Yes men, you do have a pelvic floor. In fact, aside from different genitalia, all genders have the same pelvic floor muscle and nerve make up. Even in the absence of delivering babies, the male pelvic floor and surrounding area can be susceptible to dysfunction. The following diagnoses/presentations/symptoms can all be indicative of a pelvic floor dysfunction:
-Urinary or fecal incontinence
This can be due to an underactivity or over activity of the pelvic floor muscles and can often be treated without the need of medication or surgery. Think Kegel’s are the answer to everything? They may not be in these cases if weakness is not the issue but tension or coordination is.
-Urinary frequency and urgency
This is often due to pelvic floor muscle overactivity or pelvic floor nerve irritation that create symptoms of urgency and frequency. Especially in the absence of improvement from medications or surgery, pelvic floor dysfunction is likely the culprit.
Symptoms can be due not simply an inflamed prostate but due to pelvic floor muscle tension. Research has found that people with chronic prostatitis have an impaired ability to relax their pelvic floor muscles as compared to those with no history of dysfunction.
This can be due to tension in the pelvic floor muscles that compresses nerves and arteries and veins that can decrease blood supply to the region (Kegel’s are the opposite of what you need in this case!).
-Pain with erection or ejaculation
Increased tension of pelvic floor muscles and pelvic floor muscles that cannot relax after contraction can be the culprit with erection or ejaculation pain. Muscle tension can irritate nerves that supply the pelvic floor which can then result in this pain.
-Pelvic pain: Testicular pain, Penile Pain
Whether described as sitz bone pain, testicular pain, penile pain, pubic pain, or pain of the pelvic region in general, this may be due to pelvic floor muscle overactivity. Referral patterns of pelvic floor or even abdominal muscles can be into the testicles and penis. Nerve irritation in the abdomen or pelvic floor can also refer pain to the pubic bone, testicles, and penis. Pain can be dull and chronic or sharp and shooting.
Pelvic PT’s can determine if pain is due to visceral reasons or musculoskeletal reasons. Increased tension in abdominal muscles can cause abdominal pain or bloating and slow GI motility can also lead to this pain. Both can be addressed with pelvic PT.
Everyone needs re-education and re-coordination of pelvic floor muscles before and after this surgery to help decrease incontinence post-operatively. Research finds that people who perform pelvic floor exercises correctly prior to a prostatectomy regain continence on average months quicker than those who don’t.
A common but not normal occurrence of pudendal nerve compression that can be addressed with pelvic PT to prevent further dysfunction resulting.
Pelvic PT has techniques to improve GI motility with abdominal massage and breath work and techniques to retrain pelvic floor muscles on how to properly pass a bowel movement
-Pudendal nerve pain
The pudendal nerve can get irritated due to chronic compression from sitting or cycling, anatomical entrapment, chronic pelvic floor muscle tension, nervous system upregulation, etc. Symptoms can be sharp or burning pain, numbness in the saddle region, pain with sitting, pain with urination, pain with ejaculation, etc. Often medication or surgery may not relieve all symptoms.
-Inguinal or sports hernia
Hernias may be overlooked as a cause of abdominal pain or even testicular and penile pain. Learning how to better coordinate the abdominal, adductor, and pelvic floor muscles with each other and with breath can help improve hernia symptoms without having to undergo surgery.
Often men will go to a urologist or primary care provider with these issues. However, those providers don’t often have training to assess the musculature and nerves of the pelvic region. A pelvic physical therapist will evaluate the muscles and nerves of the abdomen and pelvic floor as well as examine full body movement patterns and strength to determine the underlying drivers of dysfunction.
Will Pelvic PT Involve an Internal Exam?
One potential examination technique for men involves an internal rectal exam if warranted to assess the pelvic floor musculature and nerves. As pelvic PTs, we are sensitive to the individual needs and comforts of a patient and an internal pelvic exam is never required. A lot of information can be gathered from an external pelvic floor muscle examination and even a clothed pelvic floor external examination based on patient comfort. Fear of the exam should never stop a man from coming to pelvic PT!
On the flip side, if you are comfortable with an internal exam to thoroughly assess the pelvic floor musculature and nerves, but your PT does not perform them or is uncomfortable doing so, that is a sign to find another PT. You should feel that your practitioner has the utmost comfort in treating male pelvic floor dysfunction in order to ensure you are getting the best care you can.
Have an issue mentioned here or have an issue that hasn’t been resolved from the traditional medical route? Schedule and appointment one of our pelvic health physical therapists at our Boulder or Lafayette physical therapy clinics today.