Never Too Soon

By Riva Preil

Unfortunately, male sexual dysfunction is extremely common after radical prostatectomy (RP).  Some of the manifestations of sexual dysfunction include erectile dysfunction, anejaculation (inability to ejaculate), climacturia (orgasm-associated incontinence), and changes in penis length.  Pelvic floor physical therapy has been recommended to help decrease these symptoms…but when should the exercises be initiated?  Is it ever too soon?  And could starting a pelvic floor strengthening program too early be dangerous or harmful in any way?

Fortunately, a recent study reported in Cancer Nursing (March-April 2012) addresses this topic, and the answer is that it is safe for men to perform pelvic floor exercises immediately following catheter removal.  In this randomized controlled clinical trial, researchers assigned 35 men to an experimental group and 27 men to a control group.  The experimental group performed daily pelvic floor strengthening exercises immediately after catheter removal, and the control group performed similar exercises which were initiated three months post-operation.

The results of the experiment were that men in the experimental group demonstrated LESS sexual dysfunction than the control group.  Not only does pelvic floor physical therapy improve continence, but it also promotes restoration of potency.  Therefore, pelvic floor physical therapy is indicated for ALL male patients post prostatectomy…and the sooner, the better!

Amy is in Elle Magazine!

We’re excited to announce that Amy is featured as an expert source in the September issue of Elle magazine, in Veronica Manchester’s article “Let Who Put What Where?” about pelvic pain. Take a look at the pages below! You can click the article to enlarge and read it.






















The da Vinci Mode

By Riva Preil

Pelvic Organ Prolapse (POP), organ descent of the bladder, uterus, or rectum, is an all too common problem which affects many adult women.  There are several treatment approaches proposed by medical care providers, including physical therapy to strengthen the pelvic floor muscles that rest beneath and support the organs.  Should physical therapy alone not sufficiently reduce POP symptoms and discomfort, surgical intervention may be indicated.  However, there is a large debate within the medical community regarding what is the best surgery to perform.  Not all surgeries are created equally, and different surgeries use different materials to stabilize the pelvic floor (ex. sling vs. propylene mesh).  Women’s bodies respond differently to these variations, and some require a revision several years later if the prolapse returns.  In addition, open surgery itself puts the individual at risk of sustaining a vaginal or bladder injury during the procedure itself, and some women experience post-surgical complications such as bowel obstruction.

The traditional sacrocolpopexy procedure involves removal of the uterus followed by attaching the vaginal vault to the periosteum of the sacrum with polypropylene mesh.  This open procedure involves a vertical or horizontal abdominal incision above the pubic bone.  The incision is closed with dissolvable or removable stitches.  Fortunately, a recent study in Belgium discussed in European Urology (June 11, 2013) revealed promising results regarding a NEW technique.  The study compared the previously aforementioned technique with a minimally invasive robot-assisted sacrocolpopexy (RASC) procedure. The RASC procedure was performed with the da Vinci Surgical System (created by Intuitive Surgical Company) on 95 women between April 2006 and December 2011.  On average, the procedure took 101 minutes to perform, and at the 34 month follow up, only 4 women (4.2%) were still experiencing POP symptoms.  Only 10.5% of participants experienced urinary urgency symptoms after the surgery, all of which resolved naturally within several weeks post-surgery.  No new bowel or sexual dysfunction symptoms were reported.  Therefore, if a surgical route is indicated, speak with your doctor about whether this safe and effective approach is appropriate for you!

Experiments with Estrogen

By Riva Preil

Hormone replacement therapy (HRT) has received mixed reviews in the medical community. A wide variety of research has been performed to assess the pros and cons, especially regarding the use of estrogen. The Women’s Health Initiative Memory Study (WHIMS) studied the effects of conjugated equine estrogen, the most popular type of post-menopausal estrogen replacement. The study revealed that usage of this type of estrogen was correlated with development of cognitive issues and dementia in women aged 65 and older. The question of whether or not estrogen had similar effects on younger post-menopausal women was not addressed until a recent study, the Women’s Health Initiative Memory Study of Younger Women (WHIMSY). WHIMSY analyzed the effect of the same medications on younger aged women, specifically women who initiated treatment between the ages of 50 and 55. The results of the study, which were published in JAMA Internal Medicine on June 24, 2013, revealed that there was no significant difference in cognitive function or memory abilities between women who had received HRT compared to those who had not. It is unclear why the women receiving HRT a decade younger in the WHIMSY study did not develop the same cognitive issues as the women in the WHIMS study. Based on the research, Dr. Susan Resnick (of the National Institute on Aging) suggests “taking these types of estrogen based hormone therapies for a relatively short period of time in…early postmenopausal years may not put [women] at increased risk for cognitive decline over the long term.” If you have any questions regarding whether or not this medication is appropriate for you or someone you know, please consult with your physician.

Pilates: The Inner Lane

In our last few blogs, we focused on movement in the hip joint.  As a bonus to increasing our range of motion, we also increased the tone in our abdomen and in our gluteal muscles.  In addition, we did it all without gripping or squeezing our muscles, and by coordinating the movement with our breath.

Now, to balance out our legs and relate the abdominal tone to our inner thighs and pelvic floor, we will do a new set of exercises lying on our back.

To begin, lie on your back, preferably on a firm surface.  If possible, lay on a mat or towel on the floor and put a pillow under your head.  If you use a towel, place your feet on the floor, to prevent any possible sliding.

Next, place a small pillow or ball between your knees.  Preferably, the object should be soft to discourage any tension in your legs.

As usual, we will begin the movement by focusing on our breath.  Place your hands on your abdomen and breathe naturally.  In your mind’s eye, see your diaphragm floating up and down in your abdominal cavity, like a parachute blowing in the wind.  When I do this exercise, I always think about when we used to play with a large parachute in my elementary school gym class.

On your next inhale, feel your abdomen expand in your hands as you envision your diaphragm floating down into your pelvis. As you exhale, feel your abdominals contract as you envision your diaphragm floating up into your ribcage.

This breath coordination can be difficult to envision at first, but keep practicing.  The diaphragm moves this way naturally in relation to the abdominals.  If you attempt this exercise by envisioning what is happening, rather than forcing the movement, your body will fall into its natural rhythm.

When you feel you have mastered this concept, begin to add a light squeeze to the pillow, or object between your knees.  This slight contraction will add to the tone of your pelvic floor muscles and abdominals, as well as increase the length of your breath.  As you inhale, see your diaphragm descend and release the squeeze of the ball.  As you exhale, squeeze the ball as your contract your abdominals and float your diaphragm into your ribcage.

Repeat this exercise five to ten times.  If you are feeling any discomfort, stop the exercise.  Remember to contact your doctor or PT before continue with any painful movement.




Pilates: Foot Review

In honor of summer, and the fabulous Riva Preil, we will use this blog to echo Riva’s advice on summer footwear.  We all know that flip-flops are, in theory, the perfect summer shoe.  They are light, they are airy, and they are very inexpensive.  However, flip-flops provide absolutely no support for our feet.

In an earlier blog, I mentioned the importance of having tone in the muscles of our feet.  If the muscles of our feet have good tone, the bones of our feet can maintain the proper structure they need to balance our legs, pelvis, and spine.  However, if you absolutely need to wear your flip-flops, do the following exercise daily to maintain proper muscle tone in your feet.

You can do this exercise either sitting or standing.  In addition, you will need a small ball, preferably the size of a tennis ball.

Place the ball of your foot on the ball and anchor your heel to the floor (photo 1).  Lift your toes off the ball, and then lower them again attempting to wrap your toes around the ball.  Repeat ten times. With each repetition, the ball of your foot should spread wider and extend further over the ball.

picture032 (2)(1)

After ten repetitions, maintain your toes wrapped around the ball.  From here, begin to rotate your foot from right to left (photo 2).  Attempt to keep this motion in your ankle, rather than your knee or your hip.  Do this action ten times.


Next, roll the ball forward and backward under your foot while you point and flex your foot (photo 3).  This will help you maintain the proper heel striking rhythm that Riva mentions in her blog.  Repeat this action ten 10 times.

picture031 (2)

When you have finished with one foot, stand on both feet and observe the difference between each.  Hopefully, the foot your exercised feels more grounded, yet, light and supported.

Wednesday Night Pilates!

Don’t worry, Pilates doesn’t have to be scary. Especially not when we do it!

Every Wednesday, you can join us for a Gentle Mat Pilates class from 6:45 to 7:45pm in our office. Classes are $30 each or $125 for 5, and all you have to do is call us at 212.354.2622 to reserve your spot.

Here’s a testimonial from one of our participants:

“I have been taking the group Pilates class with Batya for several months. During this period, I have gained strength while finding relief from chronic pain. This class has given me an outlet to release stress while improving my flexibility and body awareness. Batya provides each student with individualized attention and care, and her expertise makes me feel supported and secure as I move forward at my own pace. ”
-Elizabeth A., 28 years old.

Our Gentle Pilates class can only strengthen but can relieve pain! We hope you can join us this Wednesday, or any Wednesday after that. See you soon!

Keep Calm and Kegel On!

By Riva Preil

Some of my patients have expressed concern over the concept of having strong pelvic floor muscles, especially in regard to pregnancy, labor, and delivery.  Understandably, they wonder, “Will having strong pelvic floor muscles interfere with my ability to endure labor and delivery?”  Recent research performed at Norwegian School of Sports Sciences (and published in International Urogynecology Journal, June 8 3013) reveals that the answer to their question is NO.

The prospective study measured the vaginal resting pressure of 300 women mid-pregnancy during their first pregnancy with a high precision pressure transducer attached to a vaginal balloon.  The only significant difference noted between women with higher vs. lower resting pressures was the duration of second stage labor, the time of complete cervix dilation until expulsion of the baby.  Women with higher resting tones had longer second stage labor on average; however method of delivery (vaginal vs. caesarian section), frequency of perineal tears, or necessity of using instruments (ex. forceps or vacuum) were NOT affected.  Furthermore, pelvic floor muscle strength and endurance were NOT correlated with prolonged second stage labor or any other delivery outcome.  So Kegel your pelvic floor to your heart’s content, because it will not complicate or prolong your childbirth experience.