(More) Kegels for Men?!

By Riva Preil

Women have long been familiar with the benefits of pelvic floor strengthening exercises, colloquially referred to as “Kegels,” in honor of Dr. Arnold Kegel, the individual who first described them in 1948.  Almost any woman who has ever been pregnant has been told by her doctor, sister, or friend to engage in Kegel exercises to help strengthen the muscles that get stretched and weakened during the nine months of pregnancy and during labor and delivery. However, recent conversation in the International New York Times (Pelvic Exercises for Men, Too, July 14, 2014) has turned to the benefits of Kegel exercises for MEN.  Author Roni Caryn Rabin describes how pelvic floor strengthening benefits men with urinary incontinence and possibly even sexual dysfunction.  Research has shown that Kegels are helpful for men who experience premature ejaculation, and they may possibly help men with erectile dysfunction. Rabin interviews urologist Dr. Andrew L. Siegel, creator of a pelvic floor muscle strengthening system for men called Private Gym.  The system utilizes light weights attached to a silicone band that is placed on the penis to provide resistance training to the pelvic floor muscles. Dr. Patricia Goode, medical director of the incontinence clinic at University of Alabama, participated in research in 2006 which proved that Kegels help restore continence in men after radical prostatectomy.  In fact, the results are startling- the group who participated in Kegels post-surgery were ALL, on average, fully continent within 3.5 months compared to the control group (no Kegels performed), HALF of whom were not continent after SIX months. So, men, I challenge you to join your lady friends and join the Kegel club!  If you have no idea how to perform a pelvic floor muscle contraction or have any questions about pelvic floor health, we here at Beyond Basics are happy to assist! Please let us know if there is anything we can do to help.

Pelvic Organ Prolapse Awareness Month

By Riva Preil

June marks Pelvic Organ Prolapse Awareness Month.  Pelvic organ prolapse (POP) is a descent of the uterus, bladder, and/or rectum.  It is often associated with stress urinary incontinence or bowel dysfunction.  Patients often report a feeling of fullness in the vagina or the feeling of a tampon falling out.

Multiple factors affect the development of POP, including genetic predisposition, number of previous pregnancies and deliveries, age (ex. post-menopause), and ethnicity.  Furthermore, women who have worked in professions that involve heavy lifting and increased intra-abdominal pressures (ex. flight attendants) are at a greater risk of developing prolapse.

A woman’s chances of developing prolapse increase significantly with her third child’s pregnancy and delivery.  Furthermore, women with a connective tissue disorder (ex. Ehlers-Danlos or Marfans Syndrome) are at increased risk of developing POP.

Research has shown that pelvic floor physical therapy targeted at STRENGTHENING the pelvic floor muscles can help reduce the severity of prolapse.  Therefore, pelvic floor physical therapy is an appropriate and minimally invasive treatment.  The best position for Kegel exercises is with hips elevated (ex. on a wedge or stacked pillows- refer to picture).  This position takes advantage of the gravitational pull which naturally reduces organ descent.  It sure beats having to do your Kegels standing on your head!

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Should physical therapy  alone not suffice, a pessary may be an appropriate device to help provide additional support to the system’s laxity.  In more severe cases, surgery may be the appropriate intervention.  One should speak to their doctor if they think that either of these options may be appropriate.

Whose Kegel Is It Anyway?

By Riva Preil

Okay, folks: it’s time for a game of free word association. What is the first thing that comes to mind when I say the word “Kegel”? If your response was “women”, “pregnancy”, or “incontinence”, you would be in very good company.  However, if your response was “male” or “prostatectomy,” you receive extra credit.  That is because KEGELS ARE NOT JUST FOR WOMEN: men can benefit from Kegels, or pelvic floor muscle strengthening exercises, as well.

Research has already proven that Kegels facilitate restoration of strength and continence in males post -prostatectomy, and that even one session of biofeedback pre-surgery with proper instruction of home exercises resulted in quicker recovery with decreased incontinent severity.  Recently, a study was performed to help delineate clearer pre-op guidelines and recommendations.  The study was published in The International Journal of Urology, and it consisted of a control group (132 males) and an experimental group (152 males).  The men in the control group were given verbal instructions by their surgeon on how to perform Kegels daily prior to the surgery.  On the other hand, the experimental group met with a physical therapist who educated them on pelvic floor anatomy, instructed them on proper performance of Kegels in various functional positions and activities (ex. coughing and squatting), and educated patients on how to avoid abdominal substitution.  This was achieved by using transabdominal ultrasound.  The males in the experimental group were encouraged to perform a home exercise program of 10 repetitions of 10 second endurance contractions in supine, sitting, and standing positions.  All males received the same pelvic floor physical therapy treatments following the surgery.  The researchers concluded that males who received P.T. guided pelvic floor training prior to surgery recovered 28% faster than those in the control group.  In other words, investing the time and energy to participate in a pelvic floor strengthening program prior to surgery resulted in faster return to continence post-surgery.  Take advantage of the research!  If you or someone you know is scheduled to undergo prostate surgery, please call us at Beyond Basics Physical Therapy to give us the opportunity to assist your healing process.  We would be honored to help!       

Amy Talks at Mount Sinai, Part 2

Interview with Amy Stein by Riva Preil

A continuation of our last post, in which Amy discusses her recent talk about pelvic pain and health at Mount Sinai. Here is a sampling of some questions practitioners asked. There’s helpful information here for practitioners and sufferers alike.

Can Kegel exercises help treat incontinence as well as post surgical incontinence?
I was happy to inform them that research has shown that Kegel exercises are very effective in treating postpartum and postsurgical incontinence, as well as any incontinence!

When are Kegels NOT indicated?
I responded that they are not indicated with any pain syndromes or overactive/high tone muscle conditions. For example, urinary urgency and/or frequency is often related to tight pelvic floor muscles.  Incomplete emptying of bowel movements and constipation are also often associated with overactive pelvic floor muscle tone.  In both of these instances, Kegel exercises are contraindicated.

Overall, the talk was a huge success and I received a lot of positive feedback from the physicians.

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.

keep-calm-and-kegel-on

Whoopi Goldberg. Kris Jenner. You?

What do Whoopi, Kris Jenner, and 33% of women have in common? A love for Sister Act? A penchant for Jimmy Choo? Fearlessness in the face of controversy? No! Urinary incontinence. Well…maybe the shoe bit too.

Over 20 million men and women in North America suffer from incontinence. Most people are too embarrassed to talk about it, or think that it is “normal” and just deal with it. Men don’t escape the statistics, at a prevalence of up to 11%.

There are different types of incontinence. Stress incontinence is defined as urinary leaking with increased intra-abdominal pressure, from such events as coughing, sneezing, laughing, or any physical exertion. This is a result of the pelvic floor muscles (the muscles that connect from the pubic bone to the tailbone which support the abdominal organs and assist in bowel, bladder and sexual function) being too weak and/or shortened. After vaginal delivery, the pelvic floor muscles may lengthen and weaken, and many women are unaware of how to strengthen the muscles. Both cases can result in urinary or bowel leakage.

Another type of incontinence is urge incontinence, also known as key-in-lock syndrome. A woman states that as soon as she puts the key in the door, she gets this sudden and strong urge to urinate, but is unable to control it and leaks urine. This could be the result of shortened and weak pelvic floor muscles or from an increase in the normal tone of the muscles.

One can also have a combination of stress and urge incontinence, called mixed incontinence. A woman will complain of leakage with coughing, sneezing and lifting a heavy object and also state that she gets strong urges to urinate that subsequently results in small or large amounts of urinary or fecal incontinence.

So, can these problems be fixed? YES! Medication and/or surgery are not always the answer, and sometimes can worsen patients’ symptoms. If you suffer from stress incontinence and/or decreased sexual stimulation, you need to strengthen the pelvic floor muscles. Strengthening of the muscles are called kegels, named after Dr. Arnold Kegel, the gynecologist, in 1950’s. Medications and surgery are not capable of this. There are two different types of muscle fibers in the pelvic floor, therefore, you need to do two different types of kegels: endurance holds (holding for 10 seconds) and quick holds (holding for 2 seconds) and repeating each exercise 10 times. The two exercises need to be done three to four times a day. Biofeedback, directed by a trained healthcare provider (physical therapist, nurse practitioner), can assist in understanding where these muscles are and how to do the exercises properly. They can also help develop an exercise program specific to your needs. Physical therapists also address the entire musculoskeletal system, taking into account hip strength, core stability, and pelvic alignment. With specific exercises, the leakage should stop and the orgasms will improve. Keep in mind that everyone responds differently. One person may achieve their goals within 2 months, and for another person, it may take 6 months.

Urge incontinence usually requires a more “hands-on” approach by a physical therapist that is trained in the treatment of pelvic floor dysfunction. Urge incontinence is typically the result of shortened or hypertonic pelvic floor muscles and these muscles need to be lengthened through myofascial trigger point release and connective tissue mobilization. Once these muscles are lengthened and functioning at full capacity, then you can strengthen them by performing the kegel exercises and core stabilization exercises. If one strengthens the pelvic floor muscles prior to lengthening them, then they will remain in the shortened position and the problem will persist.

A prolapse (a descent) of the bladder, colon or uterus may or may not contribute to the leakage. A prolapse is typically from weak and/or lengthened muscles and fascial tissue. A prolapse can also be helped through strengthening of the pelvic floor muscles (kegels).

What caused these problems in the first place? Sometimes this is easily answered: a fall on your tailbone, a labored vaginal delivery, or chronic straining from constipation. But, usually the answer is not easily understood. The less obvious causes of incontinence may be from poor posture, a horseback riding injury 20 years ago, multiple urinary tract infections or yeast infections. Luckily, physical therapists trained in pelvic floor dysfunction have the skill set to treat these musculoskeletal dysfunctions of the pelvic floor.

We are grateful to Whoopi and Kris for bringing light to this hot topic. Urinary incontinence is much more common than we realize. Tell your friends that they don’t have to suffer in silence.

Take time to enjoy the view without taking your pad along for the ride. See a pelvic floor physical therapist today!

 Whoopi Goldberg and Kris Jenner find their “Poise”