The same phenomenon affects cyclists and exercise bike users, with prolonged pressure on the perineum from the bicycle saddle and the straining of the exercise causing the penis and scrotum to contract involuntarily. An incorrect saddle may ultimately cause erectile dysfunction (see crotch pressure for more information). Individuals with hard flaccid syndrome or other pelvic floor disorders may temporarily have an abnormally small penis. Stretched
Neither age nor size of the flaccid penis accurately predicted erectile length. Stretched length has correlated with erect length in some cases. However, studies have also shown drastic differences between stretched and erect length. One study found that a minimal tension force of approximately 450 g during stretching of the penis was required to reach a full potential erection length. this study also found that tension forces exerted in this study by the urologist were shown to be significantly (P<0.01) lower than 450g. This may account for differences between stretched and erect length. The 2015 study of 15,521 men found that the average length of a stretched flaccid penis was 13.24 cm (5.21 inches) long, which is near identical to the average length of an erect human penis which is 13.12 cm (5.17 inches) long. An 2001 study of about 3,300 men published in European Urology concluded that flaccid stretched length was measured on average to about 12.5 cm (4.9 in). In addition, they checked for correlations in a random subset of the sample consisting of 325 men.
Nitrate medications, including isosorbide dinitrate, given before meals, may also help relax the LES and improve symptoms. The inexpensive generic combination of belladonna and phenobarbital (Donnatal and other brands) may be taken three times daily as a tablet to prevent attacks or, for patients with only occasional episodes, as an elixir at the onset of symptoms. Phosphodiesterase inhibitors, such as sildenafil, can be given to reduce symptoms, particularly pain, but small trials have not been able to demonstrate clinical improvement. Procedures
Endoscopic therapy with botulinum toxin can also be used to improve dysphagia which stabilizes unintentional weight loss, but the effect has limited effect on other symptoms, including pain, while also being a temporary treatment lasting a few weeks. Finally, pneumatic dilatation of the esophagus, which is an endoscopic technique where a high-pressure balloon is used to stretch the muscles of the LES, can be performed to improve symptoms, but again no clinical improvement is seen in regards to motility.In people who have no response to medical or endoscopic therapy, surgery can be performed. A Heller myotomy involves an incision to disrupt the LES and the myenteric plexus that innervates it. The Heller myotomy is used as a final treatment option in patients who do not respond to other therapies. Prognosis
Nutcracker esophagus is a benign, nonprogressive condition, meaning it is not associated with significant complications. See also
Esophageal spasm

References


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