When we talk about men’s pelvic floor problems we often think of bladder problems due to prostate enlargement and/or prostate cancer and associated surgeries. Unfortunately men can also experience problems relating to over-active bladder, pelvic pain including testicular and penile pain, and erectile dysfunction. Therefore when looking at the cause of pelvic floor dysfunction it is important to consider the whole system including bladder compliance, health of the urinary tract system, previous or upcoming surgery, pelvic floor function, bowel health, the stabilising muscles of the lumbo-pelvic complex, and general health.
Many men comment that they have suffered in silence for months to years before they seek help. And it takes a lot of courage to talk about bladder problems and/or sexual problems with a doctor, specialist or physiotherapist. However it is really important that they do. As we can make a very significant impact on their quality of life.
When you consider the combined impact that pain, loss of continence and sexual function can have, you wonder why we are not doing more. The social and emotional implications are broad and can affect work, sporting activities, social engagements, and relationships with friends and significant others.
The pelvic floor muscle sling is important for providing stabilisation of the pelvis, support of pelvic organs, allowing us to have normal bladder and bowel function, and healthy and satisfying sexual function. For this it not only needs to have appropriate strength, but also correct control. Problems can occur if the pelvic floor is either too weak or too tight and strong; if the pelvic floor doesn’t turn on at the correct time, or if it works all the time. As a pelvic floor physiotherapist we can assess all of these components and therefore target treatment specifically to each persons needs.
Providing accurate education and access to thorough, and clinically relevant pelvic floor physiotherapy care for men is essential.
Chronic Pelvic Pain
Chronic Pelvic Pain is commonly very difficult to diagnose, and standard tests can be negative. Possible diagnosis can include:
- non-bacterial prostatitis
- over-active bladder syndrome
- pudendal neuralgia
- proctalgia fugax
- levator ani syndrome
What all of these conditions can commonly do is refer pain to the genitals, anus, coccyx, pelvic and abdominal region.
When there has been a period of chronic pain, we often see changes in the musculoskeletal system, and peripheral and central nervous system. While these may not be the cause of the initial symptoms, they can definitely cause perpetuation of pain long after the trigger has passed.
Prostate Cancer accounted for 30% of all newly diagnosed cancers in 2010 (Australian Cancer Incidence and Mortality Book, March 2014). Surgery can unfortunately leave a very large percentage of men with urinary incontinence. It can take up to 2 years for men to regain continence, and even then they may need the use of continence pad. Another devastating statistic is that 68-99% of men can experience erectile dysfunction, with only 30% recovering fully.
A pelvic floor physiotherapist can teach men how to:
- Correctly contract the pelvic floor muscles,
- Maintain a balance of muscle strength and control,
- Coordinate pelvic floor muscles with the abdominal muscles and breathing
- Assist in management of constipation, and optimise bowel health
- Educate regarding aides to assist in erections and help maintain penile health.
- Address dysfunctions of the lumbo-pelvic complex.
Pelvic Floor Physiotherapy pre-prostate surgery has been shown to significantly decrease both the severity and duration of incontinence (Yao et al 2012). By strengthening the pelvic floor prior to surgery we improve post-operative outcomes, in much the same way as knee rehabilitation prior to ACL surgery or total knee replacement improves outcomes.
At Bondi Junction Physiotherapy we use Real-Time Ultrasound to assess and educate men on performing a correct pelvic floor contraction. The visual feedback can be invaluable and allows men see the muscles move, in a non-invasive manner (Dorey et al 2005).
Rebecca Reicher at Bondi Junction Physiotherapy has over 10 years of experience in treating lumbo-pelvic and pelvic floor conditions in men and women. Individualised, comprehensive, and compassionate physiotherapy care is guaranteed.