Did you know men often need pelvic floor therapy too?

Yes, you heard that correctly: those with male anatomy also have pelvic floor muscles and therefore may need pelvic floor physical therapy too, although, their symptoms may be similar or very different from women.

Functions of the Pelvic Floor

It is important to know the function of the pelvic floor to understand what deficits can occur when the muscles are not working properly. The functions of the pelvic floor include the 5 S’s:

1. Support: for internal organs

• • The pelvic floor acts like a hammock in your pelvis, supporting everything in the trunk above it!

2. Sphincteric: urethra, vagina, and anus

• • The muscles need to relax to empty the bowel/bladder and contract to maintain continence.

3. Sexual: relaxes for penetration and contracts for orgasm

• • The pelvic floor is needed to help maintain an erection.
  • Note: Pain with erection, ejaculation, and intercourse is not normal and can be treated!

4. Stability: fixes the trunk with extremity movements

• • The pelvic floor muscles work in conjunction with the core and hip muscles for overall stability.

5. Sump Pump: for the circulatory system

• • Those muscles help move lymphatic fluid from the legs back to the heart.

Common Issues

Men can experience a variety of problems related to these functions, such as:

• Incontinence
• Increased urinary frequency or urgency
• Pelvic pain (including penile, abdominal, rectal, testicular, hip and back pain)
• Constipation or straining with bowel movements
• Chronic prostatitis symptoms
• Erectile dysfunction
• Other bowel/bladder/sexual impairments

The Prostate’s Function in Continence and Erectile Dysfunction

The urethra exits the bladder and passes through the prostate. When the prostate is enlarged, it can constrict the urethra, leading to difficulty emptying the bladder, straining during urination, and sometimes incontinence. Prostatectomy, a common treatment for prostate cancer, can disrupt continence and erectile function due to the prostate’s proximity to the urethra. Leakage is a common issue after surgery, with post-radical prostatectomy incontinence occurring in 0.5% to 87% of patients.

There are nerve bundles found on either side of the prostate and these nerves are particularly responsible for erectile function. There are also times when you can have pelvic pain due to prostate enlargement as well. Pelvic floor physical therapy can be very helpful in regaining continence and sexual function after surgery, and some surgeons will even recommend physical therapy before surgery to enhance pelvic floor awareness and improve recovery.

How do we treat the pelvic floor muscles in men?

Yes, men can do Kegels too! However, this may not always be the best treatment option depending on what is causing the issue. There are times when Kegels can make symptoms worse for both men and women. All of our treatments are individualized. What treatment options we use will depend on the cause of the dysfunction, but will often include either strengthening the pelvic floor (which may need to happen because of aging or a recent surgery such as a prostatectomy) or we may need to relax and lengthen the pelvic floor. Often in cases of chronic pelvic pain, we need to learn to relax the muscles.

Other treatment techniques may involve manual therapy techniques, biofeedback, relaxation strategies, diaphragmatic breathing, hip/core strengthening, dry needling, functional exercise, and much more.

If you are experiencing any of these symptoms, know that you are not alone and that there is help available. Pelvic floor physical therapy is a viable and successful treatment option for many men. Don’t hesitate to reach out and take the first step toward reclaiming your health!

References:

1. https://www.bloomphysicaltherapyandwellness.com/blog/the-5-ss-functions-of-the-pelvic-floor
2. https://www.physio-pedia.com/The_Male_Pelvic_Floor
3. https://www.physio-pedia.com/Pelvic_Floor_Dysfunction#/media/File:Pelvic_Floor_Muscles_Male_and_Female.jpg
4. https://www.auajournals.org/doi/10.1097/01.ju.0000072900.82131.6f#:~:text=Urinary%20incontinence%20after%20radical%20prostatectomy,and%20improvement%20in%20surgical%20technique.&text=The%20incidence%20reported%20in%20the,0.5%253%20to%2087%25