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~Obesity in Men Linked to Urinary Frequency and Erectile Dysfunction

It has long been known that a larger tummy can lead to health complications including high blood pressure, high cholesterol, type 2 diabetes, and heart disease.  A recent study in the British Journal of Urology International found that it also affects men’s sexual and urinary health. 

The authors found that a supersized tummy was linked to more frequent urination, erectile dysfunction, and ejaculation problems.  They studied 409 men ages 40 to 91 with lower urinary tract symptoms and found that a waist measurement of over 36 inches lead to progressively increasing likelihood of problems.

The comparison of symptoms associated with waistline size is broken down here.



Larger waist (>40 inches)    

Medium Waist (36-40 inches)      

Small Waist (<36 inches)

Nighttime Urination Frequency >1 x night




Urination Frequency >8 x in 24 hrs




Erectile Dysfunction




Ejaculation Problems





This is bad news for men with a typical “beer belly” or obesity.  This study shows that approximately 10-15 men in 20 with waist sizes over 36 inches have significant problems with urinary and sexual function.

The good news is that waistline measurement is easy to perform either by a healthcare professional or at home.  Then steps can be taken to eat better and exercise more to decrease urinary symptoms.  A physical therapist can help with weight loss activities, especially if there are other health issues or pain that is preventing proper exercise. This can not only help urinary function, but improve bone health, heart health, and decrease the risks of diabetes.




~Reduced Costs And Surgeries With Early PT For Low Back Pain

A new study published in Spine determined that early treatment for low back pain led to reduced health care costs when performed by a Physical Therapist.  The authors found that early PT care resulted in reduced use of surgery, injections, Dr. visits, opioid use, and advanced imaging such as MRI. This resulted in savings of $2,736.23 on average. 

The study looked at a large sample size of 32,070 patients who consulted a primary care physician for low back pain.  Those referred to PT early, within 14 days of seeing the doctor, had significantly less health care cost than those who had delayed treatment.  

Another study in Spine showed that people over the age of 66 who saw a physical therapist within 30 days after an acute episode of low back pain were less likely to receive surgery, injection, or further doctor visits.  This study also used a very large sample size of 432,195 patients to come to their conclusion that early PT saves health care costs. 

Physical Therapists are able to work with patients with low back pain to speed up the healing process. They are able to encourage correct movements and develop exercise programs to allow faster recovery from pain and dysfunctional movements. Education is also a significant component of treatment. 

These studies show that early treatment by a PT can lead to decreased health care costs and fewer surgeries and tests.  

To read the Americal Physical Therapy Association's (APTA) press release regarding these findings click here.






~Persistent Genital Arousal Disorder (PGAD) and Physical Therapy

 By Marnie Clemens PT, DPT, OCS, WCS, FAAOMPT and Abby Newman SPT

Imagine eating your favorite food (such as ice cream) when you are hungry.  It tastes great and you really enjoy every last bite.  Now imagine eating ice cream over and over again to the point you are beyond stuffed.  What once was enjoyable becomes unpleasant and uncomfortable.  Finally, imagine being force-fed ice cream over and over again, without being able to stop.  It becomes very painful, you feel sick, and you may never want ice cream again.  What was once pleasurable has become a painful torture.  

This is how people who have persistent genital arousal disorder (PGAD or PSAS) describe their suffering.  PGAD is a condition in which a person experiences constant physical genital arousal, unrelated to sexual desire,  that persists for hours or days and does not go away with orgasm.  This is a very debilitating, painful problem- both physically and psychologically.  It is very difficult to have a normal life with this condition.  Daily activities are interrupted, things like walking, exercising, and sitting may even increase symptoms and are avoided.   Physical and sexual relationships become almost impossible. Then add the fact that friends, family, and even some uninformed medical professionals dismiss the symptoms or even make fun of them.  Suffering is very real for these people.  

There has been a lot in the recent news about this condition.  Many media outlets covered  the recent suicide of a woman who suffered from PGAD (examples here and here .  There was also recently a piece about the devastating effects on one woman's life on the Jeff Probst Show after trying to come forth with her personal PGAD story to help educate others.  

It is still a condition that is poorly understood.  Possible causes may include irritation of the nerve that supplies the clitoris (pudendal nerve), spinal issues (such as spinal cysts), compression of the clitoral circulation leading to swelling, or possibly as a rare side effect of antidepressant medication.  Sometimes there is a known trauma or specific injury such as childbirth or falling,  but often the cause remains unknown.  Medical treatment may include medication to calm the nerve irritation, stabilization of hormones in menopause, or discontinuation of SSRI antidepressant medication   

Physical Therapy can be helpful if the cause is related to the tension in the pelvic floor muscles,  compression of the pudendal nerve or spinal nerves, or connective tissue (fascial) tightness.  There are hands on techniques to treat the pelvic floor and fascia that can help relieve irritation of the nerve from these causes.  There are also very important things to avoid, such as Kegel exercises (tightening of the pelvic floor muscles).  The wrong treatment can cause more discomfort and pain.  It is important to see a PT that works with women's health and pelvic floor issues to address the problem correctly.  You can also seek a good support group online- PGAD support to learn more and connect with others with PGAD.

While there are some common threads, there is no one best course of treatment for everyone and success rates to treatment vary. Most people do best with a combination approach. Physical Therapy can help PGAD issues related to the muscles and fascia and your doctor can prescribe appropriate medication.  The take-away point is that this very real condition is no laughing matter and may be helped by treatment.


Women On Wellness Retreat Saturday, July 21st

It is time again for the Women on Wellness Retreat at Heston Farm in Fairmont, WV.  This is a great time to learn about different types of exercise and various health topics related to important women's health topics.  Take a friend and plan to enjoy the day learning about fun ways to move and take care of yourself.  Check out the details here:


~Simple Step Exercise: Breathing to Control Pain

Pause for a minute and pay attention to your breathing. What is going on right now? This is such a routine body activity that we rarely think about the quality of our breathing.  Breathing allows for oxygen to go in and carbon dioxide waste to be eliminated from the body.  This is a necessary function. Without breathing, we would quickly die.  Fortunately, the body is very good at doing this on a basic level most of the time.  This does not mean, however, that our breathing is always optimal for our health.  For example, people in pain are not good breathers. Their breathing is often shallow, fast, and involves a lot of upper body movement.  

What if there was something you could do that would improve your pain levels, blood pressure, heart rate, immune system, sleep,and energy levels as well as improve your body's reaction to stress? How much would you pay for something like this?  

Well, breathing a specific way is a simple method to get all of these benefits.   Did I mention it also happens to be FREE and you can do it anywhere?  How is that for a drug-free treatment for pain?

Go back to paying attention to your breathing while just sitting around at rest. (It is normal for your breathing to be faster with more movement when you are more active, such as climbing up stairs.)  You may notice some or all of the following signs of poor breathing habits that are especially common in people with pain:

  • shallow, fast, or uneven inhalation or exhalation
  • more than 12 breaths per minute
  • forced breathing
  • upper chest movement
  • little to no movement of chest or belly

To tap in to the relaxation response you want your breathing to have these qualities:

  • deep, slow, even inhalation and exhalation
  • less than 12 breaths per minute, even better at around 4 breaths per minute
  • relaxed breathing
  • relaxed lower rib cage and belly movement with little upper chest and no shoulder movement

To watch an example of one of the best breathers on the planet, check out a sleeping baby.  They breathe effortlessly and with their little bellies rising up and down- almost like they were born to it.  In fact, we are all born to breathe this way but somehow we tend to lose this ability along the way to being a grown-up.  Well, now is the time to start practicing the relaxed breathing that is your birthright. Along the way you just may have less pain, sleep better, and feel more relaxed.



The diaphragm is a dome shaped muscle that sits at the bottom of the rib cage.  Check out this video of the diaphragm in action.  It is the main muscle involved in breathing.  All breathing involves the use of the diaphragm,  but there are also "helper" muscles in the rib cage and the upper shoulders that help us when we need to breathe faster or more forcefully.  When these "helper" muscles are used, the brain tends to think the body is under some type of stress and gears up the other systems including the heart, blood circulation to be able to react to the stress.  This is a totally appropriate "fight or flight" reaction if you have to run really fast to get out of the way of traffic or a hungry tiger.  This is not the way you should be breathing at rest.  When you learn to return to a slower, deeper type of breathing, the brain gets the signal that "everything is ok, nothing to worry about here".  You activate the body's relaxation response and get all the benefits of doing so (improved blood pressure, heart rate, pain, etc..).




Here is a basic way to learn to perform relaxed diaphragmatic breathing or belly breathing:


  • start at first in a quiet area away from distractions
  • lie down on your back in a comfortable position
  • place one hand gently on your belly and the other on your upper chest
  • start to pay attention to your breathing
  • try to slow your breathing down gradually to a goal of around 4 seconds in and 4 seconds out
  • Monitor your hands.  You should have little to no movement at the upper chest hand and a lot of movement at the belly hand
  • breathe slowly and deeply but DO NOT force
  • the belly should gently expand like a balloon filling with air and then deflate without force
  • continue to breathe this way as long as you can
  • once you get the hang of breathing this way lying down, try it sitting or standing


The most common errors I see when people are learning to breathe this way are:

  • Trying to breathe deeply and slowly by FORCING the air in and out.  Diaphragmatic breathing should be very relaxed and quiet.  If you sound like a blowhard, you are probably trying too much.  
  • Using the upper chest to assist in deep breathing.  Again, this is trying too hard and it activates the "fight or flight" system instead of the relaxation response.  Gently pay attention to your upper and lower hands.  Bring you attention to allowing the lower belly hand move in and out.  Relax the upper chest to the point you get little movement at the top hand.  
  • Using the abdominal muscles to force the belly movement.  Do not use your abdominal muscles to squeeeeeeeeze the air out of your belly, just relax and let your belly deflate gently without effort
  • Trying to force the timing of the inhalation and exhalation.  The 4 second in-out tempo is just a guide.  Let your breathing slow down as you pay attention to your hand movement.  It will naturally reach a slower pace. 

Diaphragmatic breathing is easy to learn with a little practice.  Be patient with yourself.  Remember, most of the errors happen when you try too hard and force the breathing.  Just relax,  you will get better with time.  It is easy to incorporate diaphragmatic breathing into your day.  Once you get the hang of it, do little mini breathing breaks throughout the day.  It is especially useful if you are feeling increased pain or stress.  Take a few minutes to practice your breathing and it should help.  

Do not let the "simplicity" of this exercise fool you. I often have patients question how something as simple as breathing can help.  Like most of the important things in life, diaphragmatic breathing is very effective and makes profound changes to your body via the relaxation response. Patients are very surprised to find that this little exercise has a big impact on their lives.  They find that they are able to control their pain levels and headaches when using this technique during the day. It is also good to get into the habit of doing it before bed.  Most everyone who tries this reports they sleep more deeply and wake up more refreshed with less pain.  The hardest part of this little breathing exercise is REMEMBERING to do it.  Sometimes it helps to set an alarm on your phone or computer to remind yourself to take breathing breaks.  

Start practicing diaphragmatic breathing today.  It is simple, free, and you just might find yourself feeling better!