Men’s Pelvic Health

Yes, men also have pelvic floors! And because of this, men may also experience problems with their pelvic floors.

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Frequently asked questions about Pelvic Floor Physiotherapy for Men

What may cause you to have a problem with your pelvic floor?

  • Prostate Cancer
  • Benign Prostate Hyperplasia (BPH) – prostate enlargement
  • Prostatitis (inflammation of the prostate)
  • Proctalgia Frugax (Anal pain of unknown cause)
  • Levator Ani Syndrome
  • Pudendal Neuralgia

Signs and Symptoms you may experience

  • Difficulty, pain or hesitancy when urinating/incomplete emptying
  • Increase in frequency/urgency with bladder and/or bowel
  • Nocturia (excessive urination at night)
  • Pain with a bowel movement
  • Pain with ejaculation
  • Pain felt at the tip of the penis, at the testes/scrotum, rectum, tailbone
  • Blood in the urine or semen

Problems may arise, largely due to the design of the prostate. This walnut sized gland sits at the base of the bladder, in front of the rectum and behind the penis. The prostate is responsible for secreting a slightly alkaline, milky fluid that makes up about 30% of the semen. Below the bladder and above the prostate lies an internal urinary sphincter and below the prostate lies an external urinary sphincter. These sphincters help control fluids leaving the body through the penis. The urethra is the tube that carries urine from the bladder, travels through the center of the prostate and through to the penis.

When the prostate enlarges, it may compress the urethra causing you to have urinary issues such as hesitancy, frequency, etc. When the prostate is removed, the internal urinary sphincter is often damaged leading to urine emptying through the urethra when you don’t want it to. Radiation can often irritate the surrounding tissues and cause urinary frequency.

Why does the internal urinary sphincter become damaged when the issue is with the prostate? The close proximity of this sphincter, between the bladder and the prostate makes it very difficult to visualize during surgery so often it is either damaged or removed. The internal urinary sphincter is made up of smooth muscle and is under autonomic control.

This means that it is doing its job without you knowing or actively participating. When this sphincter is either removed or damaged, it no longer prevents urine leaving the body automatically and leaking may occur. Now the responsibility must fall on the external urinary sphincter. This sphincter is made up of skeletal muscle and is under your voluntary control. This is the sphincter that you will learn how to improve the control of. Pelvic floor physiotherapy will help you retrain your pelvic floor muscles to gain more control with your bladder.

What happens during your first session?

The session begins with a thorough subjective assessment to fully understand all your present issues in order to form a treatment plan that serves your goals. The objective assessment will include an internal rectal exam to give me information about your pelvic floor muscles such as strength, endurance and motor control. Biofeedback may be used as a tool to help you gain awareness of your pelvic floor. You will be given strengthening and/or release exercises to work on at home as well as information/options for going forward.

Common Pelvic Floor Problems in Men

Prostate Cancer

1 in 7 men will be diagnosed during their lifetime and this is the most common cancer affecting Canadian men. Prostate cancer occurs when some of the prostate cells have lost their normal control of growth and division.

Prostate Cancer Risk Factors

  • Poor diet; high in saturated fat and low in fiber
  • Family history of prostate cancer
  • Age over 50 years

Treatment Options

  • Lifestyle changes with diet and exercise
  • Androgen Deprivation Therapy (ADT)
  • Prostatectomy (Prostate Removal)
  • External Beam Radiation
  • Brachytherapy
  • Chemotherapy

Benign Prostate Hyperplasia (BPH) – prostate enlargement

This is a non-cancerous enlargement of the prostate
The enlarged prostate gland presses on the urethra and may cause urinary symptoms.

Treatment Options

  • Lifestyle changes such as maintaining a healthy weight, getting regular exercise, limiting bladder irritants such as caffeine and alcohol
  • Medications to slow the growth of the cells and/or to lessen the amount of testosterone
  • Prostatectomy – removal of the prostate

Prostatitis

This is inflammation of the prostate and can be bacterial or non-bacterial. There is still no known cause but some thoughts are that it may be caused by a previous infection or a small injury resulting in inflammation.

Treatment Options

  • Medications such as alpha-adrenergic blockers to help relax the prostate muscles, muscle relaxants to help with the pain or anti-inflammatories
  • Herbal supplements
  • Warm baths
  • A soft cushion to sit on
  • Avoiding bladder irritants such as caffeine, alcohol and spicy foods

Pudendal Neuralgia

Pudendal nerve entrapment, also known as Alcock Canal Syndrome, is when the pudendal nerve becomes pinched between the sacrotuberous and sacrospinous ligaments. Bladder and bowel can be affected as well as genitalia numbness. Sitting will be problematic whereas standing postures can relieve the symptoms.

Proctalgia Frugax (anal pain of unknown cause)

Pain and spasm felt in the rectum and anus that occurs commonly during the night. It can be caused from a cramp in the pubococcygeal muscle, a part of the levator ani muscle group. The pain comes on suddenly for no known reason and typically lasts a matter of seconds but may last up to 30 minutes. Treatment may involve warm baths and enemas, relaxation and breathing techniques, yoga postures such as downward dog and internal manual therapy.

Triggers

  • Sexual activity
  • Stress
  • Passing stools
  • Constipation

Treatment Options

  • Medications to relax the rectal muscles
  • Warm baths
  • Stretching
  • Breathing exercises