Posts Tagged ‘urinary urgency’

Percutaneous Tibial Nerve Stimulation (PTNS) For Overactive Bladder (OAB)

July 29, 2017

Andrew Siegel MD   7/29/17


PTNS therapy is a non-drug, non-surgical option to treat OAB symptoms including urinary urgency, frequency and urgency incontinence. PTNS consists of 12 weekly sessions in the office, followed by a maintenance regimen. During each 30-minute session, a thin needle electrode is placed into the ankle region and is connected to an external electrical stimulator. Up to 80% of patients improve with minimal, if any, side-effects.


Overactive bladder is a common and annoying condition present in both females and males marked by episodes of urinary urgency, frequency and, at times, incontinence. A variety of methods can be used to improve symptoms and quality of life, including the following: behavioral modifications, bladder retraining, pelvic floor muscle training, bladder relaxant medications and Botox injections.  Although medications are commonly used for OAB, the problem is that side effects and expense often limit their continued usage.


An effective alternative is neuromodulation, the least invasive technique of which is known as PTNS.  PTNS uses a thin, acupuncture-style needle placed in the ankle that is attached to a hand-held device that generates electrical stimulation.  This is a significantly less invasive means of neuromodulation than is Interstim, which requires implantable wire electrodes to be placed in the spine and continuous electrical stimulation with an implantable battery-powered pulse generator. In both instances, the sacral plexus—responsible for regulating bladder and pelvic floor function—is “modulated” by the electrical stimulation, causing a beneficial effect with improvement of OAB symptoms. With PTNS, the electrical stimulation travels up the tibial nerve to the sacral plexus, whereas with Interstim, the sacral plexus is directly stimulated by electrodes.

Nuts and Bolts of PTNS

PTNS involves once weekly visits to the office for 12 weeks, 30 minutes per session.  It can be performed on both female and male patients.

At each session, the patient is seated comfortably with the treatment leg elevated and supported.  A fine caliber needle electrode—similar to an acupuncture needle—is inserted into the inner ankle in the vicinity of the tibial nerve.  A grounding surface electrode is placed as well.  An adjustable electrical pulse is applied to the needle electrode via an external pulse generator. Activation of the tibial nerve is confirmed with a sensory (mild sensation in ankle or sole) and/or a motor (toe flex/fan or foot extension) response. Thereafter, the power of electrical stimulation is adjusted to an appropriate level and the 30-minute session begins. The patient can read, listen to music, nap, meditate, etc.

Clinical Response

Improvement in OAB symptoms often occurs by session 6, sometimes sooner. Patients who respond well to the 12-week protocol may require occasional maintenance treatments.  70-80% of patients will achieve long-term improvement in OAB symptoms. PTNS incurs minimal risks with the most common side effects being mild pain and skin irritation where the needle electrode is placed.


PTNS is covered by most insurances, including Medicare.  PTNS cannot be used in patients with pacemakers or implantable defibrillators, those prone to excessive bleeding, those with nerve damage or women who are pregnant or planning to get pregnant during the treatment period.

YouTube on PTNS

“My PTNS” educational program

My nurse practitioner and I will be giving a seminar (free of charge) on PTNS on 7PM on Thursday, September 14, 2017 at the Marriott Hotel, 138 New Pehle Avenue, Saddle Brook, NJ.  Light refreshments will be served.  Space is limited, so if interested, please call 201-487-8866 to reserve a spot.

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”:

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 

Amazon page for Dr. Siegel’s books




10 Reasons For Men To Kegel

June 4, 2016

Andrew Siegel, M.D. 6/4/16

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


pixabay image


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

Wishing you the best of health,

2014-04-23 20:16:29

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”:

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

Author page on Amazon:

Apple iBook:

Trailer for The Kegel Fix:  

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

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

Applied Kegels: Functional Pelvic Fitness

November 19, 2014

Andrew Siegel MD 11/19/14

I’ll be in Miami for a few days at the SMSNA (Sexual Medical Society of North America) meeting, so will upload this blog earlier than usual.


It’s one thing to work out your muscles in order to make them stronger, better toned and more durable, but it’s another dimension when you can put that effort to practical use over the course of your day. Since the pelvic floor muscles are muscles of function rather than form, muscles for “go” rather than “show,” they can be put into service when applied to common real life situations.

Urinary and Bowel Urgency (for both sexes)

Chances are that at one time or another you have experienced a sudden and urgent desire to use the bathroom when none was nowhere in sight. This often occurs as a result of an involuntary bladder or bowel contraction, when the bladder or bowel squeezes without your permission, sometimes on the basis of triggers that induce a conditioned response (classic triggers are hand washing, placing a key in the door to your home, rising from sitting, exposure to running water, entering the shower, cold or rainy weather, getting closer and closer to the bathroom, etc.). By recognizing the occurrence of the involuntary contraction and by actively squeezing your pelvic floor muscles using a “rapid flex” technique—rapidly pulsing the pelvic muscles 3-5 times—the urgency can be relieved (and the leakage that can sometimes occur can often be prevented). This works equally as well for bowel urgency as it does for urinary urgency.

Going a step beyond inhibiting urgency after it occurs is preventing it from occurring before it occurs. In order to do so, it is important to recognize any triggers that may induce your urgency. Immediately prior to exposure to a trigger, rapid flexes of the pelvic floor muscles can thwart the involuntary contraction before it even arises.


Dribbling After Urinating (for men)

An “after-dribble” of urine is more annoying than serious and is often a sign of weakening pelvic floor muscles, for which strengthening exercises have proven an effective remedy. Squeezing the pelvic floor muscles is the body’s natural way of expelling the contents of the urinary channel. When contracted, the bulbocavernosus muscle—the body’s urethral “stripper”—compresses the deep portion of the urethra, pushing the urine out. The 1909 Gray’s Anatomy aptly labeled this muscle the “ejaculator urine.”

By actively squeezing your pelvic floor muscles immediately after urinating by using a “basic flex” technique—powerfully pulsing the pelvic floor muscles 3-5 times for 1-2 seconds per contraction—the last few drops of urine will be directed into the toilet and not your pants.


Stress Urinary Incontinence (for both sexes)

Stress incontinence is urinary leakage provoked by sudden increases in abdominal pressure, triggered by sneezing, coughing, bending, lifting, exercising, positional change, etc. It is a common condition in women, often resulting from the pelvic trauma of childbirth, weakening the pelvic muscles and connective tissues that support the urinary channel. Although less common in men, it can occur following radical prostatectomy for prostate cancer and sometimes after prostate surgery done for benign conditions.

In order to help control stress incontinence, you need to be attentive to the triggers that provoke it. By actively squeezing the pelvic floor muscles immediately prior to the trigger exposure, the incontinence can be improved or eliminated. For example, if standing up provokes the incontinence, do a brisk pelvic floor muscle contraction using a “long, hard flex”—contracting the pelvic floor muscles powerfully for 3-5 seconds when transitioning from sitting to standing. This long, hard flex is a means of bracing the pelvic floor muscles immediately prior to an activity that incites the problem and can be a highly effective means of managing the stress incontinence. When practiced diligently, it becomes an automatic behavior.


Premature Ejaculation

Weak pelvic floor muscles seem to play a role in hindering your ability to delay ejaculation. Pelvic floor muscle exercises are a promising treatment option for premature ejaculation, as they will increase the strength, tone, power, and endurance of the pelvic muscles, which can help short-circuit the premature ejaculation. Numerous scientific studies have demonstrated the effectiveness of pelvic floor muscle training in the management of premature ejaculation.

To apply your pelvic muscle facility to the real life situation you need to recognize the imminent ejaculation, slow the pace of intercourse, pause the pelvic thrusting and perform a “hold”—a pelvic floor muscle contraction lasting about 10 seconds or so, until the point that the ejaculatory urgency disappears. By actively deploying your pelvic floor muscles by using this sustained contraction of the pelvic floor muscles, the ejaculation can often be forestalled and intercourse resumed.

Bottom Line: Pelvic floor muscle training has numerous practical benefits, from the bedroom to the bathroom. Learn more about the specifics of these exercises—rapid flexes, basic flexes, long hard flexes and holds, through the Private Gym pelvic floor muscle training program, a comprehensive, interactive, follow-along exercise program that strengthens the muscles that support sexual and urinary health. (

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”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:

Private Gym: – now available on Amazon

Pavlov, the Munchies, and the Bladder

March 23, 2013

Andrew Siegel, MD   Blog #99

Ivan Petrovich Pavlov (1849-1936) was a Russian physician, physiologist and psychologist who won the 1904 Nobel Prize in medicine.  Pavlov is best known for describing classical conditioning, summarized as follows: Pavlov recognized that meat causes dogs to salivate, an instinctual reaction called an unconditioned response. He used a metronome to call his dogs to their meaty meal and, after a few cycles of repetition, the dogs began to salivate just on the basis of the sound of the metronome. The reaction to the metronome is called a conditioned response, since it is a learned behavior.

Humans are little different from Pavlov’s dogs. Many foods literally elicit a “mouth watering” unconditioned response and certain specific contexts can exact a conditioned response in the absence of the specific food item. This can help explain the foraging for food that many of us undertake when the television gets turned on, or alternatively, the desire for snacks when we go out to the movies—I refer to this as the “media munchies.”  Similarly, when we enter our homes and head into the kitchen, many food-associated context clues—the refrigerator, pantry, kitchen table, cookie jar, etc.—trigger our desire to eat via the classical conditioning pathway. The importance of classical conditioning with respect to eating is that food-associated context cues can elicit a conditioned response that can trigger eating and drive overeating, weight gain and obesity.

Let’s now shift gears to the bladder—I must admit that this is a strange segue!  Many develop a conditioned response to cues that we associate with the act of emptying our bladders.  Any source of running water—the kitchen sink, bathroom fixture, shower, etc.—can elicit a conditioned response in which exposure to such a trigger causes urinary urgency, defined as the sudden desire to urinate and need to get to the bathroom in a hurry.  At times, it can even cause incontinence, leakage occurring before arrival to the bathroom.

When I was a wee lad (no pun intended!), I noticed that I consistently experienced the sudden need to urinate when I brushed my teeth.  For years, I was perplexed about this, thinking it had something to do with the act of brushing of my teeth, only to realize years later that it had nothing to do with the toothbrush, toothpaste or act of brushing, but with the water running from the faucet!

For ages, parents have been trying to get their infants to learn to urinate on command by sitting them on the toilet and turning the bathroom sink on, creating and reinforcing an association between running water and urinating.  It is truly a helpful tool in the effort to achieve toilet training; however, this conditioned response can come back to haunt us later in life, when exposure to running water triggers an involuntary bladder contraction (the bladder squeezing without our permission) and hence urgency and perhaps even urgency incontinence!  Other common Pavlov-type conditioned responses that can elicit an involuntary bladder contraction are putting the key in the door to one’s home, arising out of a car, and getting closer to the bathroom.  “Latchkey” incontinence is a very common condition in which simply placing the key in the lock is enough to cause intense urgency and the need to literally scramble to get to the bathroom on a timely basis.  Any cue that reminds us of the act of voiding is enough to trigger this response.

What can we do about these maladaptive and annoying conditioned responses?  If our bladders are truly full, nothing will help short of emptying them.  However, if our bladders are not full, but are simply contracting involuntarily in response to the trigger, there is a simple and effective means of countering it.  The answer is to deploy our pelvic floor muscles to counteract/prevent the involuntary bladder contraction.  Whether female or male, by doing a few rhythmic contractions of the pelvic floor muscles (Kegel exercises), either after the urgency is triggered or preferably before exposure to the trigger, the involuntary bladder contraction can be terminated/obviated.

In fact, pelvic floor muscle exercises have a number of very helpful uses and benefits and will be the subject matter of my forthcoming book entitled “Male Pelvic Fitness: Optimizing Sexual and Urinary Health.”  The female version will follow.  In the meantime, if you would like information on the pelvic floor muscles, take a look at my YouTube video, which can be accessed at:

Bottom Line: The mind-body connection is powerful beyond our understanding.  Contextual cues can provoke responses and actions in the absence of the original stimulus.

Andrew Siegel, M.D.

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

Available on Amazon in paperback or Kindle edition

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