pelvic floor therapy for men

Men’s Pelvic Health is a specialized area of rehabilitation that takes advanced education and training as well as a true understanding of the many components that contribute to a man’s overall condition. In some cases the issue is in the pelvis and can be locally treated. In other cases pelvic issues can be driven by other sites such as the gut, hip or spine. Some pelvic issues such as tightness and /or pain can be driven by emotional issues. Simply put, Men’s Pelvic Health refers to the health and wellbeing of the muscles and other structures including the mind that refer to or impact the pelvis. Pelvic floor dysfunction is what happens if one or more of those structures is not working the way it should, causing unwanted and unpleasant symptoms.

POST SURGICAL OR POST INJURY SCARRING

Fibrosis of the Anal Canal leading to pain and impaired function.

WHY DOES POST SURGICAL OR POST INJURY SCARRING NEED TO BE TREATED?

Scar tissue is a common contributing factor to pelvic pain. Scar tissue is fibrous tissue that replaces normal tissue after an injury. It’s made of the same stuff as the tissue it replaces—collagen. However, the quality of the collagen is inferior to the tissue it replaces. Plus, the tissue is usually not as elastic as the original tissue. Scarring that affects the pelvic floor can happen as a result of any trauma to the area.
Scar tissue is indiscriminate in what it attaches to. So it can adhere to skin, muscle, or connective tissue. Wherever it decides to hang out, it pulls on the surrounding tissue making the area taut and restricting blood flow, a situation that often results in pain.
Another way that scar tissue can wreak havoc within the pelvic floor is as a result of referred pain. Remember, there is a network of nerves that innervate the pelvic floor. If a scar is on top of or impinging on a nerve that also innervates another part of the pelvic floor, then that area can also be affected.
Another way scar tissue can cause problems within the pelvic floor is by impairing function in the area where it’s located. The pelvic floor is a major hub of the body. Muscles, nerves, connective tissue, and organs are all located there, and they all have important jobs to do, such as keeping us continent. For instance, if a muscle is torn and then a scar forms, that muscle may lose some of its ability to contract, which could lead to a loss of control over urination, bowel movements, or sexual function.

HOW IS THIS SCARRING TREATED THROUGH PELVIC FLOOR THERAPY?

A scar can be made more flexible by manipulating the scar tissue. The more scar tissue is moved and massaged, the softer and more similar to the tissue around it it becomes. This reduces tightness and breaks up adhesions.
So if a scar is pulled in all directions, the body will lay down the fibers of the scar tissue with more organization, and in a similar alignment to the tissues around it. This results in the scar blending in better and behaving more like normal tissue.
During Pelvic Floor Therapy treatment, the therapist will massage and manipulate your scar tissue and the area around it. Scars (internal and external) can be pushed, pulled, pinched, rolled, and rubbed.

Urinary Dysfunction

(Including pain) issues with urination, difficulty initiating voiding, stress or urge incontinence, urinary frequency, frequent night time urination, hesitancy or weak flow.

WHAT IS URINARY DYSFUNCTION?

Urinary Dysfunction includes issues with urination, difficulty initiating voiding, stress or urge incontinence, urinary frequency, frequent night time urination, hesitancy or weak flow.

WHAT CAUSES URINARY DYSFUNCTION IN MEN?

For the urinary system to do its job, muscles and nerves must work together to hold urine in the bladder and then release it at the right time.

Nerve Problems

Any disease, condition, or injury that damages nerves can lead to urination problems. Men who have had diabetes for many years may develop nerve damage that affects their bladder control. Stroke, Parkinson’s disease, and multiple sclerosis all affect the brain and nervous system, so they can also cause bladder emptying problems. A Spinal cord injury may affect bladder emptying by interrupting the nerve signals required for bladder control.

Prostate Problems

The prostate is a male gland about the size and shape of a walnut. It surrounds the urethra just below the bladder, where it adds fluid to semen before ejaculation. The prostate gland commonly becomes enlarged as a man ages. This condition is called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. As the prostate enlarges, it may squeeze the urethra and affect the flow of the urinary stream.
The surgical removal of the entire prostate gland, called radical prostatectomy, is one treatment for prostate cancer. In some cases, the surgery may lead to erection problems and UI. External beam radiation procedure is another treatment method for prostate cancer. The treatment may result in either temporary or permanent bladder problems.

HOW IS URINARY DYSFUNCTION DIAGNOSED IN MEN?

Physical Examination

A physical exam will check for prostate enlargement or nerve damage. In a digital rectal exam, the doctor inserts a gloved finger into the rectum and feels the part of the prostate next to it. This exam gives the doctor a general idea of the size and condition of the gland. To check for nerve damage, the doctor may ask about tingling sensations or feelings of numbness and may check for changes in sensation, muscle tone, and reflexes.

EEG and EMG

Your doctor might recommend other tests, including an electroencephalogram (EEG), a test where wires are taped to the forehead to sense dysfunction in the brain. In an electromyogram (EMG), the wires are taped to the lower abdomen to measure nerve activity in muscles and muscular activity that may be related to loss of bladder control.

Anorectal Manometry

Ultrasound

For an ultrasound, or sonography, a technician holds a device, called a transducer, that sends harmless sound waves into the body and catches them as they bounce back off the organs inside to create a picture on a monitor. In abdominal ultrasound, the technician slides the transducer over the surface of your abdomen for images of the bladder and kidneys. In transrectal ultrasound, the technician uses a wand inserted in the rectum for images of the prostate.

HOW DO YOU KNOW YOU NEED TO SEEK TREATMENT?

You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is frequent or is affecting your quality of life, it’s important to seek medical advice. Urinary incontinence may indicate a more-serious underlying condition. It can cause you to restrict your activities and limit your social interactions. No single treatment works for everyone. Your treatment will depend on the type and severity of your problem, your lifestyle, and your preferences, starting with the simpler treatment options.

bowel Dysfunction

(Including abdominal pain) coccyx pain, fecal incontinence, constipation, dyssynergia, pain during or after sex.

WHAT IS BOWEL DYSFUNCTION?

Bowel dysfunction is any condition or group of conditions that inhibit the normal process of body waste passage, storage and elimination.
Bowel incontinence means a problem holding in the stool. You may have unwanted stool that you can’t control. These conditions can be stressful to deal with. But don’t feel embarrassed about talking about this. We are used to dealing with these issues, and can help you manage the problem.

WHAT CAUSES BOWEL DYSFUNCTION IN MEN?

When the bowels function normally, nerves tell certain muscles when to tense up and when to relax. Nerves in the spinal cord send messages from the brain to the bladder. Muscles in the rectum and anus control or release stool. These nerve and muscle processes allow feces to be removed when you want them to.
Many conditions may affect the nerves and muscles that control the bladder and bowel. Incontinence can be caused by damage to the nerves in sphincter muscles, diarrhea, constipation, rectum bulging into the anus, crohn’s disease or ulcerative colitis. Other causes could be Stress, Multiple sclerosis, Stroke, Alzheimer’s disease, Diabetes, Infections, including spinal cord or brain infections, Hemorrhoids, problems with the pelvic floor, damage after surgery, side effects of medicine.

HOW IS BOWEL DYSFUNCTION DIAGNOSED IN MEN?

Physical Examination

A physical exam will check for prostate enlargement or nerve damage. In a digital rectal exam, the doctor inserts a gloved finger into the rectum and feels the part of the prostate next to it. This exam gives the doctor a general idea of the size and condition of the gland. To check for nerve damage, the doctor may ask about tingling sensations or feelings of numbness and may check for changes in sensation, muscle tone, and reflexes.

EEG and EMG

Your doctor might recommend other tests, including an electroencephalogram (EEG), a test where wires are taped to the forehead to sense dysfunction in the brain. In an electromyogram (EMG), the wires are taped to the lower abdomen to measure nerve activity in muscles and muscular activity that may be related to loss of bladder control.

Ultrasound

For an ultrasound, or sonography, a technician holds a device, called a transducer, that sends harmless sound waves into the body and catches them as they bounce back off the organs inside to create a picture on a monitor. In abdominal ultrasound, the technician slides the transducer over the surface of your abdomen for images of the bladder and kidneys. In transrectal ultrasound, the technician uses a wand inserted in the rectum for images of the prostate.

HOW DO YOU KNOW YOU NEED TO SEEK TREATMENT?

You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is frequent or is affecting your quality of life, it’s important to seek medical advice. Bowel incontinence may indicate a more-serious underlying condition. It can cause you to restrict your activities and limit your social interactions. No single treatment works for everyone. Your treatment will depend on the type and severity of your problem, your lifestyle, and your preferences, starting with the simpler treatment options.

Tight Pelvic Floor Muscles

May cause pelvic pain or dysfunction.

WHAT IS PELVIC FLOOR MUSCLE TIGHTENESS?

The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the bottom of the pelvis and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around your urethra & rectum. These muscles must be able to contract to maintain continence, and to relax allowing for urination and bowel movements.  
When these muscles have too much tension (hypertonic) they will often cause pelvic pain, or urgency and frequency of the bladder and bowels. When they are low-tone (hypotonic) they will contribute to stress incontinence and pelvic organ prolapse. You can also have a combination of muscles that are too tense and too relaxed.

WHAT ARE SOME SYMPTOMS OF PELVIC FLOOR MUSCLE TIGHTNESS?

One

Too much tension in these muscles can cause urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying.

Two

Some may experience constipation, straining, or pain during or after bowel movements. You may have unexplained pain in your lower back, pelvic regions, hips, genital area, or rectum.

Three

Pain during or after intercourse, orgasm, or sexual stimulation.

Four

Uncoordinated muscle contractions causing the pelvic floor muscles to spasm.

HOW IS PELVIC FLOOR MUSCLE TIGHTNESS DIAGNOSED IN MEN?

Assessment of the pelvic floor begins with careful consideration of the patient’s description of symptoms. A great deal of information is gathered during this process.
Further assessment of muscle function can be diagnosed using internal and external “hands-on” or manual techniques. They will assess your ability to contract and relax these muscles, and feel for tight bands or Trigger Points in the muscles. The bones and muscles of your lower back, hips and sacro-iliac joints will also need to be assessed.
Anorectal manometry measures the resting and active pressures of the rectum and anus and proved valuable information regarding muscle pressure and function.
Transabdominal Transperineal Ultrasound Imaging will provide vital information about muscle recruitment, the direction of muscle pull, muscle coordination and possible outlet obstructions that affect function.
If an internal examination of the muscles is too painful, the connective tissue of your abdomen, thighs, groins and low back are often very tight. The connective tissue forms the container of the muscles, and these often need to be relaxed before any internal work can be done. The connective tissue dysfunction becomes the priority before the trigger points, or tight muscles can be effectively treated.

HOW IS PELVIC FLOOR MUSCLE TIGHTNESS TREATED?

When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and pelvic floor strengthening exercises are prescribed if appropriate.
Self-care is an important part of treatment. Avoid pushing or straining when urinating and ask your health care provider about how to treat constipation. Relaxing the muscles in the pelvic floor area is important, and doing reverse kegels may be one way to help lengthen and relax these muscles. Regular deep breathing is an important part of learning to relax tension in all of your muscles, but particularly the pelvic floor. Using methods such as warm baths twice daily can also be helpful.
Good posture to keep pressure off your bladder and pelvic organs, and other stretching techniques such as yoga, can be helpful to avoid tightening and spasms in the pelvic floor muscles as well.
Persistent pain education is an important part of treating pelvic floor muscle problems since the pelvic area is an area that we often hold our stress. Anxiety, stress and our thoughts, attitudes and beliefs can perpetuate the pain in our pelvis; understanding how our pain system works has shown to be an effective way of reducing the threat of ongoing pelvic floor problems.

erectile Dysfunction

Can be a sign of a physical or psychological condition.

WHAT ARE THE SYMPTOMS OF ERECTILE DYSFUNCTION?

You may have erectile dysfunction if you regularly have trouble getting an erection, you have a reduced interest in sex, or have difficulty maintaining an erection during sexual activity. Other sexual disorders related to erectile dysfunction include premature ejaculation, delayed ejaculation, anorgasmia, or the inability to achieve orgasm after stimulation. You should schedule a consultation if you have experienced any of these symptoms for 3 or more months.

WHAT CAUSES ERECTILE DYSFUNCTION?

There are many possible causes of erectile dysfunction, and can include both emotional and physical conditions.
A few common causes of erectile dysfunction includes:
  • Cardiovascular disease
  • Diabetes
  • Hypertension
  • High Cholesterol
  • Obesity
  • Low Testosterone levels
  • Kidney disease
  • Aging
  • Stress
  • Anxiety
  • Depression
  • Relationship Problems
  • Prescription Medications, such as those used to treat high blood pressure or depression
  • Sleep Disorders
  • Drug Use
  • Consuming Excessive Alcohol
  • Using Tobacco Products
  • Health Conditions, such as Parkinson’s or Multiple Sclerosis (MS)
  • Damage to Pelvic Area through injury or scarring
  • Peyronie’s Disease
Erectile dysfunction can be caused by only one or by a number of these factors.

Curved Painful Erections

Known as Peyronie’s Disease, Fibrous scar tissue inside the penis that causes curved, painful erections.

WHAT IS PEYRONIE’S DISEASE?

Peyronie’s Disease is where segments of flat scar tissue forms under the skin of the penis. These can cause the penis to bend or become indented when erection(s).

WHAT ARE SOME SYMPTOMS TO LOOK FOR?

Plaques made of scar tissue mostly form on the top of the penis. The plaques make the tunica albuginea less flexible and may cause the penis to bend upwards when it stiffens. When plaques form on the bottom side of the penis, the curve may be downward or sideways. Sometimes plaques form that go all the way around the penis. These plaques most often do not cause curving but may cause the shaft of the penis to narrow like the neck of a bottle.
Peyronie’s disease are having a bent/curved penis, lumps in the penis, painful erections, soft erections, having trouble with sex because of a curved/bent penis.

WHAT CAUSES PEYRONIE’S DISEASE?

Peyronie’s disease is caused by a minor injury to the penis. This type of damage is most often caused by vigorous sex, but can also be caused by sports or other accidents. Injury to the tunica albuginea may result in scar tissue forming in the cells (fibrosis). The scar tissue then forms the plaque of Peyronie’s disease. Peyronie’s disease is the result of a problem in the way the body heals wounds.
Men with certain connective tissue disorders (such as Dupuytren’s contractures or tympanosclerosis) and men who have a close family member with Peyronie’s disease have a greater risk of getting it. Certain health issues, such as high blood sugar, tobacco use, or past pelvic trauma, may also lead to wound healing problems and may help cause Peyronie’s disease.

HOW IS PEYRONIE’S DISEASE DIAGNOSED?

Peyronie’s disease is diagnosed using a physical exam. The hard plaques can most often be felt whether the penis is stiff or not. To check how the penis curves, your health care provider may inject a drug into your penis to make it stiff and may take pictures to study. In some cases, dynamic ultrasound, which uses sound waves to get a picture of what is in your body, is used to see where the plaque is, check for calcium buildup and show how the blood flows in your penis.

Erect Penile or Perineal Pain

Known as Hard Flaccid Syndrome a chronic pelvic pain syndrome which results in penile or perineal pain, shortening or cramping of the penis, penile numbness, erectile dysfunction, pain and or weakness with ejaculation or urination.

WHAT IS HARD FLACCID SYNDROME?

Hard flaccid syndrome is a chronic pelvic pain syndrome which results in penile or perineal pain, shortening or cramping of the penis, penile numbness, erectile dysfunction, pain and or weakness with ejaculation or urination. Men may also need more physical stimulation in order to achieve or maintain erection. Men can describe the penis as feeling hollow, semi-engorged and somewhat rubbery.

WHAT CAUSES HARD FLACCID SYNDROME?

The cause of the hard flaccid is unfortunately unknown. Men usually end up seeing numerous specialists and undergo various tests, which have normal results. Because of this, it is theorized that the cause of hard flaccid can be multifactorial, with biological, social, and psychological triggers. A physical or psychological stressor can trigger an emotional response, which can then stimulate the pelvic muscles and cause a sustained muscle contraction. This can then lead to a shortening of the contractile tissues of the penis, thus leading to tightness of the surrounding muscles and tissue and then causing pain. A traumatic event, such as rough masturbation, can lead to injury of nerves and pelvic floor musculature, which can contribute to the onset of symptoms. This can then lead to psychological problems which can result in erectile dysfunction and decreased libido.
Stress and anxiety about the condition can also exacerbate the condition. Chronic pain can change behaviors into catastrophic thinking about the condition. This can cause more muscle tension and increased feelings of helplessness and negativity. Patients with chronic pelvic pain are likely to remain catastrophic in their thinking about pain for prolonged periods if they don’t or are unable to seek help.

HOW DO YOU TREAT HARD FLACCID SYNDROME?

Pelvic floor physical therapy can help men with hard flaccid. Treatment sessions can include internal and external pelvic floor trigger point release, learning relaxation strategies to reduce stress, and gentle core strengthening exercises to decrease stress on the pelvic floor musculature.

Pre or Post-Prostatectomy Training

Patients may experience erectile dysfunction, urinary issues and/or abdominal symptoms.

WHAT IS PROSTATECTOMY?

Prostatectomy is a surgery to remove part or all of the prostate gland. The prostate gland is situated in the male pelvis, below the urinary bladder. It surrounds the urethra, which carries urine from the bladder to the penis.

WHY WOULD I NEED THERAPY AFTER A PROSTATECTOMY?

Most men recover from pain and incontinence after prostatectomy surgery. Advances in the treatment of post-prostatectomy urinary incontinence have reduced the usual time to continence, thereby reducing post-op stress, anxiety and isolation. Advances in the medical treatment of erectile dysfunction has greatly changed the usual post-op course of erectile dysfunction.

Sexual Dysfunction

May be caused by some of the issues already mentioned or by other issues.

WHAT IS SEXUAL DYSFUNCTION?

Normal sexual functioning in men relies on the complex interaction between biological, emotional, cognitive, behavioural, contextual and interpersonal factors.
There are multiple physiological processes involved in male sexual function such as:
  • Sexual desire (libido)
  • Erectile functioning
  • Ejaculation
  • Orgasmic ability and quality

WHAT CAUSES SEXUAL DYSFUNCTION?

Testosterone levels play an important role in physiological libido. Erectile function forms an important part of a man’s sexual function, but it is only a part of the picture.
  • A normal erection depends on a sequence of physiological, neural, vascular, metabolic and endocrine events.
  • There are different types of erections; reflexogenic, psychogenic and nocturnal
  • Reflexogenic erections occur when the penis is physically stimulated
  • Psychogenic erections from other stimulation such as visual, auditory or psychological inputs.
  • Nocturnal erections occur in men every night with about 5-8 per night and can last up to 30 minutes each

HOW DO YOU TREAT SEXUAL DYSFUNCTION?

Your Urologist will order blood tests, check blood flow to the penis, and perform other tests that will determine the course of treatment. Tight and weak pelvic floor muscles that lack endurance can inhibit blood supply to the penis and cause erections to wane. Pelvic floor conditioning has been proven to reverse this particular cause of dysfunction.