Don’t suffer in silence

THE incidence of urogenital prolapse in our country is unknown. What is known is that many women with this condition suffer in silence as they do not seek medical advice.

Urogenital prolapse is one of the main reasons for major gynaecological surgery in developed countries like Britain and the United States.

After the doctor has confirmed the diagnosis, one can undertake several measures to make life easier.

Regular pelvic floor (Kegel’s) exercises will reduce leakage of urine, strengthen the pelvic muscles, and assist in recovery after surgery. To locate the muscles, imagine trying to stop passing urine or opening the bowels. The muscles squeezed are the pelvic muscles.

Alternatively, one can insert two fingers into the vagina and squeeze until one can feel the vagina tighten around the fingers. The muscles contracted are the pelvic muscles.

Start tightening the muscles by counting to five, then relax the muscles by counting to five. As muscle strength improves, increase the count to 10. Repeat this 10 to 15 times.

Kegel’s exercises can be done lying down, sitting up or standing with the knees together or slightly apart. It is important to check that the muscles in the legs, abdomen or buttocks are not tightened, and to continue breathing normally during the exercises.

The exercises should be done daily; the frequency will depend on the doctor’s advice.

As prolapse symptoms can be aggravated by standing, it helps if one avoids standing for a long period of time.

The consumption of a high-fibre diet can reduce constipation and straining. Other alternatives to sexual intercourse should be considered if there are such difficulties. Advice can be sought from the doctor.

If one is overweight, measures should be taken to reduce weight and then to maintain it. These include diet, exercises, behaviour therapy and medication, advice for which can be provided by the doctor.

Non-surgical treatment

Currently, the pessary is the only available non-surgical treatment. It is a small device that is inserted into the vagina to reduce prolapse, to provide support to related pelvic structures and to relieve pressure on the bladder and bowel.

It is made of silicone or plastic, and comes in different sizes and shapes.

Pessary use is suitable for the pregnant, those who want to have more children, those who are awaiting surgery, are unsuitable for surgery or who choose not to have surgery.

Before fitting a pessary, the factors to be considered include the nature and extent of the prolapse, the patient’s manual dexterity and level of sexual activity. A pessary has to be individually fitted. The doctor may have to insert a pessary more than once to find one that is comfortable for the patient. After insertion, the patient will be asked to carry out various activities to check that the pessary stays in place.

Once a suitable pessary is found, the doctor will then arrange for a follow-up appointment, after which further appointments will be arranged accordingly.

The doctor may also teach the patient how to remove and re-insert the pessary, as well as how to clean it.

Some pessaries can be left in place during sexual intercourse but others may get in the way. Sometimes there may be a foul discharge. If this or other problems arise, it is essential to consult the doctor. The need for regular follow-up has to be emphasised.

Pelvic floor exercises, as described in the preceding section, are helpful in preventing the prolapse from getting worse and may reduce some of the symptoms. However, it will be some months before the benefits of regular exercise can be felt.

Hormone therapy (HT) may strengthen the pelvic muscles and vaginal wall by increasing the oestrogen and collagen levels. However, it has not been shown to be effective in treating prolapse.

Before commencing HT, there should be a frank discussion with your doctor about its pros and cons. Arrangements will also have to be made for regular follow-ups.

Surgical treatment

There are two types of surgery available for urogenital prolapse – reconstructive or obliterative surgery.

Before deciding on surgery, women are advised to have a frank discussion with their gynaecologist. The questions to be addressed include, among others:

What surgery is recommended and why?

How will the surgery be carried out.

What route will be used? Abdominal or vaginal?

Who will conduct the operation?

What are the complications that may arise?

To what extent will the proposed surgery relieve symptoms?

What are the alternative treatments and their advantages and disadvantages?

Reconstructive surgery aims to correct the prolapsed vagina, while relieving symptoms and maintaining or improving vaginal sexual function. The surgical routes may be vaginal or abdominal, with the former being preferred by the majority of gynaecologists.

Anterior colporrhaphy is a procedure that repairs anterior vaginal wall prolapse, with reported success rates of 80%-100% in case series, and 40%-60% in random trials.

Posterior colporrhaphy is a very effective procedure that repairs posterior vaginal wall prolapse. Because painful vaginal intercourse (dyspareunia) rates are unacceptably high, gynaecologists have modified their operative techniques to reduce this side effect by not narrowing the vagina too much.

Uterine prolapse is treated by removing the uterus (hysterectomy) or suspending it. A hysterectomy is only done if the patient does not plan to have any more children.

The uterus is usually removed by the vaginal route, unless it is very large. After the removal of the uterus, the pelvic ligaments may be shortened and re-attached to hold up the vagina.

After a hysterectomy, there are no more periods and one cannot get pregnant. It is a major decision that must be discussed thoroughly with the doctor.

Operations that suspend the uterus are done in women who do not want to lose their uterus or who want to get pregnant in the future. The surgical routes are abdominal or vaginal with some evidence to suggest there are better results with the abdominal routes. The uterus is held up with mesh or stitches to the pelvic ligaments.

There is widespread use of mesh to correct prolapse. However, the safety and effectiveness data published is limited. Some mesh products reportedly have high success and high complication rates.

This led the World Health Organisation, at its 3rd International Consultation on Incontinence in 2005, to declare that transvaginal mesh “should only be used in well designed clinical trials and not in general practice until more data is available.”

Obliterative surgery corrects the prolapse by putting the pelvic organs back into place and then closing off the vaginal canal totally or partially.

Such operations are seldom done nowadays and are reserved only for senior women who have severe medical conditions and are no longer sexually active.

The advantages of this type of surgery are shortened operating time, decreased risks and a very low prolapse recurrence rate.

The obvious disadvantage is the elimination of the potential for vaginal intercourse.

As such, before such procedures are carried out, both the patient and her partner must be completely comfortable about the loss of vaginal sexual function.

Prevention

There is limited data on the measures that can prevent urogenital prolapse. However, there are a number of things that one can do to reduce the risk of getting a prolapse, or to prevent a mild one from worsening. They include:

Regular Kegel’s exercises to keep the pelvic muscles toned. Kegel’s exercises are an effective treatment for urinary incontinence and other pelvic floor conditions.

Eating plenty of fibre to prevent constipation and straining.

Avoid lifting heavy weights.

Cut down on or stop smoking.

Redcing weight if one is overweight or obese.

Some doctors advocate elective Caesarean section to prevent the development of subsequent prolapse. However, there are no criteria available that can tell who would or would not benefit from such intervention.

It is important for women with prolapse to seek medical advice and not suffer in silence, as untreated prolapse has a significant impact on the quality of life.

Kegel And Penis Enlarging Excercises

Many have heard that performing Kegel exercises can possibly lead to better ejaculatory control. Is this actually true? And how does one perform the Kegel exercises? Here are the answers to these and their benefits for ejaculatory control.

Do they work?

These can indeed lead to better ejaculatory control during sexual intimacy, when practiced consistently. What they do is strengthen the muscles of the pelvic diaphragm, which can then be used to provide males with greater control during sex.

Kegels refer to exercises that restore and increase the tone of the pubococcygeus muscle by regular clenching and unclenching.

A strong PC muscle helps men to:

Prevents incontinence

Increases the flow of blood to the penis

Maintains control of erections and ejaculations

Keeps the prostate in check in old age

kegel helps preventing hemorrhoids from forming. Especially with pregnant women, hemorrhoids is caused because there’s more blood circulating through your veins when you’re pregnant. This can cause your veins, specifically those below your uterus, to be dilated. Now this is where Kegel kicks in! By doing Kegel practice you can benefit from it in two ways. The first is that they will increase blood circulation to your rectum, this prevent hemorrhoids.

What are the standard exercise routines for enlargement purposes?

The common enlarging exercises consist of stretching routines and jelqing exercises. Essentially a stretching routine will consist of several ”holds” in the outstretched position for a period of seconds, a pause/rest, then repeat. Jelqing on the other hand, consists of repeated massaging movements for several minutes. Jelqing is usually the much stronger enlargement enhancing exercise while stretching is often used as a supplement routine.

What are the benefits of Kegel Exercises?

Easy! Improved ejaculatory control for one..:-) Longer, stronger, harder and FULLER erections are another that are widely reported by many men who practice them. There are even BETTER reasons for your overall reproductive health, as many doctors believe that strengthening the pelvic floor and associated muscles have potentially, a wide range of benefits that extend beyond the penis, and may ward off other age related sexual, urinary and reproductive problems!

This exercise is the most natural penis health exercise. It does not have any hard-to-do steps that make it difficult to perform. You only need to identify where your pubococcygeus muscle is, as instructed above, and you can already perform the exercise. The Kegel penis enlargement exercise provides substantial improvements in ejaculation control. It undoubtedly solves the problem with premature ejaculation.

By practicing when you are at home, you can have much more control over your ejaculation because you are able to stop the flow of semen much easier then if you have a weak muscle. That way you can ejaculate when you want to and not when your body says to. These exercises do not work overnight though. You need to take a couple of months of intense practicing to make sure you have the results that you desire. However, when the muscle is strong and in good shape you will be happy to see the results.

So now you know all about the PC muscle and the kegel exercise to strengthen them. You should also be prepared to deal with incontinence and most importantly improve your sex life. As with all fitness routines you should consult your physician before making any changes. Good luck and good health.

The Truth About Kegel Exercises

A kegel is the name of a pelvic floor exercise. These originate from your pubic bone, go under your genitals and attach to your tailbone. These muscles support the uterus, bladder and bowel.

If you do Kegel exercises regularly and keep your pelvic floor muscles toned, you may reduce your risk of incontinence and similar problems as you get older. Kegel exercises can also help your control urinary incontinence.

Kegel muscles can also heighten your arousal during sex, enhance your orgasms, improve blood circulation to the genitals, and increase vaginal tone and lubrication.

Kegel exercises are recommended especially during pregnancy. Well-toned pelvic floor muscles may make you more comfortable as your due date approaches.

Here are several ways to help find the right muscles:

To make sure you know how to contract your pelvic floor muscles, try to stop the flow of urine while you’re going to the bathroom. If you succeed, congratulations you got the basic move.

Do not make a habit of starting and stopping your urine stream. Doing Kegel exercises with a full bladder or while emptying your bladder can actually weaken the muscles. It can also lead to incomplete emptying of the bladder, which increases your risk of a urinary tract infection.

Another technique is to insert a finger inside your vagina and try to squeeze the surrounding muscles. You should be able to feel your vagina tighten and your pelvic floor move upward. Then relax your muscles and feel your pelvic floor move down to the starting position. As your muscles become stronger and you become more experienced with the exercises this movement will be more pronounced.

If you’re having trouble finding the right muscles, call your doctor or other health care provider so they can give you important feedback. The Dr. can make sure that you learn to isolate and exercise the correct muscles.

Once you have identified your pelvic floor muscles, empty your bladder and sit or lie down. Then:

-Contract your pelvic floor muscles.
-Hold the contraction for three seconds then relax for three seconds.
-Repeat 10 times.
-Once you’ve perfected three-second muscle contractions, try it for four seconds at a time, alternating muscle contractions with a four-second rest period.
-Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

To get the most out of the exercise, focus on tightening only your pelvic floor muscles or isolating your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Also, try not to hold your breath. Just relax, breathe freely and focus on tightening the muscles around your vagina and rectum.

Once you have located the muscles simply tighten and relax the muscle over and over, about 200 times a day. You can perform a set of 10 Kegel exercises 2 to 3 times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as checking e-mail or commuting to work.

Vary your technique with one of these methods:

-Try sets of mini-Kegels. Count quickly to 10 or 20, contracting and relaxing your pelvic floor muscles each time you say a number.

-Visualize an elevator. Slow down the exercises, gradually contracting and releasing your pelvic floor muscles one at a time. As you contract, visualize an elevator traveling up four floors. At each floor, contract your muscles a little more until you reach maximum contraction at the fourth floor. Hold the contraction and then slowly release the tension as you visualize the elevator returning to the ground floor. Repeat 10 times.

If you do your Kegel exercises on a regular basis, you can expect to see some results, such as less frequent urine leakage, within about eight to 12 weeks. Your improvement may be dramatic or, at the very least, you may keep your problems from worsening. As with other forms of physical activity, you need to make Kegel exercises a lifelong practice to reap lifelong rewards.

Kegel Exercises for Your Pelvic Muscles

How do pelvic muscles get weak?

Pelvic muscles help stop the flow of urine. For women, pregnancy, childbirth and being overweight can weaken the pelvic muscles. For men, prostate surgery can weaken pelvic muscles. Weak pelvic muscles can cause you to leak urine. Fortunately, pelvic muscles are just like other muscles--exercises can make them stronger. People who leak urine may have better control of these muscles by doing pelvic muscle exercises called Kegel exercises.

This handout focuses on Kegel exercises for women because it is much more common for women to leak urine than for men. If you are a man who leaks urine, talk to your doctor about whether Kegel exercises can help you.

Which muscles control my bladder?

At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back and sides of the pelvic bones. Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle (see picture below).

These are the same muscles that you would use to try to stop the flow of urine. They are the muscles you will exercise and strengthen.

How do I exercise my pelvic muscles?

You can exercise almost anywhere and any time--while driving in a car, at your desk or watching TV. To exercise these muscles, just pull in or "squeeze" your pelvic muscles (as if you are trying to stop urine flow). Hold this squeeze for about 10 seconds, then rest for 10 seconds. Do sets of 10 to 20 contractions per day.

Be patient and continue to exercise. It takes time to strengthen the pelvic muscles, just like it takes time to improve the muscles in your arms, legs or abdomen. You may not notice any change in bladder control until after 6 to 12 weeks of daily exercises. Still, most women notice an improvement after just a few weeks.

A few points to remember

• Weak pelvic muscles often lead to urine leakage.
• Daily exercises can strengthen pelvic muscles.
• These exercises often improve bladder control.
• Ask your doctor or nurse if you are squeezing the right muscles.
• Tighten your pelvic muscle before sneezing, lifting a heavy object or jumping. This can prevent pelvic muscle damage and urine leakage.