Men’s health generally refers to conditions of the pelvic floor that affect men specifically. This would include chronic urological pain syndromes like chronic non-bacterial prostatitis, erectile dysfunction, post-prostatectomy incontinence, proctalgia fugax (spasm of the rectum), and constipation. Other pain conditions that affect men include penile pain, testicular pain, post-ejaculatory pain and pudendal neuralgia.
Stress incontinence can be a common problem for men after a prostatectomy. Urinary or fecal urgency is the strong urge to go to the bathroom with an inability to delay toileting. Urinary frequency (voiding more than 7-8x/day) and urge incontinence are also likely to happen after a prostatectomy. Incontinence can be associated with either a weak or an over active pelvic floor. An internal exam is required to sort out the contributing factors associated with post-prostatectomy incontinence.
Urge incontinence can be strongly associated with anxiety and stress as well; it can also occur because of habits like going “just in case”, as you leave home, the gym or the office. This requires a thorough psychosocial assessment to look at distress factors that may be contributing to tension in the pelvic floor and troublesome toileting habits.
Post-void dribble is the loss of urine within the first few minutes of leaving the toilet. This can be due to incomplete emptying (rushing to void), or pelvic floor tension.
Pain with intercourse can occur during an erection or after ejaculation. Generalized pain symptoms in the testicles, penis or perineum are strongly associated with tension in the pelvic floor muscles. Tension in the pelvic floor muscles can also sensitize the nerves that travel through the pelvic floor; this is called pudendal neuralgia. Muscle tension throughout the lower spine and pelvic girdle may also refer to the spine, perineum or pelvic floor.
This suggests that men require a thorough musculoskeletal examination including the low back, hips, pelvis and pelvic floor.
Experts in the urology field will readily say that the prostate has been “framed” and is often blamed for musculoskeletal pain in the pelvic floor. Tension in the pelvic floor and pelvic girdle will cause prostate symptoms such as:
This area of physiotherapy has been poorly studied and recognized in the male population. Women are much more likely to be treated for pelvic pain conditions and incontinence; however, men are rarely screened for these problems, and are less likely to discuss them with their primary care provider.
Physiotherapy has been recognized as an important component for treating painful bladder symptoms in both men and women. Again, the contribution of pelvic floor problems to urological pain conditions in men has been poorly understood in the past. This is changing quickly with the development of pelvic health physiotherapy.
A pelvic health physiotherapist will assess all the contributions to pain and incontinence including musculoskeletal problems in the hips and low back, tension in the pelvic floor muscles and weakness of the pelvic floor muscles. Tension needs to be addressed before strength problems can be properly trained.
A sensitive nervous system is highly correlated with pelvic pain; physiotherapists should use a biopsychosocial perspective with all pelvic pain conditions, looking for distress markers such as:
A thorough program addressing all the factors that are driving the pelvic pain condition should be addressed by the physiotherapist, with referral to an inter-disciplinary team as needed.
Pelvic pain is a highly treatable condition when addressed from a whole person perspective. Looking at all the social, physical and distress factors will help the therapist and patient to get to the bottom of the pain problem.
Pelvic floor physiotherapy is very successful in resolving issues with incontinence, both stress and urge incontinence, as well as post-void dribble.
An internal exam is an integral part of treatment of pelvic floor problems. It is not mandatory and much can be accomplished with even a good external exam that takes the pelvic floor into consideration. However, an internal exam is the gold standard.
Men who sit for prolonged periods of time, endurance athletes, cross-fit athletes, and men with stress-driven problems often end up with pelvic floor problems that need to be addressed with pelvic floor physiotherapy.
Don’t suffer silently! Don’t suffer alone!
Physiotherapy for men’s health problems are a crucial step in recovering function and quality of life.