Join NJU for a Tee-Off Against Prostate Cancer

13 Mar 2019 News

New Jersey Urology is once again proud to sponsor the Tee-Off Against Prostate Cancer event at TopGolf in Edison, NJ. All proceeds will benefit ZERO – The End of Prostate Cancer.

When: Sunday, March 24th | 2 p.m.
Where: TopGolf Edison (1013 U.S. Route 1, Edison, NJ 08817)

Get your friends, family, and co-workers together for a great time at TopGolf and help us put an end to prostate cancer! Enjoy three hours of play, an All-American buffet with beer and wine, and take home a swag bag of goodies! Form a team of six players or register as an individual and be assigned to a team.

The funds raised from the Tee-Off Against Prostate Cancer event are invested around the country to provide research for new prostate cancer treatments, free prostate cancer testing, and education for men and families about prostate cancer. No other prostate cancer charity spends more per dollar on programs – more than 85 cents. ZERO puts every donation to good use!

REGISTER HERE

Can Varicocelectomy Improve In Vitro Fertilization (IVF) Outcomes? 

11 Mar 2019 Blog

Written by Dr. Eric Seaman:

Varicoceles are enlarged scrotal veins that lie next to the testicle or testicles. Varicoceles can be associated with loss of testicular size, testicular pain and infertility. Varicocele repair, also known as varcocelectomy, has been reported to improve results of semen analysis and its use in the treatment of male factor infertility has been well established.

In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) has also been used very effectively in the treatment of male factor infertility. IVF with ICSI involves the injection of single sperm into individual eggs in order to produce embryos. These embryos are allowed to mature outside the body into blastocysts. A single blastocyst is then, typically, transferred back to the female partner.

Because so few sperm are required for IVF-ICSI, many have questioned whether varicocelectomy has any role in improving outcomes. Even in cases where sperm counts are too low to pursue the more primitive technique of Intrauterine Insemination (IUI), there are often a million sperm or more beyond what is necessary to pursue IVF with ICSI. So even if varicocele repair results in improved semen parameters, does it actually matter? Are IVF pregnancy results improved?

The surprising answer is that literature supports the fact that it does. A 2016 retrospective meta analysis by Kirby at al, (Fertil Steril. 2016;106(6):1338) examined the effect of varicocelectomy repair on pregnancy rates after IVF with ICSI. Although pregnancy rates did not show significant improvements, live birth rates actually did.

Within that meta-analysis, one study cited, Esteves et al (J Urol. 2010; 184: 1442), revealed significantly higher pregnancy and live birth rates in a report comparing results of 80 men who underwent varicocelectomy prior to IVF vs162 men who did not.

Still, the decision of whether to perform varicocelectomy involves additional considerations. First, it is a minor surgical procedure for the male. Every procedure (including IVF with ICSI) involves risks and benefits. Second, improvements in semen parameters usually don’t occur for at least 3 months after the procedure is performed, adding more waiting time for the couple.

On the other hand, varicocelectomy sometimes offers a chance at avoiding IVF-ICSI altogether. I have personal recent experience in performing varicocelectomy on a patient who had a sperm count well below one million per ml (referred as severe oligospermia). The patient elected to have a microsurgical varicocelectomy. Four months after surgery, his sperm density increased to nine million per ml and a few months later, he and his wife conceived naturally. Certainly, that is not what always happens, but it is important to realize that sometimes it can.

Learn more about men’s health services at New Jersey Urology >

Kidney Stones 101: Symptoms, Treatment and Prevention

4 Mar 2019 Blog

Written by Dr. Andrew Siegel:

Kidney stones are a common problem that I treat daily. Kidney stones are often related to our dietary habits, the amount of fluids that we drink, and our weight.

If you have ever suffered with a kidney stone, you know what excruciating pain is. Many women who have experienced both passage of a kidney stone and natural childbirth without any anesthesia will report that the childbirth was the less painful of the two!

Stones are a common condition that have occurred in humans since ancient times — kidney stones have even been found in an Egyptian mummy dated 7000 years old. The good news is that most of them will pass spontaneously without the necessity for surgical intervention. If surgery is required, it is minimally invasive (open surgery for kidney stones has virtually gone by the wayside).

How do kidney stones form?

Kidney stones form when minerals that are normally dissolved in the urine precipitate out of their dissolved state to form solid crystals. This crystal formation often occurs after meals or during periods of dehydration. Most kidney stones manifest themselves during sleep, at a time of maximal dehydration.

Dehydration is also why kidney stones occur much more commonly during hot summer days than during the winter. Anything that promotes dehydration can help bring upon a stone, including exercise, saunas, hot yoga, diarrhea, vomiting, being on bowel prep for colonoscopy, etc.

In addition to dehydration, another factor that can contribute to kidney stone formation is excessive intake of certain vitamins. The biggest culprit is Vitamin C, also known as ascorbic acid. When metabolized by the body, vitamin C is converted into oxalate, one of the components of calcium oxalate stones, the most common type of stone. The problem is that vitamin C is a water-soluble vitamin, so any excessive intake is not stored in the body but appears in the urine in the form of oxalate.

Additionally, excessive dietary protein intake, fat intake, and sodium are all associated with an increased risk for kidney stones. Having inflammatory bowel disease or previous intestinal surgery can also increase the risk for stones. Urinary infections with certain bacteria can promote stone formation. Having a parathyroid issue and high circulating calcium levels is another cause of kidney stones. Obesity is also a risk factor for kidney stones. Some stones have a genetic basis, with a tendency to affect many family members.

A kidney stone starts out as a tiny sand particle that grows as the “grain” is bathed in urine that contains minerals. These minerals are deposited and coalesce around the grain. They can grow to a very variable extent so that when they start causing symptoms they may range from being only a few millimeters in diameter to filling the entire kidney.

What are the symptoms?

Some stones are “silent” because they cause no symptoms and are discovered when imaging studies are done for other reasons. However, most stones cause severe pain known as colic. Colicky pain is often intermittent, originating in the flank area and radiating down towards the groin.  It often causes an inability to get comfortable in any position, and is associated with sweating, nausea, and vomiting. Kidney stones can also cause blood in the urine, sometimes visible and, at other times, only on a microscopic basis.

When a stone moves into the ureter (the tube running from the kidney to the bladder), it can become impacted and block the flow of urine. Stones can sometimes cause lower urinary tract symptoms such as urgency and frequency, particularly when the stone approaches the very terminal part of the ureter that is actually tunneled through the wall of the bladder.

How are they diagnosed?

Kidney stones are usually easily diagnosed, based upon their rather classical presentation. However, on occasion, a stone causes no symptoms whatsoever and is picked up incidentally on an imaging study such as an ultrasound, a CAT scan, or an MRI. The imaging study of choice for evaluating a kidney stone is an unenhanced CAT scan (without contrast). A plain x-ray of the abdomen is very useful for stones that contain calcium, and thus are readily visible on an x-ray.

How are they treated?

Most stones will pass spontaneously without intervention given enough time. Conservative management involves hydration, analgesics and the use of a class of medications known as alpha-blockers that can help facilitate stone passage by relaxing the ureteral smooth muscle. As long as the pain is manageable and there is progressive movement of the stone seen on imaging studies, conservative management can continue to be an option.

Intervention is mandated under the following circumstances: intolerable pain; refractory nausea and vomiting with dehydration; larger stones that are not likely to pass; failure of a stone to pass after a reasonable amount of time; significant obstruction of the kidney; a high fever from a kidney infection that does not respond to antibiotics; a solitary kidney; and certain occupations that cannot risk impaired functions such as an airline pilot.

There are a number of minimally invasive means of treating kidney stones depending upon the size of the stone, its location, and the degree of obstruction of the urinary tract. Gone are the days when treating a kidney stone required a painful incision and a prolonged stay in the hospital. Shockwave lithotripsy is commonly used to treat stones in the kidney or upper ureter. Typically done under intravenous sedation, shockwave lithotripsy uses shock waves directed at the kidney stone via x-ray guidance to fragment the stones into pieces that are small enough so that they then can then pass down the ureter, into the bladder and out the urethra with the act of urinating.

Another means of managing stones, particularly amenable to stones in the lower ureter but also applicable to any stone, is ureteroscopy and laser lithotripsy. This procedure is done under general anesthesia. A narrow lighted instrument known as a ureteroscope is passed up the ureter to visualize the stone under direct vision.  A laser fiber is then utilized to break the stone into tiny particles. The largest fragments are removed using a special basket. A ureteral stent is often left in place after this procedure to allow the ureter to heal as well as to prevent obstruction of the kidney.

What are the risk factors?

You are at high risk for kidney stones if you:

  • Don’t drink enough fluids
  • Have an occupation that requires working in hot environments
  • Exercise strenuously without maintaining adequate hydration
  • Are a male, since the male to female ratio of kidney stone incidence is 3:1
  • Had a previous kidney stone, since about 50% of people who have a stone will experience a recurrence
  • Have a family history of kidney stones
  • Have a urinary tract obstruction
  • Have an excessive intake of oxalate, calcium, salt, protein and fat
  • Take excessive amounts of vitamin C, A, and D
  • Have an intestinal malabsorption
  • Have gout
  • Have parathyroid disease

Kidney Stone Prevention

The key to preventing kidney stones is to stay well hydrated, particularly when exposed to hot environments or when exercising for prolonged periods of time. It is also important to avoid overdoing it with certain vitamins—particularly vitamin C. The two biggest risk factors for kidney stones are, in fact, dehydration and excessive intake of vitamin C. Chances are that if you have a healthy diet, you have more than adequate intake of vitamin C and any extra is potentially dangerous. A good sign of adequate hydration is the color of your urine: the urine of a well-hydrated person will look light in color like lemonade, whereas the urine of a dehydrated person will look like apple juice.

So drink up, particularly on hot days…and squeeze some citrus fruit into your water instead of popping a vitamin C supplement…your kidneys will thank you!

Find a urologist near you >

The Prostate Gland: Man’s Center of Gravity

25 Feb 2019 Blog

Written by Dr. Andrew Siegel

The prostate gland is a mysterious male reproductive organ that can be a source of curiosity, anxiety, fear and potential trouble. Since this gland is a midline organ nestled deep within the pelvis, I like to think of it as man’s “center of gravity.”

Where exactly is the prostate gland?

The prostate gland is located behind the pubic bone and is attached to the bladder (above) and the urethra (below). The rectum is directly behind the prostate (which permits access for prostate exam). The prostate is situated at the crossroads of the urinary and reproductive tracts and completely surrounds the urethra, allowing its many ducts to drain into the urethra. The relationship between the prostate and the urethra can potentially be the source of problems for the older male. When a man ages, the prostate gland gradually enlarges. This prostate enlargement can constrict and block the urethra, giving rise to bothersome urinary symptoms.

What is the prostate, what purpose does it serve, and how does it function?

The prostate is a male reproductive gland that produces prostate fluid, a nutrient and energy vehicle for sperm. The prostate consists of glandular and fibro-muscular tissue enclosed by a capsule of collagen, elastin and smooth muscle. The glandular tissue contains the secretory cells that produce the prostate fluid.

Semen is a “cocktail” composed of prostate fluid mixed with secretions from the seminal vesicles and sperm from the epididymis. The seminal vesicle fluid forms the bulk of the semen. The seminal vesicles and vas deferens (tubes that conduct sperm from testes to prostate) unite to form the ejaculatory ducts.

At the time of sexual climax, prostate smooth muscle contractions squeeze the prostate fluid through prostate ducts at the same time as the seminal vesicles and vas deferens contractions squeeze seminal fluid and sperm through the ejaculatory ducts. These pooled secretions empty into the urethra (channel that runs from the bladder to the tip of the penis). Rhythmic contractions of the superficial pelvic floor muscles result in the ejaculation of the semen.

What are the zones of the prostate gland?

The prostate gland is comprised of different anatomical zones. Most cancers originate in the “peripheral zone” at the back of the prostate, which can be accessed via digital rectal exam. The “transition zone” surrounds the urethra and is where benign enlargement of the prostate occurs. The “central zone” surrounds the ejaculatory ducts, which run from the seminal vesicles to the urethra.

Curious facts about the prostate:

  • The prostate functions to produce a milky fluid that serves as a nutritional vehicle for sperm.
  • Prostate “massage” is sometimes done by urologists to “milk” the prostate to obtain a specimen for laboratory analysis.
  • The prostate undergoes an initial growth spurt at puberty and a second one starting at age 40 or so.
  • A young man’s prostate is about the size of a walnut, but under the influence of aging, genetics and testosterone, the prostate gland often enlarges and constricts the urethra, which can cause annoying urinary symptoms.
  • In the absence of testosterone, the prostate never develops.
  • The prostate consists of 70% glands and 30% muscle. Prostate muscle fibers contract at sexual climax to squeeze prostate fluid into the urethra. Excessive prostate muscle tone, often stress-related, can give rise to the same urinary symptoms that are caused by age-related benign enlargement of the prostate.
  • Women have a female version of the prostate, known as the Skene’s glands.

Learn more about Men’s Health at New Jersey Urology >

4 Common Causes of Urinary Incontinence in Men

18 Feb 2019 Blog

Urinary incontinence is the accidental leakage of urine that you can’t control. Anywhere from 5% to 15% of men over the age of 60 are affected.

Urinary incontinence is not just a medical problem – it often becomes an emotional and social problem that interferes with people’s everyday lives. Often targeting the cause of urinary problems can help you and your doctor find the best treatment option to reduce bladder leakage and restore daily function.

Common Causes of Urinary Incontinence in Men:

  • Prostate problems. Prostate problems, especially as men age, can result in problems with urinary incontinence. If the prostate is enlarged, it may affect the flow of urine and cause a weak stream, frequent urination, or leaking. When the prostate is removed for cancer treatment, it is common to have stress incontinence, meaning coughing or sneezing can trigger leakage.
  • Conditions that cause nerve damage. Because muscles and nerves must work together to control the bladder, any condition that damages the nerves can create urinary problems. Conditions may include Parkinson’s, a stroke, diabetes, or multiple sclerosis. Injuries of the spinal cord can also result in urinary incontinence.
  • What you drink. Certain types of beverages can put stress on the urinary system. Limiting the amount of alcohol, caffeine, or carbonated beverages that you drink can help reduce bladder leakage. Staying hydrated is important, but it is not necessary to drink a certain amount of water during the day.
  • Being overweight. Being overweight can cause or worsen male incontinence because extra weight weakens the muscles that help with bladder function. Obesity may affect female incontinence more than in men, but it can still be a factor of male incontinence.

Treating Male Urinary Incontinence

There are many ways to ease the symptoms of male urinary incontinence, including behavioral treatments, medication, and surgery. Find a urologist near you by visiting our locations page.

5 Signs of Bladder Cancer: What Women Should Know

11 Feb 2019 Blog

Written by Dr. Paul Littman:

Even if you’re vigilant about getting routine GYN care, bladder cancer may not be on your radar. After all, it’s far more common among men than women, and the majority of cases affect patients over age 65. However, don’t let those stats keep you from learning to spot the symptoms.

Many people mistakenly think bladder cancer is only a disease of older men, but there are more than 18,000 women who are diagnosed with this cancer every year in the United States. Because women may not be on the lookout for early signs of bladder cancer, the Bladder Cancer Advocacy Network reports that women are more likely to be diagnosed with bladder cancer at an advanced stage.

Knowing the signs and symptoms can help you get diagnosed sooner, which may improve your prognosis. Here are five warning signs to watch for:

  1. Blood in your urine. This is the most common early symptom of bladder cancer, and it’s an easy one for women to overlook because it’s typically painless and you can go weeks or even months between occurrences. Many women ignore this symptom because they connect it with menstruation or menopause. Women who have microscopic blood in the urine without symptoms of urgency, frequency or pain often don’t have a urinary tract infection (UTI). In fact, the blood in the urine may be due to cancer or other conditions.
  2. UTI-like symptoms. Bladder cancer can often be mistaken for a UTI because many of the symptoms overlap. Patients may experience increased frequency of urination, urgency to urinate, pain with urination, or urinary incontinence. If you’ve noticed any urinary problems—you have to go all the time, or you feel like you have to go but can’t, or you have a hard time emptying your bladder—or if antibiotics don’t seem to be helping your UTI symptoms, talk to your doctor.
  3. Unexplained pain. Pain is often associated with more advanced bladder cancers. Pain can occur in the flank area, abdomen, or pelvis. Patients can also develop pain in their bones if the cancer has spread to their bones. If you’re having aches and pains in those areas, tell your doctor—especially if you’ve also had the aforementioned spotting or UTI symptoms.
  4. Decreased appetite. Appetite loss is a common cancer symptom, and bladder cancer is no exception. If the cancer has grown or spread, you might have weight loss or feel tired and weak. Of course, there are plenty of other things that can mess with your appetite, so don’t automatically assume the worst—but do talk to your doctor about it if it persists.
  5. Smoking. According to the National Institutes of Health, about 50% of women diagnosed with bladder cancer are smokers. Smoking is the biggest risk factor for bladder cancer. If you notice any of the above symptoms and you smoke, let your doctor know as soon as possible.

Because it’s easy to chalk up symptoms to a stubborn UTI or normal vaginal spotting, bladder cancer may be overlooked in women, and they are often not diagnosed until their cancer has spread and it’s harder to treat. So if you’re worried, don’t just write off your symptoms. A urogynecologist is the perfect type of doctor to determine if it’s a minor infection or something more serious—and if it is bladder cancer, it’s easier to treat if you catch it early.

Find a doctor near you >

Male Sexual Dysfunction: A Predictor of Heart Disease

4 Feb 2019 Blog

Written by Dr. Andrew Siegel:

Having some fat on our bodies is not a bad thing, as long as it is not excessive. Fat serves a number of useful purposes: it cushions internal organs, provides insulation to conserve heat and it is a means of storing energy and fat-soluble vitamins. Fat is also part of the structure of the brain and cell membranes and is used in the manufacturing process of several hormones.

All fat is not created equal. It’s all about location, location, location.

Not all fat is the same. It’s important to distinguish between visceral fat and subcutaneous fat. Visceral fat– also referred to as a “pot belly” or “beer belly” – is internal fat located deep within the abdominal cavity. Subcutaneous fat – also known as “love handles,” “spare tires,” or “muffin top,” – is superficial fat located between the skin and the abdominal wall.

In addition to the physical distribution of the fat being different, so is the nature of the fat. Although neither type is particularly attractive, visceral fat is much more hazardous to one’s health than subcutaneous fat. Visceral fat increases the risk of heart disease, diabetes and metabolic disturbances. Subcutaneous fat is inactive, relatively harmless, and generally does not contribute to health problems.

Factoid: A beer belly is called a beer belly for good reason. One of the real culprits in creating visceral fat is drinking liquid carbs, including sweetened beverages (sodas, iced tea, sports drinks), fruit juices (such as orange or cranberry) or alcoholic beverages. These liquid carbs have no fiber and are essentially pre-digested, stimulating an insulin surge and rapid storage as fat. It’s always better to eat the fruit rather than drink the juice because fruit is loaded with fiber that fills you up, slows the absorption process, and contains abundant phytonutrients.

Visceral fat essentially is a metabolically active endocrine “organ” that does way more than just create an unsightly protrusion from our abdomens. It produces numerous hormones and other chemical mediators that have many detrimental effects on all systems of our body, including risk of diabetes, cardiovascular disease, low testosterone, erectile dysfunction (ED) and premature death.

Sexual dysfunction

Beer belly and metabolic syndrome are highly associated with low testosterone and poor erection and ejaculation function. The fatty tissue present in obese abdomens contains abundant amounts of the enzyme aromatase, which converts testosterone to estrogen —literally emasculating obese men. So, visceral fat can steal away our masculinity, male athletic form and body composition, mojo, strength, and the ability to obtain and maintain a good quality erection.

ED serves as a good proxy for cardiac and general health. The presence of ED is as much of a predictor of heart disease as is a strong family history, tobacco smoking, or elevated cholesterol.

FactoidThe penis can function as a “canary in the trousers.” Since the penile arteries are generally rather small (diameter of 1- 2 mm) and the coronary (heart) arteries larger (4 mm), it stands to reason that if vascular disease is affecting the tiny penile arteries and causing ED, it may affect the larger coronary arteries as well — if not now, then at some time in the future. In other words, the fatty plaque that compromises blood flow to the smaller vessels of the penis may also do so to the larger vessels of the heart and thus ED may be considered a genital “stress test.”

While the penis can genuinely shrink for a variety of reasons, most of the time it is a mere illusion — a sleight of penis. Obesity causes a generous pubic fat pad that will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding or buried behind the fat pad. Lose the fat and presto…the penis reappears. Yet another reason to remain lean!

Trivia: It is estimated that for every 35 lbs. of weight gain, there is a one-inch loss in apparent penile length.

What does this all mean?

  • Visceral fat is a bad, metabolically-active form of fat that is highly correlated with metabolic syndrome, diabetes, heart disease and sexual dysfunction.
  • ED often occurs in the presence of “silent” heart disease (no symptoms) and serves as a marker for increased risk for heart disease (as well as stroke, peripheral artery disease and death). ED will often occur 3-5 years before heart disease manifests. Early detection of ED provides an opportunity to decrease the risk of heart disease and the other forms of blood vessel disease. ED has a similar or greater predictive value for heart disease as do traditional factors including family history, prior heart attack, tobacco use and elevated cholesterol. The greater the severity of the ED, the greater the risk and extent of heart disease and blood vessel disease.

What can I do?

Lifestyle intervention has the potential for reversing visceral obesity, metabolic syndrome and sexual dysfunction. This lifestyle intervention involves achieving a healthy weight, losing the belly fat, eating healthy, exercising regularly, quitting smoking, limiting alcohol intake, and managing stress.

Learn more about Men’s Health services at New Jersey Urology >

Why You Should Exercise the Pelvic Floor Muscles

28 Jan 2019 Blog

Written by Dr. Andrew Siegel:

We hear much about the importance of strengthening our “core” muscles. Most core exercise programs focus on the abdominal, hip, and back muscles. However, there are deeper core muscles that form the floor of the core muscles–the pelvic floor muscles—that are often neglected. These muscles play a vital role in sexual, urinary, and bowel health and in maintaining proper form, balance and posture during virtually every form of exercise.

The Pelvic Floor Muscles

The pelvic floor muscles are not well-respected external glamour muscles. However, these often-ignored pelvic muscles are hidden gems that work diligently behind the scenes. These muscles have a role that goes way beyond the joint movement and locomotion function of the external muscles. Although concealed, the pelvic muscles have a profoundly important role in sexual, urinary, and bowel function as well as in supporting our pelvic organs.

Use Them Or Lose Them

The pelvic floor muscles, as with other muscles in the body, are subject to adaptation. Unused as intended, they can become thin, flabby and poorly functional as happens with aging, weight gain, a sedentary lifestyle, poor posture and other forms of injury and trauma, chronic straining, and surgery. Used appropriately as designed by nature, they can remain healthy in structure and function. When targeted exercise is applied to them, particularly against the forces of resistance, they can be enhanced. Diligently practiced pelvic exercises will allow one to reap tangible rewards, as having fit pelvic muscles is the essence of functional fitness.

Pelvic Floor Muscle Training: In Isolation and Integrated With Other Workouts

There are two means of working out the pelvic floor muscles: in isolation and integrated. In order to become the master of your pelvic domain, it is initially important to isolate the pelvic floor muscles. Once pelvic floor muscle competence is established, pelvic exercises can then be integrated into other exercise routines and workouts. In real life, muscles do not work in isolation but rather as part of a team, the pelvic muscles being no exception. The pelvic floor muscles often contract in conjunction with the other core muscles in a mutually supportive and synergistic fashion. In fact, many Pilates and yoga exercises emphasize consciously contracting the pelvic muscles simultaneously with the other core muscles during exercise routines.

Engaging the pelvic floor muscles while doing squats, lunges, etc., serves not only to integrate the lower regions of the core and provide optimal support and “lift” of the floor of the core, but also as a means of exercising the mind-body connection. It is important to avoid overexertion of the pelvic floor muscles and awareness directed towards this region is sufficient without the necessity for a forceful contraction.

Dynamic exercises in which complex body movements are coupled with core and pelvic stabilization—such as squats and deadlifts—enhance non-core as well as core strength and function to the maximum. The core muscles, including the pelvic floor, stabilize the trunk when our limbs are active, enabling us to put great effort into limb movements. It’s impossible to use the arm and leg muscles effectively in any athletic endeavor without engaging a solid core as a platform from which to push off (think martial arts). Normally this happens without conscious effort, but with some focus and engagement, the core and pelvic floor contraction can be optimized. The stronger the platform, the more powerful the potential push off that platform can be.

Pelvic Contractions To Counteract Intense Training Regimens

Weight training and other forms of intense exercise result in tremendous increases in abdominal pressure. This force is largely exerted downwards towards the pelvic floor, particularly when exercising in the standing position, when gravity also comes into play. Engaging the pelvic floor during such efforts will help counteract the vector of downwards forces exerted on the pelvic floor.

Knack Maneuver

Many females and certain males (particularly after radical prostatectomy) suffer with stress urinary incontinence, a spurt-like urinary leakage that occurs at times of increased abdominal pressure such as with sports and other high impact activities including jumping and kickboxing. For years, urologists and gynecologists have advocated the “knack” maneuver to counteract this, a technique in which the pelvic muscles are braced and briskly engaged at the time or just before any activity that triggers the stress incontinence. When practiced diligently, this can ultimately become an automatic behavior.

Bottom Line: The pelvic floor muscles are out of sight and therefore out of mind. However, these muscles that form the floor of the core are fundamental to many important body functions (sex, urinary and bowel). Pelvic floor muscle conditioning will not only help keep these functions in working order, but also is a vital component to the performance of complex movements that require engagement and stabilization of the core muscles.

10 Ways to Get Your Best Night’s Sleep

21 Jan 2019 Blog

Written by Dr. Andrew Siegel:

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. 

What’s obvious

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.

What’s not so obvious

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.

What to do

The good news is that sleep deprivation can be alleviated. Here are a variety of 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.

Read more health and wellness tips on our blog >

Fluctuating Urine Color and Odor – What Does It Mean?

14 Jan 2019 Blog

Urine color can range from pale yellow to deep amber – but what does it mean? There are many factors that can affect urine color, including fluid balance, diet, medicine and disease.

Urine Color

How dark or light the color of your urine is depends on how much water you drink. Water and other fluids dilute the yellow pigments in urine, so the more you drink, the clearer your urine will be. In cases of dehydration, the urine can become a dark amber color.

Some vitamins and supplements – such as Vitamin B – can turn urine bright yellow. Some foods – such as blackberries, beets or rhubarb – can turn urine a reddish-brown. Having blood in your urine can also make it appear reddish-brown, so it’s important to observe and take note of these subtle signs and symptoms.

Urine Odor

Some foods (such as asparagus), vitamins, and antibiotics (such as penicillin) can cause urine to have a different odor. A sweet, fruity odor may be caused by uncontrolled diabetes. A urinary tract infection (UTI) can cause a foul odor.

When to See a Doctor

Sometimes, symptoms can be very vague or subtle which makes it very difficult to figure out what the problem is. If you are dehydrated your urine will be more concentrated and urinating may cause discomfort. Drink enough fluids to keep your urine light yellow or clear, this will help decrease discomfort.

Visible blood in the urine is often a sign of a urinary tract infection or kidney stone. Dark or orange urine may be a sign of liver malfunction. You should notify your doctor if you experience any of these symptoms.

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