UNFPA campaign to end obstetric fistula invites you to change the world.

Fashion Internationale de la Mode Africaine

FIMA 2011

It was a pleasure to return to Niamey, Niger, this trip by far the most fashionable, sponsored by internationally renowned designer Alphadi and his innovative wife Kadidja, along with United States Ambassador Bisa Williams and the First Lady of Niger, colleague Dr Malika Issoufou Mahamadou. Promoting health and wellness along with creativity, fashion, beauty and the power of the African Diaspora, Fashion Internationale de la Mode Africaine 2011 made a clear statement – Health is Beautiful.

The Fashion Internationale de la Mode Africaine whirlwind of creative genius is the brainchild of haute couture designer Alphadi, whose dedication to the promotion of African fashion transcends the political landmines and traditional dogma of Nigerien culture, sparking debate in his country and awe in the world of international fashion.

Women’s Health

Committed to promoting health and wellness along with creativity and couture, FIMA 2011 invited 3 American physicians, Dr. Emily Nichols and her husband Dr. Jonel Daphnis – specialists in internal medicine and adult/pediatric emergency medicine, and myself – specialist in urogynecology and obstetric fistula repair. It was a pleasure to reconnect with colleague and expert fistula surgeon Dr. Abdoulaye Idrissa, connecting his work at the National Hospital in Niger with the newly minted Cure Hopital au Niger run by Dr. Gary Roark, and a tragedy to see the women suffering fistula waiting for surgical repair at the National Hospital no longer permitted to live on the hospital grounds, relocated instead to a garbage dump across the street from the hospital, camped out in a shared sisterhood of sorrow, resilience, patience and hope.

Dr. Gary Roark of CURE Hopital au Niger and Dr. Abdoulaye Idrissa of Hopital National, Niamey Niger

Obstetric Fistula

Obsetric fistula patients living in garbage dump next to hospital, Niamey Niger 2011

While these women gave permission to show their faces, the picture chosen is one that preserves anonymity, both for their privacy rights and to highlight the non-anonymous rag tents fenced with garbage in the background. In this place of filth and feral cats they have camaraderie, belonging and hope that was lost to them in their lives of exile as totally incontinent obstetric fistula sufferers living on the margins of their communities. As of my last mission to Niamey in 2005, these women were permitted to live on hospital grounds while waiting for surgery and after discharge from hospital while securing arrangements to return home. New hospital rules do not permit overnight stays unless you are in a hospital bed. With no half-way house option, these women now live across the street from the hospital, in sight of the side-entrance, in an open air garbage dump.

Maternal Mortality

The prevalence of obstetric fistula is difficult to know with certainty, typically extrapolated from the maternal mortality data to which it is closely related. Niger, for many years running, lays claim to the worst maternal mortality rate on the planet, at 1:7 risk. Compare this to maternal mortality in developed nations at 1:4000, and the difference between the two is simply obscene.

Obstructed Labor, Death and Disability

One great contributor to maternal mortality is obstructed labor. Without ready access to trained clinicians during labor, or EmOC (emergency obstetric care), women in obstructed labors lasting for 3, 4, 5 days and some up to a week, have 2 possible outcomes- maternal death, or maternal survival with severe damage to bodily function, including vaginal fistula causing constant incontinence of urine or stool, severe foot drop from pelvic nerve compression, uterine infection resulting in infertility, and vaginal fibrosis precluding sexual function, usually in some combination of miseries and almost always associated with a stillborn infant. Can you imagine the trauma, depression and anxiety these women suffer?

In developed nations we call this obstructed labor “failure to progress”, preventing the stillborns, fistulas, nerve damage and vaginal destruction with cesarean section performed according to accepted standards of care. For women living in remote rural areas of poor nations, access to such care does not exist. Women labor alone, or with a local lay-midwife with no formal training.

Access to emergency obstetric (EmOC) care allows any woman of any age and condition to be delivered safely, to be able to count on her own survival and that of her baby. Reduce maternal mortality through EmOC and watch obstetric fistula disappear, watch neonatal survival improve, just as occurred in the States and Europe with the advent of ready access to Cesarean delivery made possible by the then novel application of Ether anesthesia in the late 1800′s. Some 200 years later, the pregnant women of Niger are living as did women worldwide in 1850, in fear of their lives and the lives of their unborn babies with every single pregnancy every single time.

Taking care of the women takes care of the children, takes care of the men, takes care of the community and creates a new future full of hope and possibility for the country. Right now, as this post occurs, the pregnant women of Niger would be safer in DR Congo, in Somalia, Sudan, Bangladesh, Pakistan or Afghanistan. And all of these women in all of these developing and middle income countries can only dream of the safety and optimal mother-child outcomes enjoyed by their sisters lucky enough to live in wealthy nations where antenatal care and routine access to EmOC has nearly obliterated the constant threat of pregnancy-related death and disability.

With this initial collaboration of Nigerien and American doctors, the First Lady of Niger, the US Embassy and the creative genius of the House of Alphadi FIMA 2011, we look forward to the day when the women of Niger can rest assured that they, their daughters and grand daughters will bring forth future generations in comfort, in safety, in health as a birthright for mother and child.

FIMA 2011 Touareg Haute Couture – Niamey Niger

Content is copyright protected on date of online publication. Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org

Choking the chicken has risks.

Masturbation

When it comes to sexual pleasure, masturbation can both help and hurt your sexual satisfaction. For those of you uncertain exactly what masturbation entails,  masturbation is the term for genital self-stimulation.

The downside of masturbation? Reaching orgasm through masturbation can make orgasm difficult to achieve with a partner.

Men can develop what is called “delayed ejaculation”, where it’s difficult — or even impossible — to orgasm during partner sex because he’s man-handled himself to the point where orgasm occurs only through the EXACT pressure, friction and rhythm from his own hand, something a partner’s hand, mouth, vagina or anus simply cannot replicate. Further, the instant gratification from masturbating can be so appealing that one loses interest in sex with a partner.

Sex Addiction & Pornography

Internet-fueled pornography addiction lends a modern day wrinkle to the ramifications of masturbation, where men (usually) become so acclimated to the variety and instant, rapid fire gratification potential of online pornography that they become sexual anorexics when it comes to real-time sex with a real live woman. How sad! There’s even a website devoted to this social blight: Partners of Sex Addicts Resource Center that offers help for porn-addiction and related issues. Porn masturbation sex addiction is ruining relationships with such voraciousness that the courts are clogged with the detritus of porn-rocked marriages suffering from cybersex addicted spouses.

Women run the risk of developing their own version of “delayed ejaculation” finding themselves in a similar predicament where orgasm is possible only through genital self-stimulation, without which anorgasmia takes over, making partner-sex, well, “anti-climatic”….

Onanism

Traditionally reviled in Judeo-Christian societies, ejaculating outside of the reproductive parts of a woman was a mortal sin for which Onan, second son of Judah, was struck dead prematurely by Yahweh Himself for “spilling his seed upon the ground”. References to the evil and inevitable effects of “Onanism” in Victorian-era health manuals included cerebral palsy (they had a different name for it back then), mental retardation and birth defects of all varieties, not to mention insanity and infertility in the afflicted self-abusers. Oye!

The upside of masturbation (beyond male hydraulics)? Contemporary sex science shows that masturbation can help men control orgasm and avoid premature ejaculation, –and can help both men and women feel more confident about sexuality by allowing you to discover the variety of maneuvers your partner finds advantageous.

The moral (don’t act like you didn’t see this coming) of the masturbation story? Use it, don’t abuse it.

Content is copyright protected on date of online publication. Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org.

Just because you’ve gone through menopause doesn’t mean sex—and the DESIRE for sex—should stop.

Ten years ago, a sex study published in Journal of the American Medical Association found that 43% of women suffer from sexual dysfunction at some point…compared to just 31% of men.

To be fair, and clear, the conclusions drawn from this study continue to be hotly debated since publication, as many in the healthcare profession raised concerns about the medicalization of women’s sexuality and the integrity of this study’s conclusions, which many specialists consider exaggerated.

That said, many women find the age related decrease in sexual urges disturbing and distressing.

Traditionally, a woman reporting problems with libido finds herself thwarted in her efforts to restore prior sexual appetites, as the medical profession is notorious for telling women they have to “live with it”.

Testosterone is good for girls AND boys

Despite this, the only FDA-approved treatments for problems between the sheets—Viagra, Cialis, and Levitra—target men.

This is why Procter and Gamble introduced Intrinsa, a testosterone patch medication designed to treat female sexual dysfunction, or FSD, caused by natural reductions in testosterone as women approach age 50. Low testosterone can affect libido and sexual arousal.

FSD involves any condition involving the inability to become or remain aroused during sex, the inability to achieve an orgasm,  and/or the presence of pain during intercourse. Not all of these symptoms are due to testosterone deficiency. The symptoms of FSD are often more prominent during hormonally vulnerable periods, like menopause or during lactation and breast feeding. Menopause can occur naturally with age, or abruptly when a woman’s ovaries are removed surgically.

Intrinsa is targeted at women who have undergone the menopausal transition and who are suffering sexually as a result of the age-related, inevitable drop in testosterone levels. Intrinsa  is a clear, egg-shaped patch which adheres to the skin on a woman’s belly that works by releasing small, controlled amounts of testosterone into a woman’s bloodstream.

Testosterone is a “masculine” sex hormone which is produced by a woman’s ovaries and adrenal gland. A woman’s testosterone level drops with most with birth control pills, and always with natural or surgical menopause. By age 45 or so, most women’s testosterone levels have decreased  by 50% from peak levels in the mid-20′s!

The theoretical clinical benefit to increasing serum levels of testosterone in the blood is to  reduce libido and arousal symptoms of FSD. Being a patch, Intrinsa CAN cause side effects, such as rash, redness, itching, and irritation at the patch site.

More importantly, testosterone is a powerful hormone, to be used with the greatest of caution and fastidious monitoring. More is NOT better! Because testosterone is a male sex hormone, overdosing may cause extremely troubling and potentially irreversible side effects such as: deepening of the voice, an increase in facial hair, enlargement of the clitoris, weight gain, cardiovascular conditions and hair loss.

Despite Intrinsa’s promise to effectively treat sexual dysfunction, however, the US FDA rejected the medication in 2004, citing a need for more studies. As a result, Proctor and Gamble took Intrinsa to Europe, where it is available by prescription. If you want to try Intrinsa, clear it with your doctor and hop the red-eye. Otherwise, women in the States suffering arousal disorder-type sexual dysfunction can talk to their gynecologist about diagnosing and treating androgen deficiency syndrome…a fancy term for “low testosterone”, that may be treatable with off-label applications of currently available hormone preparations on this side of the pond.

More women than ever before are showing up at the hospital in labor and asking for a cesarean section.

According to the National Institutes of Health, the rate of c-section delivery has increased 40% since the mid-90s, a trend reflected in these NIH summary statements:

Between 1996 and 2007, the C-section rate rose by 53 percent, with similar rises seen among all age, racial and ethnic groups, according to the report released Tuesday from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics, which used birth certificate data to arrive at this conclusion.

and:

After a slight dip in the late 1990s, C-section rates began marching relentlessly upward again. The pace of the increase has accelerated since 2000, with the overall rate surging from 23 percent to 32 percent in 2007

That translates to about one in four American babies being born via cesarean section.

So why has “cesarean on demand” become so popular?

One frequent reason is today’s mom-to-be believes avoiding a vaginal birth will reduce her risk of incontinence and pelvic organ prolapse down the road.

Pelvic organ prolapse is a condition that occurs when a woman’s bladder, rectum, or uterus shifts from its proper location, and moves into the vaginal canal.

But giving birth via cesarean section is NOT NECESSARILY the 100% protection from protection that some women think it is.

If only we came with zippers

Pelvic Organ Prolapse and Pregnancy

There’s new research on this topic, reflected in a new study published in the International Urogynecology Journal that examined the impact of a woman’s first pregnancy on pelvic support and found that less than one year after giving birth via c-section without labor, 21% of women experienced moderate organ prolapse and 5% of women who had cesarean deliveries experienced severe prolapse.

Since cesarean delivery did not necessarily prevent prolapse, the study’s authors suggest that simply BEING PREGNANT can increase a woman’s likelihood of prolapse, regardless of delivery mode!

This coincides with data showing that 50% of women who have borne children will experience prolapse at some point,  compared with 30% of ALL women, including women who’ve never been pregnant.

It IS important to note that women who gave birth vaginally DID experience higher rates of prolapse, according to the same Urogynecology Journal study.

But are these numbers significant enough to warrant cesarean on demand?

Maternal and neonatal mortality, uterine rupture, placenta previa & obstetric hemorrhage

Maternal mortality rates from cesarean are THREE TIMES higher than in vaginal delivery, according to Obstetrics and Gynecology.

Moreover, Birth magazine reported that babies are more than twice as likely to die when delivered via cesarean.

Knowing this, it makes sense NOT to opt for c-section delivery unless there is a legitimate medical reason for the best health of the mother or the baby.

Once the uterus heals from cesarean, future pregnancies are at risk for uterine scar separation, called uterine rupture, that can be deadly for the baby, and for problems with placenta previa, where the placenta is low and can hemorrhage at any time, further risking the life of the baby. Uterine rupture and obstetric hemorrhage are two good reasons to take cesarean section very seriously.

Thinking about elective cesarean section? Be a smart mother – make a wise choice with your obstetrician.

For a video on this topic, visit HealthGuru.com video on the truth about childbearing and cesarean on demand

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org

The Center for Disease Control attests that at least 77% of American adults don’t get enough Vitamin D. And while that’s bad news for everyone, it’s often WOMEN who suffer most.

Vitamin D - good for bones, prolapse, incontinence, autism, ...

Vitamin D is involved in regulating up to 2,000 different genes in the human body.

Considering that this amounts to 10% of our makeup, it’s disturbing that so many adults are D deficient.

Recent research shows that women in particular should be concerned about getting adequate levels of vitamin D.

A study at Boston University School of Medicine recently found that pregnant women who are vitamin D deficient are FOUR TIMES more likely to require delivery by cesarean section.

Similarly, the risk for both preeclampsia, which is dangerously high blood pressure, and pre-term labor, is significantly increased when a mom-to-be is lacking the nutrient.

And risks from a mom’s D-deficiency extend to an infant, as well.

Vitamin D is important for the proper development of a fetus’s brain, and it’s a significant factor in preventing respiratory infections and wheezing after birth.

Vitamin D deficiency is also being investigated as a potential culprit in the development of autism!

Low levels of the nutrient can also make it more difficult to conceive a pregnancy in the first place, according to findings reported in the American Journal of Clinical Nutrition.

And even if you’re not trying to conceive, researchers at Creighton University in Omaha found that women who get adequate amounts of vitamin D are up to 60% LESS likely to get breast, skin and lung cancer.

Plus, multiple studies have linked vitamin D deficiency in women to mood disorders such as premenstrual syndrome, seasonal affective disorder, major depressive disorder, and non-specific mood disorder.

Postmenopausal women should be aware that low levels of the nutrient may lead to osteoporosis, or thinning bones.

Women of all ages with vitamin D Deficiency are more likely to suffer urinary incontinence and pelvic organ prolapse.

No matter what your age or stage of life, ensure that you’re getting enough of this VITAL nutrient by asking your doctor to test your blood levels.

Women who are deficient may benefit from a daily supplement or increased sun exposure.

To learn more about essential vitamins and minerals, check out this video on Vitamin D and Womens Health, courtesy HealthGuru.com

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org.

You may be unacquainted with the term “rectocele,” but for almost 19% of women, the condition is all too familiar!

In a normal female pelvis, the rectum rests behind the vagina.

The two are separated by a thin wall of fibrous tissue called fascia.

When the fascia becomes weakened or damaged, the front of the rectum can bulge into the vagina. This is known as rectocele.

Rectocele - how it looks to the patient

Pregnancies and childbirth, chronic constipation and the natural aging process are the most common causes, but other factors can contribute to weakening of the fascia, too, including: chronic cough or bronchitis, repeated heavy lifting, and being overweight or obese.

Whatever the cause, rectoceles may induce a sensation of rectal pressure or fullness.

Difficulty having bowel movements and a feeling that the rectum has not fully emptied afterward are also common.

Severe rectoceles may even become visible, appearing as a ballooning bulge protruding through the vaginal opening.

For more mild cases of rectocele, a vaginal pessary may effectively treat the problem. Pessaries are removable supportive devices that hold the rectum in place.

More often than not, though, treatment for a severe rectocele requires surgery, performed through a small incision in the back wall of the vagina. .

The most common type of rectocele surgery is a levatorplasty, using sutures to bring the inside edges of the levator ani, or Kegel, muscles closer together, reducing the rectocele bulge back to a normal contour.

This method works because the levator muscles support the entire pelvic floor like a sling, and they’re often pulled apart with rectocele.

Some specialists believe, and some clinical research shows, that levatorplasty rectocele surgery may be more likely to result in pain than other rectocele repair techniques.

Knowing this, some doctors choose to do a newer procedure called site-specific rectocele, which uses sutures to close ONLY the holes in the connective fascia tissue, bypassing the levator muscles completely.

Although LESS likely to cause pain, site-specific rectocele techniques are MORE likely to result in recurrence of the rectocele.

Because each procedure has its good and bad points, it’s important to discuss the best rectocele repair for YOU with your surgeon.

For more information, see this video on Understanding Rectocele, courtesy HealthGuru.com

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org.

PELVIC ORGAN PROLAPSE:

NO DIFFERENCE IN SEXUAL QUALITY OF LIFE BETWEEN PROLAPSE PATIENTS CHOOSING PESSARY VS SURGERY.

Ladies, it's all about choice

Pelvic organ prolapse is a condition where the organs around the vagina are out of place – bladders drop (called cystocele), rectums bulge forward and sometimes out of the vaginal opening (rectocele), and/or the uterus drops down, literally falling out of the vagina turning everything inside out when its severe (uterine prolapse).  When prolapse is so bad that things are bulging out between the vaginal labia (yup, it happens) most women are uncomfortable to want to do something about it.
With severe prolapse, whatever the prolapsing part(s), and it’s usually more than one thing out of place, there are 2 choices – reconstructive surgery, or a vaginal prosthesis called a pessary.  A pessary is a vaginal widget that holds things up where they need to be when it’s inside. They come in all shapes and sizes – the easiest pessaries are ring-shaped. They’re easy because women can remove and insert them easily and reliably without assistance. Ring pessaries are sort of like contraceptive diaphragms in terms of insertion and removal. But sometimes, due to weak, thin Kegel muscles or uterine prolapse so severe that it pushes the rings out, sturdier pessaries, such as Gellhorns, donuts and Gehrungs, are the only ones that stay in.

Some women don’t like pessaries – or can’t find any that fit comfortably. They usually opt for prolapse surgery that puts all the organs back into position. The surgery can be complicated and, as with all surgeries, results can be less than perfect, making pessaries a viable option for women who are poor surgical candidates or simply don’t want to undergo extensive soft-tissue reconstructive surgery.

These British researchers undertook the task of looking at whether or not either treatment choice, surgery or pessary, affected sexual quality of life.  In data published in the March 2011 issue of the International Urogynecology Journal, they  found some interesting trends – women choosing surgery were younger, and at first glance seemed to have better sexual quality of life than their pessary using sisters, but when the statistician removed age differences, the sexual quality of life was the same between the two groups. Interestingly, 31 women who started with pessary didn’t like it and switched to surgery. Not much is said about them as the study design excluded data of patients who switched groups after the initial choice of treatment.

Here’s the study summary written for the June 2011 literature review for Journal of Sexual Medicine:

Abdool Z, Thakar R, Sultan AH, Oliver RS

Prospective evaluation of outcomes of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse.

Int Urogynecol J (2011)22:273-78.

A prospective, non-randomized design compared women with prolapse opting for pessary management vs reconstructive surgery of pelvic organ prolapse, using baseline  and 1 year quality of life data, including but not limited to sexual function (Sheffield Pelvic Organ Prolapse Quality of Life questionnaire-SPS-Q).

Women referred to the Urogynaecology unit of Mayday University Hospital in Surrey, England were evaluated and counseled regarding prolapse management.  Each completed the SPS-Q, a 13 item quality of life assessment tool addressing impact of prolapse on bladder, bowel and sexual function using four-point ordinal response scales (never, occasionally, most of the time, all of the time), validated and sensitive to changes in clinical status. Women choosing pessary were first fitted for ring pessaries; the most user-friendly. If rings did not work, gellhorn or donut pessaries were fitted for sexually inactive women, and cubes fitted for sexually active women, as cubes are easily removed for sexual activity.

Patients were excluded if they underwent incontinence surgery or switched from pessary to surgery (N=89) either due to use of pessary as interval measure in preparation for surgery (N=58), or because pessary was too problematic, prompting a change of heart in favor of prolapse surgery (N=31).

554 women entered the trial, 359 with pessary and 195 choosing surgery. Women excluded from final analysis numbered 195 in the pessary group and 88 in the surgery group.  The final analysis was carried out on women completing questionnaire at 1 year who either underwent surgery as first option or were still using pessary at 1 year, 46% of the pessary group and 55% of the surgical patients.

Mean age was higher in the pessary group (68 vs 60 yrs). Other demographic measures were equivalent. At 1 year there was statistically significant improvement in sexual function in both pessary and surgery patients, in addition to similar improvement in bladder, bowel and prolapse symptoms. Frequency of intercourse was better in the surgical group (54% vs 46% p=0.028), however this sexual frequency difference faded when controlling for age.

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org.

If you have a vagina and you’re old enough to vote, then Kegel Exercise belongs in your feminine fitness daily routine. Before you dive into pelvic fitness, it’s important to know what Kegel muscles actually DO. Kegels—or the levator ani muscles—wrap around a woman’s most important parts: her bladder, vagina, and rectum.

Research shows that toned levator ani muscles can reduce urinary incontinence, prevent problems with vaginal laxity and help a woman achieve a stronger orgasm. Clinicians and researchers in urogynecology also suspect, but have yet to prove, that these muscles help prevent pelvic organ prolapse, a condition in which  a woman’s bladder, rectum, or uterus falls into her vagina.

For women looking to live their best lives, strengthening your Kegel muscles—or pelvic floor fitness—just makes sense!

HOW TO CHECK YOUR KEGEL EXERCISE ACCURACY:

To get started, sit in bed relaxed against pillows, knees up and separated, using a hand mirror to look at your perineum,which is the skin between your anus and vagina.

Pull in using the muscles you use to urinate, as if you’re trying to stop urine midstream.

If you’re Kegeling correctly, you’ll see your perineum retract into your body.

You should feel the pull in your urethra and anus, NOT your butt or abs.

If you have trouble with proper Kegeling, talk to your gynecologist about pelvic floor physical therapy.

Pelvic floor physical therapy involves working with a Kegel coach, using biofeedback, and/or pelvic muscle electrical stimulation, each designed to “train” your pelvic muscles to perform correctly.

Once you’ve got the art of Kegeling down, get in the habit of doing tKegels daily.

Here’s Dr. Romanzi’s “Starter Set for Kegel Beginners”:

For the first set, perform 10 controlled, sustained contractions, holding each for five seconds, relaxing out of each slowly, and contracting into the next one without taking a break in between. Don’t forget to BREATH. If you find yourself holding your  breath, count softly or sing while contracting the levator muscles.

For the second set, perform 30 quick contractions, holding for just one second each.

There’s no need for a break between the two sets. Simply move from one right on to the next.

Do 2-3 of each set per day. Be creative! There are many ways and settings in which one can Kegel – no one will know if you’re Kegeling on the bus or in a meeting or while driving your car (at a stop sign, preferably).

In terms of where you should do your Kegel exercises, there’s only one rule: NEVER do them on the toilet!

Not only is 8 seconds of urination too short to really benefit your muscles, but it’s also distracting to your bladder, which has an important job of its own to do!

Other than that, you can fit in a Kegel routine whenever—and wherever—you prefer!

For more information, check out this  video \”Kegel Exercise: The Facts\”, courtesy HealthGuru.com

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org.

Image of the Bladder on X-Ray

At birth, a female’s bladder rests in front of her vagina and just behind the pubic bone. The bladder and vagina are separated by connective tissue called the vesicovaginal fascia. This fascia is anchored to each hip bone by tendons known as the arcus tendineus fascia pelvis.

Vesicovaginal connective tissue is NOT particularly strong. Even in a young woman who has never given birth, the tissue layer is only about as thick as five sheets of paper! When a woman gives birth, the vesicovaginal fascia can weaken and stretch. Other factors that can contribute to the weakening of this and other pelvic supportive tissue include: being overweight or obese, engaging in recurrent heavy lifting, the normal aging process, and repeated coughing or constipation.

Weakened vesicovaginal connective tissue may result in a vaginal hernia that allows the bladder to drop, a condition called cystocele. If the vesicovaginal space wears out in the center, the bladder may bulge into the vagina in what’s called a CENTRAL cystocele. Meanwhile, if the tissue disconnects from the arcus tendineus inside the hip bones on either side, the result is a PARAVAGINAL cystocele.

Cystocele Symptoms

But no matter the type, cystocele can cause unpleasant symptoms, like a vaginal bulge coming out between the labia, or make urinary incontinence worse, or prevent the bladder from emptying fully. Women may also experience chronic pressure in the pelvis or vagina that may be worse when coughing, bearing down, or lifting. Severe cystoceles may even emerge through the vaginal opening, causing a soft bulge that may feel like sitting on an egg.

Cystocele Treatment

While it can be uncomfortable and embarrassing, treatment options DO exist to repair cystocele, or dropped bladder . In mild cases, a removable support device called a pessary can push the bladder back into place. More severe cystoceles may require surgery. Traditionally, bladder lift surgery involved tucking stitches into the remnants of the supportive tissue between the bladder and the vagina during a procedure called anterior colporrhaphy.

This surgery has a recurrence risk as high as 30%, so many surgeons may prefer to insert a graft, which is a thin sheet of body-friendly material, as extra support between the bladder and the vagina. The trade-off for the graft’s sturdier hold is a slightly higher risk of complications including prolonged healing inside of the vagina and slightly longer time on the operating table. The recurrence rate of cystocele repaired with graft material is much lower than traditional colporrhaphy repairs.

Because each procedure has its pros and cons, talk to your doctor about the best repair option for YOU!

For more information on cystocele, visit Cystocele and Pelvic Organ Prolapse information and see this video on Understanding Cystocele, courtesy HealthGuru.com

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org.