimize disease risk and optimize vitality. 

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”:  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

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

 

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Pelvic Floor Muscle Exercises: A Vital Part Of Any Balanced Exercise Program

August 15, 2015

Andrew Siegel MD  8/15/15

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Image above: Credit to Eli Christman (https://www.flickr.com/photos/gammaman/7170043719/ CC BY 2.0 http://creativecommons.org/licenses/by/2.0, via Wikimedia Commons)

We hear much about the importance of strengthening our “core” muscles. Most core exercise programs focus on the abdominal, hip, and back muscles. However, there are deeper core muscles that form the floor of the core muscles–-the pelvic floor muscles—that are often neglected, particularly by men. These muscles play a vital role in sexual, urinary, and bowel health and in maintaining proper form, balance and posture during virtually any and every form of exercise. Incorporating a pelvic floor muscle program into your workout routine will be to your benefit. 

The Pelvic Floor Muscles

The pelvic floor muscles are not the well-respected, glitzy, for show, mirror-appealing, external glamour muscles. However, these hidden and often-ignored pelvic muscles are hidden gems that work diligently behind the scenes—muscles of major function and not so much form—that have a role that goes way beyond the joint movement and locomotion function of the external muscles. Although concealed, the pelvic muscles have powerful and beneficial functions, particularly so when intensified by training.

Although not our muscles of glamour, they are our muscles of “amour,” and have a profoundly important role in sexual, urinary, and bowel function as well as in supporting our pelvic organs.

Use Them Or Lose Them

The pelvic floor muscles, as with other muscles in the body, are subject to adaptation. Unused as intended, they can suffer from “disuse atrophy,” becoming thin, flabby and poorly functional as happens with aging, weight gain, a sedentary lifestyle, poor posture and other forms of injury and trauma, chronic straining, and surgery. Used appropriately as designed by nature, they can remain healthy in structure and function. When targeted exercise is applied to them, particularly against the forces of resistance, they can be enhanced. Diligently practiced pelvic exercises will allow one to reap tangible rewards, as having fit pelvic muscles is the essence of functional fitness.

Pelvic Floor Muscle Training: In Isolation and Integrated With Other Workouts

There are two means of working out the pelvic floor muscles: in isolation and integrated. In order to become the master of your pelvic domain, it is initially important to isolate the pelvic floor muscles. Once pelvic floor muscle competence is established, pelvic exercises can then be integrated into other exercise routines and workouts. In real life, muscles do not work in isolation but rather as part of a team, the pelvic muscles being no exception. The pelvic floor muscles often contract in conjunction with the other core muscles—particularly the transversus abdominis—in a mutually supportive and synergistic fashion. In fact, many Pilates and yoga exercises emphasize consciously contracting the pelvic muscles simultaneously with the other core muscles during exercise routines.

Engaging the pelvic floor muscles while doing squats, lunges, etc., serves not only to integrate the lower regions of the core and provide optimal support and “lift” of the floor of the core, but also as a means of exercising the mind-body connection.  It is important to avoid over-exertion of the pelvic floor muscles and awareness directed towards this region is sufficient without the necessity for a forceful contraction.

Dynamic exercises in which complex body movements are coupled with core and pelvic stabilization—such as squats and deadlifts—enhance non-core as well as core strength and function to the maximum. The core muscles, including the pelvic floor, stabilize the trunk when our limbs are active, enabling us to put great effort into limb movements. It is impossible to use the arm and leg muscles effectively in any athletic endeavor without engaging a solid core as a platform from which to push off (think martial arts). Normally this happens without conscious effort, but with some focus and engagement, the core and pelvic floor contraction can be optimized. The stronger the platform, the more powerful the potential push off that platform can be.

Pelvic Contractions To Counteract Intense Training Regimens

Weight training and other forms of intensive exercise result in tremendous increases in abdominal pressure. This force is largely exerted downwards towards the pelvic floor, particularly when exercising in the standing position, when gravity also comes into play. Engaging the pelvic floor during such efforts will help counteract the vector of downwards forces exerted on the pelvic floor.

Knack Maneuver

Many females and certain males (particularly after radical prostatectomy) suffer with stress urinary incontinence, a spurt-like urinary leakage that occurs at times of increased abdominal pressure such as with sports and other high impact activities including jumping and kickboxing. For years, urologists and gynecologists have advocated the “knack” maneuver to counteract this, a technique in which the pelvic muscles are braced and briskly engaged at the time or just before any activity that triggers the stress incontinence. When practiced diligently, this can ultimately become an automatic behavior.

Bottom Line: The pelvic floor muscles are out of sight and therefore out of mind. However, these muscles that form the floor of the core are fundamental to many important body functions (sex, urinary and bowel). Pelvic floor muscle conditioning will not only help keep these functions in working order, but also is a vital component to the performance of complex movements that require engagement and stabilization of the core muscles.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: Available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com.  In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-founder of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program.  Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: http://www.PrivateGym.com or available on Amazon.

10 Myths About Kegel Exercises: What You Need to Know

November 14, 2014

Andrew Siegel, M.D.

 

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Myth: Kegels are just for the ladies.

Truth: Au contraire…men have essentially the same pelvic floor muscles as do women and can derive similar benefits to sexual, urinary, and bowel health.

 

Myth: The best way to do Kegels is to stop the flow of urine.

Truth: If you can stop your stream, it is indeed proof that you are contracting the proper set of muscles. However, this is just a means of feedback to reinforce that you are employing the right muscles, but the bathroom should not be your Kegel muscle gymnasium.

 

Myth: You should do Kegel exercises as often as possible.

Truth: Pelvic floor muscle exercises strengthen and tone the pelvic floor muscles and like other muscle-strengthening routines, should not be performed every day. Pelvic exercises should be done in accordance with an intelligently designed plan of progressively more difficult and challenging exercises that require rest periods in order for optimal muscle growth and response.

 

Myth: You can and should do Kegels anywhere (while stopped in your car at a red light, waiting in line at the check out, while watching television, etc.)

Truth: Exercises of the pelvic floor muscles, like any other form of exercise, demand gravitas, focus, and isolation of the muscle group at hand. Until you are able to master the exercise regimen, it is best that the exercises be performed in an appropriate venue, free of distraction, which allows single-minded focus and concentration. This is not to say that once you achieve mastery of the exercises and a fit pelvic floor that you cannot integrate the exercises into the activities of daily living.

 

Myth: Holding the pelvic floor muscles tight all the time is desirable.

Truth: Not a good idea…the pelvic floor muscles have natural tone to them and when you are not actively engaging and exercising them, they should be left to their own natural state. There exists a condition—tension myalgia of the pelvic floor muscles—in which there is spasticity, tightness and pain due to excessive tension of these muscles. Pelvic floor training in this circumstance must be done with caution in order to avoid aggravating the pain, but maximal muscle contraction can induce maximal muscle relaxation, a meditative state between muscle contractions.

 

Myth: Focusing on your core is enough to ensure pelvic floor muscle fitness.

Truth: The pelvic floor muscles do form the floor of the “core” group of muscles and get some workout whenever the core muscles are exercised. However, for maximum benefit, specific focus needs to be made on the pelvic floor muscles. In Pilates and yoga, there is an emphasis on the core group of muscles and a collateral benefit to the pelvic floor muscles, but this is not enough to achieve the full potential fitness of a regimen that focuses exclusively on the pelvic muscles.

 

Myth: Kegel exercises do not help.

Truth: Au contraire…pelvic floor muscles have proven to help a variety of pelvic maladies in each gender. In females, pelvic floor muscle training can help urinary and bowel incontinence, pelvic relaxation, and sexual dysfunction. In males, pelvic floor muscle training can help incontinence (stress incontinence that follows prostate surgery, overactive bladder, and post void dribbling), erectile dysfunction, premature ejaculation and other forms of ejaculatory dysfunction as well as help bowel incontinence and tension myalgia of the pelvic floor.

 

Myth: Kegels are only helpful after a problem surfaces.

Truth: No, no, no. As in any exercise regimen, the best option is to be proactive and not reactive in order to maintain muscle mass and strength in order to prevent problems from arising before they have an opportunity to do so. Pelvic floor muscle training done during pregnancy can help prevent pelvic issues from arising in females and pelvic muscle training in males can likewise help prevent the onset of a variety of sexual and urinary maladies. There is no better time than the present to start pelvic exercises to delay or prevent symptoms.

 

Myth: You can stop doing Kegels once your muscles strengthen.

Truth: No, “use it or lose it” applies here as it does in any muscle-training regimen. Muscles adapt positively to the stresses and resistances placed upon them and so they adapt negatively to a lack of stresses and resistances. “Disuse atrophy” is a possibility with all muscles, including the pelvic floor muscles.

 

Myth: It is easy to learn how to isolate and exercise the pelvic floor muscles.

Truth: No, not the case at all. Studies have shown that over 70% of women who think they are doing pelvic floor muscle exercises properly are actually contracting other muscles, typically the rectus, the gluteal muscles, and the adductor muscles of the thigh. One of the greatest challenges is that there have been no well-designed, easy-to-follow pelvic muscle training programs…UNTIL NOW! The Private Gym Company was established after recognizing that there was an unmet need for a means by which a pelvic floor muscle-training program could be made accessible and available in the home setting. This comprehensive, interactive, follow-along exercise program is available on DVD…PrivateGym.com.

 

Myth: Kegels can adversely affect your sex life.

Truth: Absolutely not… In both genders, pelvic floor muscle training has been found to improve sexual function. The pelvic floor muscles play a critical role in both female and male sexuality, supporting clitoral and penile erections as well as ejaculation in males and orgasm in both genders.

 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: http://www.MalePelvicFitness.com

Private Gym: http://www.PrivateGym.com – now available on Amazon

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

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

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: www.MalePelvicFitness.com

For more info on the Private Gym: www.PrivateGym.com

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