Flip Your Script

Over the years I have treated patients and trained clients who have/had pelvic floor dysfunction of some sort. The commonality of these types of issues is more prevalent than you think. One in three women will experience a pelvic floor disorder (PFD) in their lifetime. For women, PFD’s occur when women have weakened pelvic muscles or tears in the connective tissue, which may cause pelvic organ prolapse, bladder control problems, or bowel control problems. In men, PFD’s can present themselves in ways of Urinary or bladder control issues: feeling the need or urge to urinate, painful urination or an inability to fully empty the bladder during urination. Constipation, straining or pain during bowel movements. Pain or pressure in the rectum. A heavy or bulging feeling in the rectum. Many people mainly see PFD’s as a female issue but the reality is it one of the most common diagnoses for men over 50, accounting for nearly 2 million healthcare provider visits/year and can affect 10-15% of men. Being that this blog is primarily for men’s health and fitness, I am going to focus on the male side of PFD’s but I will cover some female issues as well and why diagnosing men is such a mystery of sorts.

WHAT IS MALE PELVIC FLOOR DISEASE?

Male PFD is usually a series of symptoms that affect the pelvic region. The spectrum of presenting symptoms can be broad and vary between men but there is commonality though. Most men find that symptoms change throughout the day or change from day to day. Symptoms can range anywhere from: pelvic/tailbone pain, painful ejaculation, abdomen aches, burning pain during urination/urethral pain, low back pain and testicular pain just to name a few. You can basically equate the pain with what’s associated getting kicked in the nuts.

One of the most common diagnoses for men under 50 is Prostatitis or inflammation of the prostate. This is sometimes caused by a bacterial infection and a round of antibiotics can clear it up in a few days/weeks. Regarding chronic prostatitis, antibiotics won’t help so you may need to see a Pelvic Physical Therapist for help to manage pain/discomfort in conjunction with your PCP.

Pudendal Neuralgia is the nerve that innervates the underside of the penis, the perineum, the scrotum, some pelvic floor muscles and around the anus. These nerves travel through the pelvic floor muscles and can get irritated if the pelvic floor muscles become very tight. Often times when the pelvic floor muscles become very tight, that prevents you from using them correctly. When you go to a Physical Therapist they will often times tell you that there are many reasons that these muscles can become tight and they will evaluate them during an initial screening. Common reasons can include trauma, heavy lifting, sitting, previous infections, scar tissue, etc.

HOW DO MEN KNOW THAT THEY HAVE A PELVIC FLOOR DYSFUNCTION?

Believe it or not, your penis is probably one of the best indicators that something may be wrong with your pelvic floor muscles. Inability to maintain erections, leaking urine during the day, trouble ejaculating are all symptoms of an issue with your pelvic floor and if you suspect something is wrong, make an appointment with your doctor to see what avenues of treatment are available for you. Other symptoms you may experience are urgency in urination, painful urination and the inability to empty the bladder fully. Constipation, straining or pain during bowel movements. Pain or pressure in the rectum. A heavy or bulging feeling in the rectum. Yeah, it is as bad as it seems so if you suspect something is wrong, make an appointment with your doctor and see what avenues of treatment are available for you.

WHAT DOES A TREATMENT PLAN LOOK LIKE FOR PATIENTS?

Obviously, this is a serious condition and must be treated as such because it can have a real impact on the quality of your everyday life. The good news is that it is 100% treatable, usually by a Physical Therapist who specializes in pelvic floor dysfunction. Pelvic floor therapy or pelvic rehabilitation as it is called is a type of treatment that can help patients manage the symptoms associated with their pelvic floor muscles. We rarely hear about men’s pelvic floor issues, mainly because we tend to forget that men even have pelvic floors because most of the issues stem from women in pregnancy and experience trauma delivering. A pelvic floor physical therapist can help men improve their pelvic muscle strength and control, increase blood flow to the area, and reduce pain and discomfort. It may also help men improve their bladder control, bowel control and even erectile dysfunction. A men’s pelvic floor physical therapist can provide education and exercises to help men learn to strengthen, relax, and stretch the pelvic floor muscles to improve their function.

What exercises help strengthen the pelvic floor? One of the exercises that PT’s focus on is called diaphragmatic breathing. This type of breathing is belly-breathing that quiets our nervous system. It helps our abdominal wall expand and, more importantly, helps our pelvic floor muscles to relax. Many women who have these problems are known to do kegel exercises as part of their therapy plan but should men do kegel exercises? Well….sometimes. These exercises can be performed by tightening and releasing the muscles that control urine flow. “I will often have my male patients stand in front of a mirror so that they can visualize the muscles working. It is important not only do contract the muscles, but also to give themselves time to fully relax between contractions.”, says a PT from the Franciscan Health Network. However, for many of our patients with bladder urgency/frequency or pelvic pain, kegel exercises can actually make their symptoms worse. “If your problem is due to tense muscles instead of just weak muscles, repeatedly contracting the pelvic muscles can be irritating to the muscles and result in more tension.”

Pelvic floor therapy is something necessary for both men and women suffering from pelvic floor dysfunction. Still stuck with the question “Should you go for pelvic floor therapy?” You don’t have to live in pain and you shouldn’t. Call your doctor and let them help you set up an appointment to have testing conducted so you can receive the proper care that you need to get on with your active life.

John J. Schessler, Jr. is a Pittsburgh-based certified Master Trainer, Bodybuilding Specialist & Exercise Therapist. He has been working in the fitness industry for over 15 years and has helped numerous clients become healthier and surpass their goals. He is also the host of the podcast, “ManAlive!”, available on Apple Podcasts and is a Men’s Life Coach and Motivational Speaker. If you would like to contact John concerning speaker bookings, personal training inquiries, etc., please contact John directly at pghwellnesspt@gmail.com.

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