This shouldn’t have to be said, but as it seems to often be forgotten, I’ll just say it - all people have pelvic floors, even those with male anatomy. This means that they also can struggle with pelvic floor dysfunction, but may present differently. In this blog post, I will discuss some common pelvic floor dysfunction and symptoms in those with male anatomy, barriers to receiving care, as well as pelvic floor physical therapy treatment options and what that may look like in this particular patient population.

Just like in those with female anatomy, pelvic floor problems can look like bowel, bladder and/or sexual dysfunction, or present as pelvic pain. The pelvic floor muscles should be able to contract, relax and stretch when necessary - if the pelvic floor muscles are unable to perform those functions, that’s when symptoms may occur. To break down and simplify those three functions a little further, contracting the pelvic floor muscles is essential for holding pee/poop/gas in as well as getting and maintaining an erection, while relaxing is necessary for all of the above coming out as well as for ejaculation. Stretching of the pelvic floor goes hand-in-hand with relaxing the muscles and assists in the exit of a bowel movement, for example.

Barriers to Receiving Pelvic Floor Physical Therapy

Pelvic floor physical therapy and the availability of specially trained pelvic floor physical therapists have become more common for the female patient population; however, further specialty training and education is required to treat the male patient population which isn’t quite as common or accessible. There can be many barriers to males receiving the care that they need, such as…

1. Lack of pelvic floor physical therapy clinics in the area

2. Lack of pelvic floor physical therapist specially trained in treating male anatomy

3. Lack of awareness from other healthcare providers in regards to pelvic floor dysfunction in males

4. Embarrassment that may keep a male pelvic patient from seeking out professional help

Common Reasons for a Male to see a Pelvic Floor Physical Therapist

There are many various reasons that a male might need to see a pelvic floor physical therapist. But here is a list of some of the most common reasons:

• Urinary incontinence

• Bowel/fecal incontinence

• Testicular pain

• Groin pain

• Pain with sex

• Pelvic pain

• Pain with ejaculation

• Penile pain

• Erectile dysfunction

• Bladder pain

• Tailbone pain

• Post-prostate surgery issues

• Pudendal Neuralgia

• Abdominal pain

• Pain with bladder/bowel functions

Many of these issues or symptoms can go hand-in-hand with some other common dysfunctions, like hip, low back or sacral pain, which is why a full body approach to pelvic floor dysfunction is absolutely necessary!

Possible Causes of Pelvic Floor Dysfunction in Males

While there can be many individual factors that come into play in regards to pelvic floor dysfunction, here are some more common causes or factors that may contribute to pelvic floor dysfunction in someone with male anatomy.

• Prostate surgery

• Pelvic trauma or surgery

• Repeated heavy weightlifting

• Long-term cough

• Constipation and/or straining to empty the bowels

• Being overweight/obese

• Previous infections

• Stress

• Prolonged sitting

There are other factors that may contribute to pelvic floor dysfunction as well, such as an increase in age contributing to a weaker pelvic floor or having pain in other locations that can cause pelvic floor tension in response to that pain.

What to Expect with Pelvic Floor Physical Therapy

As with any other physical therapy session, the initial session will include a lot of information gathering about your medical history, your current complaint and symptoms and your experiences thus far that have brought you in to seek help. Following the verbal information gathering, your pelvic floor physical therapist will want to then do a visual examination of your posture and movement patterns, keeping in mind that a full body approach is necessary when treating the pelvic floor.

Palpation (touch) will also be necessary in order to determine if there are any tissue restrictions, imbalances or changes of the abdomen, inner thighs, pelvis, buttocks and low back. As information is gathered, your pelvic floor physical therapist will also be screening for systemic, hormonal and neurological/psychological contributors to your symptoms.

One of the main parts that makes the pelvic floor initial session different from other physical therapy sessions you may have experienced is the internal evaluation part. Pelvic floor physical therapists should be specially trained in the internal examination, assessment and treatment of the pelvic floor muscles. However, not all pelvic floor physical therapists are trained in examining, assessing and treating the male pelvic floor. This is what sets Advanced Pelvic and Spine Physical Therapy apart in that we do have that specialty training and education. For our male patients, an intrarectal exam may be indicated depending on your particular pelvic floor dysfunction and symptom presentation. This part of the evaluation is very important and can provide a lot of valuable information as well as help guide the treatment plan; however, if you are uncomfortable, our pelvic floor physical therapist’s are more than happy to sit and talk with you about it further!

After the examination is completed, further discussion takes place in order to share the initial assessment findings, what it all means, cover all of your goals for treatment and together, a comprehensive and realistic treatment plan is determined to move forward with.

The Benefits of Internal Pelvic Floor Assessment and Treatment

So, you may be wondering, is an internal pelvic floor treatment really necessary? And the answer - if your particular presentation of symptoms and pelvic floor dysfunction warrants an internal evaluation and/or treatment, then yes, it is absolutely necessary! Here is a little further information in regards to what the goal is with internal pelvic floor treatment.

• Pelvic Floor Muscle Reeducation

  The pelvic floor muscles may not have the coordination and muscle tone that is needed in order to function properly. Internal treatments can assist in helping to regain coordination and tone and therefore restore function!

• Strengthening and Relaxation

  If the pelvic floor is weak or overly tight (hypertonic), an internal assessment can help to initially diagnose either of those as well as continued internal pelvic floor treatment in order to help either down train or up train the muscles depending on your particular pelvic floor muscle diagnosis.

• Pelvic Pain Relief

  Internal pelvic floor assessments can address pelvic pain by identifying trigger points, releasing muscle tension, and improving blood flow to the area. This can alleviate discomfort associated with pelvic floor dysfunction. Continued internal treatments may be warranted for long-term pain relief.

Further Pelvic Floor Physical Therapy Treatment Options

Aside from internal work, there are many other treatment options that will likely be utilized if you receive pelvic floor physical therapy. These other types of treatments you may be more familiar with, such as exercises, stretches, education and discussion of building helpful habits. You may also be asked to continue specific exercises or activities at home in order to compliment the in-person sessions you attend and help to make further progress towards your goals.

There is no one size fits all when it comes to your specific treatment, exercises, stretches, activities or habit changes. These should all be very individualized to YOU and your specific outcome goals. After each session, you should leave with more information in regards to your condition and feeling more empowered with the tools you will learn in order to move forward and towards your specific goals!

Advanced Pelvic and Spine

Our pelvic floor physical therapists are uniquely trained to treat male pelvic anatomy with conditions that relate to men's urologic, sexual, and colorectal health.

Here, you can expect an empathetic and caring pelvic floor physical therapist who is highly trained in treating pelvic conditions of male anatomy. Above all, we understand this is a sensitive area and topic. Our pelvic floor physical therapists will work with you to make sure you are comfortable and informed about your condition and treatment. If you feel that you would benefit from pelvic therapy, book an appointment today or reach out with any questions.