10 Ways to Get A Good Night’s Sleep

20 Jan 2020 Blog

In addition to exercise and healthy eating as the key pieces to a healthy lifestyle, modern science supports quality sleep as a third piece of equal importance. According to the CDC, more than one third of Americans are not getting enough sleep on a regular basis. 

How Much Sleep Do I Need?

Getting enough good quality sleep is important for our well-being and daily functioning. We’ve all enjoyed the joyous experience of a great night’s sleep, waking up well-rested, energetic and optimistic. On the other hand, we’ve all also experienced a poor night’s sleep, awakening feeling physically exhausted, mentally spent, and often in a disassociated “zombie” state.

The amount of sleep each person needs is biologically determined and different for everyone. Some can make do with five hours of sleep while others require ten hours. As a general rule, seven to eight hours of sleep is recommended. Regardless, sleeping has a restorative function as our brains and bodies require this important down time for peak performance.

Why Do I Need So Much Sleep?

Good quality sleep is an important component of overall health, wellness, and fitness. Sleep deprivation can have a negative impact on numerous bodily functions, including:

  • Cognitive
  • Endocrine
  • Metabolic
  • Cardiovascular
  • Gastrointestinal
  • Immunity

While sleeping, there is an increased rate of anabolism (cellular growth and synthesis) and a decreased rate of catabolism (cellular breakdown). These processes are disrupted by sleep deprivation. Chronic sleep issues can result in making one feel ill and appearing much older than they are.

Sleep disruption results in decreased levels of leptin (a chemical appetite suppressant), increased ghrelin levels (a chemical appetite stimulant), increased corticosteroids (stress hormones) and increased glucose levels (higher amounts of sugar in the bloodstream). As a result, chronic sleep deprivation commonly gives rise to increased appetite, increased caloric intake and the disassociated “zombie” state – resulting in dysfunctional eating patterns, consumption of unhealthy foods, and weight gain. In addition, chronic fatigue impairs one’s ability to exercise properly, if at all.

Chronic sleep deprivation also results in irritability, impaired cognitive function and poor judgment. The inability to be attentive and focused interferes with work and school performance, causes increased injuries (such as falls), and motor vehicle accidents.

How To Get a Good Night’s Sleep

The good news is that sleep deprivation can be alleviated. Here are ten ways to get a good night’s sleep:

  1. Lead an active lifestyle with lots of exercise and stimulation.
  2. Whether you are an early riser or a night owl, try to be consistent with wake-up and bedtimes on both weekdays and weekends. If these times vary greatly, you’re setting yourself up for sleep problems by disturbing your body’s internal clock.
  3. Maintain a comfortable sleeping environment with a good quality supportive bed, comfortable pillows, a dark room, cool temperature and, if you like, “white noise” (I find that the monotonous sound of the sea produced by a sound machine, coupled with the gentle whirring of an overhead fan, is an instant relaxer).
  4. Avoid caffeine (coffee, tea, cola, etc.) particularly after 6 p.m. Herbal teas (like chamomile) can be soothing and relaxing.
  5. Avoid eating a large dinner or eating very late at night.
  6. Don’t drink too much alcohol.
  7. Avoid exercising late in the evening.
  8. Reduce the stress in your life as much as you can. Engage in a de-stressing activity immediately before sleep, such as reading, watching a movie or television show, or doing crossword puzzle.
  9. Try to minimize evening exposure to the bright light (“blue light”) of cell phones, tablets and computers that inhibits production of the sleep-promoting hormone melatonin. Under normal circumstances, melatonin levels rise with darkness. If possible, dim the light settings on electronic devices that are used at night.
  10. Supplemental melatonin seems to help some people, but is ineffective for many others (including myself), but may be worth a try.

Written by Dr. Andrew Siegel


10 Easy Food Substitutions for a Healthy Eating Lifestyle

Today’s entry is about a healthy eating lifestyle—as opposed to a diet—that works for me and I promise will help you improve your body shape and shed excess pounds. I want to emphasize that this is not a fad diet. It’s a style of eating that can be easily incorporated to replace the typical calorie-rich, nutrient-poor Western diet that is overloaded with highly processed foods that contribute to chronic health problems. As opposed to many weight loss programs that are gimmicky, unbalanced, unhealthy, and unsustainable, this approach is a no-nonsense, intelligent one—clean, lean, with plenty of green—that will stave off your hunger and hold caloric intake in balance with expenditure, making it effective and durable.

The Bialy Diet

First, I will introduce the bialy diet. It is sensible and nutritious eating, replacing unhealthy, high-calorie foods with healthy, low-calorie alternatives. For example, eating bialys instead of bagels. A bialy diet does not imply eating a bialy at every meal, but is simply code for substituting healthier choices for unhealthier ones!

bialy | bēˈälē | noun (plural bialys) US a flat bread roll topped with chopped onions

Who doesn’t love a fresh, warm NY bagel with a smear of cream cheese? Sadly, the answer is our bodies and our health. The 360-calorie bagel with two tablespoons of cream cheese (100 calories) is 460 calories of mostly refined carbs and fat. A great alternative is a bialy, a delicious flat bread roll that contains no hole and has a depressed middle that is flavored with cooked onions and poppy seeds. The 180-calorie toasted bialy with a teaspoon of light butter with canola oil (20 calories) is only 200 calories, tastes delicious, and doesn’t leave you feeling bloated. This with a mug of strong black coffee and half a grapefruit with a few strawberries or blueberries thrown on top is my typical breakfast. Sometimes on the weekends I will have an egg white omelet on a bialy with a slices of NJ tomato and avocado!

The Mediterranean Diet

Mediterranean style eating emphasizes less meat and more fish, an abundance of vegetables and fruits (rich in biologically active compounds including antioxidants, vitamins, minerals and fiber), whole (unrefined) grains, legumes and healthy vegetable fats from olives, avocados, nuts and seeds. Herbs and spices are used to flavor food, rather than salt. Dairy products are eaten in moderation.

The 80/20 Strategy

Another element of a healthy eating lifestyle is the 80/20 strategy. This means that 80% of the time you adhere to a healthy eating style, but 20% of the time you give yourself a break, jump off the wagon and indulge in limited amounts of whatever temptation indulgence you would like. This avoids deprivation and, in my opinion, is “an inoculation to prevent the disease.” On the limited list are sweets including cookies, cakes, donuts, candy and liquid carbohydrates such as sugary drinks including soda, ice tea, lemonade, sports drinks and fruit juices. The only liquid carbohydrate I consume is alcohol in moderation, wine being a component of Mediterranean-style eating.

Here are 10 easy substitutions that incorporate the above mentioned healthy-eating lifestyles:

  1. Bialys instead of bagels
  2. Seafood and lean poultry instead of red meat (if you do eat red meat, consume only the leanest cuts and opt for grass-fed instead of corn-fed)
  3. Vegetable protein (legumes such as peas, soybeans and lentils) instead of animal protein
  4. Olive oil instead of butter
  5. Real fruit instead of dried fruit or fruit juice
  6. Whole grains (wheat, brown rice, quinoa, couscous, barley) instead of refined grain products
  7. Flavored seltzers or sparkling water instead of soda
  8. Plain Greek yogurt instead of sour cream
  9. Soy, rice, almond or other nut-based milks instead of dairy
  10. Low-fat or non-fat dairy products instead of whole milk products

Other Nuggets of Advice:

  • The pathway to a healthy weight is slow and steady, demanding patience and time
  • Eat slowly, deliberately and mindfully
  • Get enough good quality sleep to help keep the pounds off
  • Avoid late night meals and excessive snacking
  • Stay well hydrated as it is easy to confuse hunger with thirst
  • Do not skip meals
  • Keep healthy foods accessible
  • Avoid foods that contain unfamiliar, unpronounceable, or numerous ingredients
  • Organic does not imply healthy or low-calorie
  • Let the last thing you eat before sleep be healthy, natural and wholesome (e.g., a piece of fruit)—you will feel good about yourself when you get into bed and even better in the morning

A lifestyle of healthy eating can improve your overall wellness, both physical and mental. Here’s to a happy, healthy new year!

Written by Dr. Andrew Siegel


5 Diet Changes That May Reduce the Risk of Kidney Stones

Every year, more than half a million Americans go to the emergency room for kidney stone related problems. Although there is no definitive, single cause for kidney stones, making some changes to your diet can reduce your risk for developing new stones.

What are kidney stones?

Kidney stones are small, hard deposits made of minerals and acid salts. In many cases, the stones form when urine becomes concentrated, which allows the minerals and salts to stick together.

How can I prevent them?

Although there is no one-size-fits-all diet for preventing kidney stones, there are changes you can make to your diet that will reduce your risk of developing new stones.

  1. Stay hydrated. Adults should drink about 2 liters of liquid daily (eight 8-ounce glasses). Remember to replace liquids that are sweat out (through exercise or hot weather) in addition to the daily recommended intake. Stick to mainly water and no-calorie or low-calorie beverages.
  2. Reduce sodium intake. Avoid salty foods that have a lot of sodium (the C.D.C. recommends staying under 2,300 mg per day). The following foods are high in salt and should be eaten in moderation:
    • Cheese
    • Frozen foods and meats
    • Canned soups and vegetables
    • Bread (bagels, rolls, baked goods)
    • Salty snacks
  3. Eat the recommended amount of calcium. If you take daily supplements, make sure you aren’t getting too much calcium. Eating calcium-rich foods and beverages daily is recommended, and you can usually get enough daily calcium without supplements.
  4. Eat more fruits and vegetables. At least five servings of fruits and vegetables daily are recommended (especially those who form kidney stones). Fruits and vegetables provide potassium, fiber, magnesium, antioxidants, phytate, and citrate, which may keep stones from forming. One serving equals one piece of fresh fruit or one cup of raw vegetables.
  5. Eat less meat. Animal protein (including meat, fish, poultry, pork) can raise your levels of uric acid, which can cause stones to form. Your healthcare provider may recommend limiting the amount of meat you eat on a daily or weekly basis and recommend eating more plant-based protein options.

6 Surprising Risk Factors for Erectile Dysfunction (ED)

Having problems with erections from time to time is common and shouldn’t be cause for concern. However, if these problems become progressively worse or happen routinely with sex, you may want to speak with your doctor about erectile dysfunction (ED). Erectile dysfunction, or impotence, is the inability to develop and maintain an erection firm enough for sexual intercourse. According to the Urology Care Foundation, ED affects as many as 30 million men.

Although increasing age is the biggest contributing factor, here are six other risk factors for erectile dysfunction that may surprise you:

  1. You have anxiety at work. Men who work in an environment that causes anxiety and/or depression are more likely to suffer from ED. Erections require the nervous system to trigger them, so if the system is depressed, it can be difficult to trigger and maintain an erection.
  2. You have diabetes. ED prevalence in men with diabetes ranges from 35-75% and occurs 10-15 years earlier than men without diabetes. Irregular blood sugar can damage the nerves and blood vessels that allow blood flow in the penis.
  3. You have bad oral hygiene. Research shows that men who suffer from chronic periodontitis are more likely to suffer from ED. Periodontitis is often associated with oral inflammation, which decreases nitric acid production and blood flow.
  4. You regularly add salt to food. High blood pressure and cholesterol are often associated with high-sodium intake, which restricts blood flow. Restricting blood flow to the penis may be a contributing cause of ED.
  5. You enjoy riding a bike. Bike riding can desensitize and damage the nerves in the pelvic floor, which can make it difficult for men to get an erection. Scale back on the number of miles you ride on your bike each week and focus on other kinds of exercise if ED is a problem for you.
  6. You’re trying to reverse hair loss. Certain medications for hair loss, such as Propecia and Avodart, can cause ED because they reduce the amount of dihydrotestosterone in the blood.

Talk to your doctor if you’re experiencing symptoms of erectile dysfunction. There are many treatment options available to improve your quality of life.


New Jersey Urology Partners with Urology Care Alliance

2 Dec 2019 News

The partnership creates largest urology network in the United States

Bloomfield, NJ: New Jersey Urology (“NJU”), the leading urology service provider in New Jersey, and Urology Management Associates (“UMA”) are pleased to announce a partnership with Urology Care Alliance (“UCA”), effective December 1, 2019.

The partnership creates the largest urology group in the tri-state area, with 155 providers in 60 locations, including six cancer treatment centers. Combined, the organizations will have more robust resources for patients and employees alike and be able to better serve patients in central New Jersey and eastern Pennsylvania. UCA physicians will continue to provide care in their existing offices serving Mercer, Middlesex, Monmouth, and Somerset Counties in New Jersey, and Bucks County in Pennsylvania.

“We are proud to welcome Urology Care Alliance (UCA) to the NJU family,” Scott Ciccarelli, Chief Executive Officer at UMA, said. “Their innovative practices, centralized locations, and best-in-class urology care increases our ability to provide outstanding patient care. With the addition of UCA’s treatment center, NJU now has six state-of-the-art cancer treatment centers across the state. Our rapid growth validates NJU as a leader in comprehensive urologic services that enables outstanding patient outcomes and facilitates practice growth.”

UCA President Dr. Gary Karlin said, “Urology Care Alliance is looking forward to joining New Jersey Urology. This merger will allow us to continue to offer the finest urologic patient care and expand our services in this ever-changing field of urological medicine.”

UCA CEO Alan Plotkin added, “Joining forces with New Jersey Urology is a great opportunity to continue to grow our practice and to remain a strong urologic and cancer treatment presence in central New Jersey and Bucks County, Pennsylvania.”

The Bloom Organization served as buy-side advisor to UMA. Henry Bloom, founder of The Bloom Organization, said, “We are pleased to be able to support the growth of NJU and UMA and look forward to continuing to build the leading platform in the urology industry.”

NJU welcomes the UCA physicians: Saad Antoun, MD; Alex Arnouk, MD; Akwasi Boateng, MD; Phillip Brackin Jr., MD; Doh Cha, MD; Michael Cohen, MD; William Ding, MD; Jarad Fingerman, DO; Marc Feder, MD; Russell Freid, MD; Drew Hecht, DO; Gary Karlin, MD; Alex Kirshenbaum, MD; David Koota, MD; Steven Orland, MD; Matthew Pagano, MD; Ravi Rajan, MD; Steven Richards, MD; Emad Rizkala, MD; Christopher Schaefer, DO; Marc Schwarzman, MD; Troy Sukkarieh, MD; Deep Trivedi, MD; John Watson, MD; Akira Yamamoto, MD; Vitaly Zholudev, MD.


About Urology Management Associates:

Urology Management Associates was formed in August 2018 to provide administrative services to New Jersey Urology. The establishment of UMA enables NJU to continue to focus on providing world-class urology services while remaining a physician-led organization. UMA plans to partner with additional urology groups to provide administrative practice management services initially in the greater New York metropolitan area with long-term plans to expand nationally.

About The Bloom Organization:

Bloom has been advising physicians on transactions since 1990. Founded and lead by Mr. Henry Bloom, the Company is based in Aventura, FL and serves clients nationwide. Bloom’s investment banking expertise is in the healthcare services sector.

5 Common Vasectomy Myths Debunked by Urologists

According to the Urology Care Foundation, more than 500,000 men in the U.S. choose vasectomy for birth control each year. But is it right for you? Because it’s a permanent form of birth control, many men have questions or concerns before having a vasectomy. This is normal and to be expected. To help you make an informed decision, our urologists are debunking some common vasectomy myths:

Myth: Vasectomy is a risky surgery.

Truth: A vasectomy is a safe and effective minor surgery that is usually performed in your doctor’s office. However, all surgeries have risks. After a vasectomy procedure, mild discomfort, bruising, and swelling is normal. Most men recover within one to two weeks.

Myth: Vasectomy can always be reversed.

Truth: While many men are good candidates for a vasectomy reversal procedure, only about half of these procedures are successful. The tube that the sperm passes through, called the vas deferens, is reconnected during a vasectomy reversal. It is a more complicated surgery because there are different ways to reconnect the vas deferens. Because there is no guarantee that a vasectomy reversal will be successful, it is important to be sure that you want to get a vasectomy in the first place.

Myth: You’ll lose sexual function.

Truth: A vasectomy does not hinder your sex life as the production of testosterone is not affected. The procedure blocks sperm but does not reduce the amount of semen produced, so there is no noticeable difference when you ejaculate.

Myth: Vasectomy is 100% effective right away.

Truth: It can take two to three months following a vasectomy to ensure there is no live sperm. A backup form of birth control should be used during this time. Only 1 to 2 women out of 1,000 will get pregnant in the year following their partner’s vasectomy.

Have other questions about vasectomies and vasectomy reversals?

If you have questions about getting a vasectomy, contact your local NJU office to schedule a consultation with a urology specialist.


NJ Monthly Top Doctors 2019

NJU Physicians Selected as New Jersey Monthly 2019 Top Doctors

We’re proud to announce that 12 New Jersey Urology physicians have been honored as 2019 Jersey Choice Top Doctors by New Jersey Monthly Magazine.

More than 25,000 New Jersey–based doctors were invited to recommend the physicians they would choose to treat their own family members.

2019 Jersey Choice Top Doctors in Urology:

See New Jersey Monthly’s complete list here >

Pelvic Floor Disorder: Causes, Symptoms and Treatment

According to the National Institutes of Health, roughly a quarter of U.S. women are affected by a pelvic floor disorder. Pelvic floor disorders are a result of weakened or injured muscles and connective tissue in the pelvic cavity that may cause a variety of uncomfortable symptoms making physical activity difficult and sexual intercourse painful.

What is the pelvic floor? What does it do?

The pelvic floor—which men and women both have—is a hammock-shaped group of muscles, connective tissues, and nerves that support the organs and help them function. Both men and women have a:

  • Bladder
  • Bowel
  • Rectum

Men also possess a prostate, whereas women possess a uterus and a vagina. These organs are also a part of the pelvic floor, which extends between the tailbone, pubic bone and hip bone.

What is a pelvic floor disorder?

A pelvic floor disorder refers to a dysfunction of any part of the pelvic floor, resulting in conditions such as:

  • Constipation, difficulties with emptying the bowels
  • Fecal incontinence, an inability to control bowel movements
  • Pain during intercourse or vaginal penetration
  • Pelvic organ prolapse, a weakness in the muscles that causes the organs to shift into the vaginal canal space
  • Urinary incontinence, a loss of control in managing the flow of urine

These conditions occur when the muscles become weakened or the connective tissue tears, typically due to trauma to the pelvic area, childbirth or natural deterioration with age. Genetics, excess weight (which places extra pressure on the pelvic floor) and lifestyle are also thought to play a role, as well as a variety of health issues such as:

  • Diabetes, which may impact how well the pelvic floor muscles function
  • Parkinson’s disease, a degenerative disease of the nervous system that affects nerves and muscle movement
  • Stroke, which can damage the part of the brain that controls bladder/bowel movement or include a medication regimen that causes incontinence as a side effect
  • Spinal stenosis, a narrowing of the spinal canal—typically in the neck or low back—that places pressure on the spinal cord or related nerves, potentially resulting in loss of bladder or bowel control

Symptoms can vary depending on which part of the pelvic floor is affected, but can include:

  • A feeling of needing to constantly have a bowel movement or a feeling of not completely emptying after a bowel movement
  • Any consistent pain in the pelvis, rectum or genital area, especially during intercourse
  • Painful or frequent urination
  • Pressure sensation in the vagina, such as the feeling that you are sitting on something or is protruding from the vagina
  • Straining or having to shift position in order to complete a bowel movement or while trying to empty the bladder

Although pelvic floor disorders may sound scary, they’re a fairly common issue, especially in women. In fact, according to one study, one-quarter of adult women in the U.S. report having at least one of these disorders.

What kind of doctor should I see for a pelvic floor disorder?

You can certainly speak to your OB/GYN or primary care provider (PCP) about the issues you are experiencing, but your best bet is to be seen by a urogynecologist or a urologist who specializes in pelvic floor disorders.

What is a urogynecologist?

A urogynecologist is a urologist or OB/GYN who opts to undergo highly-specific subspecialty training for conditions that impact the pelvic floor. This includes completing a fellowship—additional training after completing a residency program—that focuses on surgical and nonsurgical care of non-cancerous gynecologic issues.

When should I seek medical help for my pelvic floor disorder symptoms?

We understand that these issues can be uncomfortable to talk about, but they are common problems that can be medically managed with the right care. There is no reason to compromise your quality of life when there are plenty of treatment options available. Reach out to your PCP or OB/GYN for a urogynecologist recommendation.

At New Jersey Urology, we’re proud to have urogynecologists on staff to help patients living with these issues. Together, they offer years of combined experience in providing patients relief from pelvic floor disorders utilizing the latest techniques the industry has to offer, both surgical and nonsurgical, in a comfortable environment. This can include everything from specialized exercises (pelvic floor therapy) to a minimally invasive surgical repair of the pelvic floor.


Ejaculation: What to Expect As You Age

There is little written on ejaculatory issues aside from timing problems (premature and delayed ejaculation) and hematospermia (blood in the semen). However, not a day goes by in my urology practice where I do not see at least several patients who complain about declining ejaculation function.

What does the word ejaculation mean?

Ejaculation derives from ex, meaning out + jaculari, meaning to throw, shoot, hurl, cast.

Trivia: You do not need an erection to ejaculate and achieve an orgasm. A limp penis cannot penetrate, but is very capable of ejaculation and orgasm. 

What happens to ejaculations as we age?

Ejaculation and orgasm often become less intense, with diminished force, trajectory and volume. What was once an intense climax with a substantial volume of semen that could be forcefully ejaculated gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis. 

So what’s the big deal?

Men don’t like meager, lackadaisical-quality ejaculations and orgasms. Sex is important to many of us and getting a good quality rigid erection is foremost, but the culmination—ejaculation and orgasm—is equally vital. We may be 40 or 50 years old, but we still want to point and shoot like we did when we were 20. As the word origin indicates, we want to be able to shoot out, hurl or cast like an Olympian and we want that intensely pleasurable feeling of yesteryear.

The science of ejaculation

Sexual climax consists of three phases—emission, ejaculation, and orgasm. When the intensity and duration of sexual stimulation surpasses a threshold, emission occurs, in which secretions from the prostate gland, seminal vesicles, epididymis, and vas deferens are deposited into the urethra within the prostate gland. During ejaculation the pelvic floor muscles contract rhythmically, sending wave-like contractions rippling down the urethra to forcibly propel the semen in a pulsating and explosive eruption. Orgasm is the intense emotional excitement that accompanies the physical act of ejaculation.  

Big head versus little head

Ejaculation is an event that takes place in the penis; orgasm occurs in the brain.

The process of emission and ejaculation is actually a very complex and highly coordinated neurological event involving several specific centers in the brain (amygdala, thalamus and other areas), spinal cord and peripheral nervous system.

What makes up the love juices?

Less than 5% of the volume of semen is actually sperm and the other 95+% is a cocktail of genital juices that provides nourishment, support and safekeeping for sperm. 70% of the volume comes from the seminal vesicles, which secrete a thick, viscous fluid and 25% from the prostate gland, which produces a milky-white fluid. A negligible amount is from the bulbo-urethral glands, which release a clear viscous fluid (pre-come) that has a lubrication function. 

What’s normal volume?

The average ejaculate volume is 2-5 cc (one teaspoon is the equivalent of 5 cc).  While a huge ejaculatory load sounds like a good thing, in reality it can cause infertility. The sperm can literally “drown” in the excessive seminal fluid. 

Why does the seminal tank dry with aging?

As men get older, there are changes in the reproductive organs, particularly the prostate gland, one of the few organs in the body that enlarges with age.

The aging prostate and seminal vesicles produce less fluid; additionally the ducts that drain the genital fluids can become clogged. In many ways, the changes in ejaculation parallel the changes in urination experienced by the aging male. Certain medications that are used to treat prostate enlargement profoundly affect ejaculatory volume. Additionally, the pelvic floor muscles—which play a vital role in ejaculation—weaken with aging. 

What about the pelvic floor muscles?

The pelvic floor muscles play a key role in ejaculation. The bulbocavernosus muscle (BC) is the motor of ejaculation, that which supplies the “horsepower.” The BC surrounds the inner, deepest portion of the urinary channel. It is a compressor muscle that during sex engorges the spongy erection chamber that surrounds the urethra and engorges the head of penis. At the time of climax, the BC expels semen by virtue of its strong rhythmic contractions, allowing ejaculation to occur and contributing to orgasm.

A weakened BC muscle may result in semen dribbling with diminished force or trajectory, whereas a strong BC can generate powerful contractions that can forcibly ejaculate semen at the time of climax.

How to get the juices flowing again?

Pelvic floor muscle training can be a useful tool to improve ejaculation. The stronger the BC, the higher the ejaculatory horsepower and the better the capacity for engorgement of the erection chamber that envelopes the urethra, resulting in optimized urethral pressurization and ejaculation. The intensified ejaculation resulting from a robust BC can enhance the orgasm that accompanies the physical act of ejaculation.

Written by Dr. Andrew Siegel


How To Use Your Pelvic Floor Muscles to Overcome Overactive Bladder

What is overactive bladder?

Overactive Bladder (OAB) is defined as urinary urgency (the sudden and urgent desire to urinate) and frequency (urinating too often, which can be during both awake and sleep hours), with or without urgency incontinence (urinary leakage associated with the urgent desire to urinate). It’s often due to involuntary contractions of the urinary bladder in which the bladder squeezes without its owner’s permission. Although it can occur without provocation, it’s commonly triggered by positional changes such as going from sitting to standing, exposure to running water, approaching a bathroom, and when placing the key in the door to one’s home.

The American Urological Association guidelines for OAB recommend pelvic floor muscle (PFM) training as first-line therapy for OAB. Voluntary PFM contractions can effectively inhibit involuntary bladder contractions and squelch the urgency and urgency incontinence.

How does the bladder work?

In order to effectively tap into the powers of the pelvic floor, a basic understanding of bladder function is necessary. During urine storage, the bladder muscle is in a relaxed, non-contracting state, and the urinary sphincters – responsible for urinary control – are engaged (contracted). During urine emptying, the bladder muscle contracts and the sphincter muscles relax synchronously.

This “antagonistic” relationship between the bladder muscle and the PFMs can be used to the advantage of those suffering with OAB. Because people with OAB often have bladders that contract involuntarily causing the symptoms of urgency and frequency, a means of getting the bladder to relax is to intentionally engage the PFMs to benefit from the reflex relaxation of the bladder that occurs with voluntary contraction of the PFMs.

The PFM-Bladder Reflex

This is a very useful and practical reflex that you can easily access. This reflex is unique because it can be engaged voluntarily and because it results in the relaxation of a muscle as opposed to its contraction. Anyone who has ever experienced an urgent desire to urinate or move one’s bowels will find this reflex of great practical use. When the reflex is deployed, it will result in relaxation of both the urinary bladder and rectum and a quieting down of the urgency.

How to Use the PFM-Bladder Reflex To Overcome OAB

When you feel the sudden and urgent desire to urinate, pulse the PFMs five times, briefly but intensely. When the PFM are so deployed, the bladder muscle reflexively relaxes and the feeling of intense urgency should disappear. Likewise, when the PFMs are so deployed, the rectum relaxes and the feeling of intense bowel urgency should diminish. This reflex is a keeper when you are stuck in traffic and have no access to a toilet!

PFM training helps stimulate the inhibitory reflex between the PFMs and the bladder muscle. A PFM training program will stimulate your awareness of the PFMs and enable you to isolate them and increase their strength, tone, and endurance. The inhibitory reflex will become more robust and you’ll develop an enhanced ability to counteract urgency, frequency and urgency incontinence. Urgency can often be diminished and the urgency incontinence can often be abolished.

Getting beyond inhibiting urgency after it occurs is preventing it from occurring in the first place.  In order to do so, it’s important to recognize the specific triggers that induce the urgency, frequency or incontinence: hand washing, key in the door, rising from sitting, running water, entering the shower, cold or rainy weather, etc.  Prior to exposure to a trigger, rapid flexes of the PFM can preempt the involuntary bladder contraction before it has a chance to occur.

Bottom Line: There are many treatments available for OAB, including decreasing your fluid and caffeine intake, bladder retraining, oral medications, Botox injections into the bladder and neurostimulation. As a first-line approach, tap into the powers of your PFM and harness the natural reflex in which involuntary bladder contractions can be inhibited or prevented by engaging your PFM.

Written by Dr. Andrew Siegel


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