Archive for July, 2014

Advice From My Patient

July 29, 2014

Andrew Siegel, MD   Blog # 165

Last week I had the pleasure of being invited to lunch and to play a round of golf at a beautiful private course with two of my patients who are club members. One gentleman is in his 60s and the other in his 70s. I received some very excellent technical golf advice from the younger of the two, of which my game is in dire need of (my goal that afternoon being not to embarrass myself…I believe I achieved that!).

In addition to sound advice about my swing mechanics, as we approached an on-the-course restroom, my patient also gave me some sage life advice for the aging male: “Never pass up the opportunity to use the bathroom; never trust a fart; and never waste an erection.”

 As I later thought about his adage that involved seemingly disparate entities—the urinary tract, the intestinal tract, and sexual function—it occurred to me that the common thread was altered pelvic organ and pelvic floor muscle function. What he was really saying was that there are age-related changes of the function of the pelvic organs and the pelvic floor muscles.

Allow me to deconstruct his advice. “Never pass up the opportunity to use the bathroom,” implies the presence of urinary urgency and frequency, often signs of an enlarging prostate and/or overactive bladder. What he was recommending was “defensive voiding,” a technique of keeping the bladder as empty as possible on as regular a basis as possible to try to avert urinary urgency as well as urgency incontinence, a situation that occurs as the bladder leaks urine before its owner is able to get to the bathroom.

With “Never trust a fart,” he was expressing the point that a young man has a very “intelligent” anal sphincter, smart enough to distinguish between liquid, solid, and gas and that, with the aging process, the sphincter, well… becomes less clever. The aging anal sphincter is no longer always accurate in making the distinction between these three physical states, a critically important distinction, a mistake of which can lead to some embarrassing consequences.

Never waste an erection,” reveals the truism that at some point in life getting an erection at will is no longer an option. As we age, erectile dysfunction, or altered function, strikes most of us. When we are so fortunate as to get an erection—which for some men may be a rare occurrence—the opportunity should not be squandered and full advantage of the fortuitous moment should be made.

Pelvic floor muscle exercises can bolster the strength and tone of the pelvic floor muscles, which can improve sexual, urinary and bowel health. Such exercises improve overactive bladder responsible for urinary urgency, anal sphincter weakness responsible for not being able to trust flatulence as such, and erectile dysfunction, such that one’s ability to perform is more in one’s own hands and less up to the whim of nature.

The adage is totally relevant to the aging female as well, except for the part about “never wasting an erection.” Women, in fact, suffer with overactive bladder and anal sphincter issues at a higher prevalence than men. Pelvic exercises can help improve these issues, as well as female sexual issues. Dr. Arnold Kegel popularized pelvic floor exercises in females in order to improve their sexual and urinary health, particularly after childbirth, and his legacy is the pelvic floor muscle exercises that bear his name, known as “Kegels.” Kegel believed that in females, well-developed pelvic muscles are associated with few sexual complaints, and that sexual feeling in the vagina is closely related to muscle tone and can be improved through muscle education and resistive exercise.

Bottom Line: Keep your pelvic floor muscles fit and you just might be able to pass up the opportunity to use the bathroom, trust a fart, and not think twice about wasting an erection.

Andrew Siegel, M.D.

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; available in e-book (Kindle, iBooks, Nook, Kobo) and paperback

I can’t think of a more relevant occasion to repeat the book’s dedication:

This book is dedicated to my patients, many who have opened up their lives and hearts and have shared very personal and intimate details with me. They have been among my most important teachers and have given me a wealth of information that is not to be found in medical textbooks or journals. Meaningful, enjoyable, and rewarding relationships have been developed and nurtured over the years and it has been a privilege and an honor to be entrusted with their urological care. Engaging their confidence and respect through our interactions has proven to be one of the most satisfying and fulfilling aspects of being a physician.

Private Gym website where pelvic floor instructional DVD and resistance training equipment are now available