What does pelvic floor dysfunction feel like for men and folks with male anatomy

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Fiona McMahon PT, DPT
What does pelvic floor dysfunction feel like for men and folks with male anatomy
Important Note

Important Note: For the purposes of this article, we will be discussing pelvic floor dysfunction for individuals with penises using the term men to describe folks with male anatomy. We do acknowledge not all men have penises.
Anyone of any gender or anatomy can experience pelvic floor dysfunction.

What is the Pelvic Floor?

The pelvic floor is the group of muscles that lives between your pubic bone and tailbone. Another way to think of the pelvic floor is the area that would make contact with your bicycle seat. These muscles are, in a word, AMAZING. They have many important jobs in the body. The pelvic floor muscles are responsible for keeping us continent, supporting our pelvic organs, maintaining sexual function (erection and ejaculation), stabilizing the spine, and helping to return blood and lymphatic flow back into the body so it doesn’t stagnate in the pelvis and/or lower extremities. When things go wrong with your pelvic floor, you may see symptoms in the aforementioned functions.

What are Symptoms of Pelvic Floor Dysfunction in Men

Since the pelvic floor performs so many functions, you can see many different symptoms when something goes wrong with the pelvic floor. The following is a non-exhaustive list of symptoms and conditions you may experience when something goes wrong with the pelvic floor.

Prostatitis and Chronic Pelvic Pain Syndrome

In my experience, prostatitis is one of the single most common things I treat at Beyond Basics. It’s an extremely common condition. It is estimated that 35-50% of men will experience prostatitis symptoms in their lifetime (Rees). Symptoms include:

  • The sensation of having a golf ball stuck in the rectum
  • Hesitant urinary stream (having trouble getting the urine to start flowing)
  • Post void dribble (spotting of urine on underwear following voiding)
  • Pain that radiates into the abdomen (this is one of the differences from symptoms of benign prostatic hyperplasia)
  • Erectile dysfunction and decreased libido
  • Painful ejaculation
  • Painful or burning urination
  • Genital pain: penile, testicular, groin, and perineal pain

Prostatitis can be caused by infection, inflammation, and most commonly, (90-95% of cases) problems within the pelvic floor, (which can be treated by physical therapy).

What are Symptoms of Pelvic Floor Dysfunction in Men

 

In cases that are caused by infection, your doctor may prescribe antibiotics to treat the infection. For nonbacterial prostatitis physical therapy can be an excellent place to start! Clinical Professor of Urology, R.U. Anderson and his colleagues described the relationship between the presence of myofascial trigger points, (which are highly irritable bands of muscle knots) and symptomatic prostatitis. They also showed that physical therapy intervention, including manual release of these trigger points was effective in reducing symptoms of prostatitis. The benefit of physical therapy was shown again to be more effective than placebo in a 2011 paper by a Clinical Researcher and Urologist J. Curtis Nickel. In addition to treating the trigger points themselves, PT’s work to determine what lead up to the formation of the trigger points in the first place, whether that be poor habitual posture, poor strength, or tight muscles in other parts of the body. They also teach patients how to avoid clenching their pelvic floor to prevent exacerbating symptoms. This type of therapeutic approach was found to be effective in reducing pain in 72% of participants in a study conducted by Anderson and colleagues in 2005. The therapists at Beyond Basics Physical Therapy work to go beyond simple treatment of the trigger points themselves. We develop plans and treatments to prevent their recurrence in the future. Some other effective physical therapy techniques that we use include but are not limited to, joint mobilization to assist proper structural alignment, therapeutic exercise, postural and neuromuscular re-education, and a detailed and individualized home exercise program.

Urinary Dysfunction

Urinary dysfunction can occur with or without pain. Either way, issues with urination can be incredibly disruptive. Common urinary problems we see at BBPT in People of all genders are:

  • Incontinence
  • Difficulty voiding
  • Frequency
  • Urgency
  • Pain

Let’s dive a little deeper into each of these types of urinary dysfunction

Let’s dive a little deeper into each of these types of urinary dysfunction.

Incontinence

Incontinence can take many different forms. Stress incontinence occurs when one leaks a little urine with activities like jumping, running, coughing, and or sneezing. Typically stress incontinence occurs when the muscles of the pelvic floor can’t quite counteract the downward pressure on the bladder caused by these activities. Though Kegels may help, they aren’t always the solution if you have a tight and weak pelvic floor. You may also need additional training to move a bit more efficiently, with added shock absorption to reduce the pressure on your pelvic floor.

You may also experience post-void dribbling. Typically post-void dribbling is seen by slight leakage after peeing. You may notice a damp spot on the outside of your trousers after going to the bathroom. This often happens because the muscles that surround the urethra get tight and act almost like a foot on a garden hose, sometimes making it harder to pee and causing pee to get caught in the urethra only to dribble out at inopportune times.

You may also find that you have difficulty voiding when you have a tight pelvic floor. Tight pelvic floor muscles can make the muscles of the bladder work less effectively, and make the outlet through which pee has to get out, smaller and tighter. You may notice difficulty starting your urinary stream, start and stop urination, and splayed urinary stream with pelvic floor dysfunction.

Urge incontinence occurs, as the name implies when you get a sudden urge to urinate and cannot hold back the flow of urine. Commonly, urge incontinence occurs when nearing home, rounding the block to your apartment, at the sound of running water, or while waiting in line to use the loo. A physical therapist can be instrumental in helping you to train your bladder to react less to these triggers and improve your ability to delay urination when required.

Bladder training and pelvic floor physical therapy can also help with issues like frequency. Normal bladder frequency occurs approximately every 2-3 hours during the day and 0 times at night if you are under 65 and one time at night if you are over 65.

Bladder pain can come in many different forms. You can have pain with bladder filling, active urination, or immediately thereafter. Oftentimes, pelvic floor tightness can play a key role in bladder pain. In addition to treating tight pelvic floors, a pelvic floor PT can also guide you through lifestyle and behavioral modifications that can further reduce your pain.

Ways you can help your bladder right now

  • If you don’t have pain, try lengthening the time between “goes” 10-15 minutes at a time and practice deep diaphragmatic breathing in the interim.
  • If you experience sudden urge, DON’T PANIC! Rushing often makes it worse. Breathe slowly and calmly make your way to the toilet.
  • When hesitancy strikes, breath deeply. Try sitting on the toilet to relax the pelvic floor and make peeing easier.
  • Avoid drinking water 2 hours before bedtime if you are experiencing frequency at night.
  • If you are constipated, work on managing that problem. The bladder lives right in front of the rectum. A large backup of stool will press on the bladder, irritating it and reducing its holding capacity.

Ways you can help your bladder right now

 

Erectile Dysfunction

Erectile dysfunction (ED) can be an extremely frustrating condition. ED can be an important indicator that some other component of your health, whether it be your heart, your mental health, physical activity, or muscles may need a little extra attention. New-onset ED should be checked out by a healthcare provider to rule out any cardiac contributors to your erectile dysfunction.

What do muscles have to do with erections? A lot. The muscles of the pelvic floor play a vital role in the sexual function of all genders, and as we will explore, there is a considerable amount of muscular coordination required for erection and orgasm. The pelvic floor muscles have to relax enough to let blood into the penis to allow for erection, but then contract to allow the blood pressure in the penis to remain high enough for penetration.

Physical therapy can help to improve the function of the muscles that are responsible for erection, ejaculation and orgasm. As we described earlier, the pelvic floor muscles play an integral role in male sexual function, from erection to ejaculation. When men come into physical therapy after complaining of erectile dysfunction, a pelvic floor physical therapist will examine the muscles of and surrounding the pelvic floor to see if they are too tight or weak to generate enough force to maintain adequate blood pressure in the penis, examine bony malalignments which may be impairing the full function of the muscles and nerves of the pelvic floor, as well as many other things that may be impacting the full function of the pelvic floor.

The effects of physical therapy on erectile dysfunction have been illustrated in many studies. In a 2014 study, Professor of Sexology, Pierre Lavoisier and colleagues examined the effects of a program of pelvic floor physical therapy on erectile function of 108 men suffering from erectile dysfunction. The men in this study had no neurological conditions that could affect their erectile function. In this study, the participants were given 20 sessions of physical therapy which included muscle strengthening and electrical stimulation of the muscles of the pelvic floor. At the end of the study, Lavoisier and colleagues found that physical therapy was effective in strengthening the muscles of the pelvic floor, specifically the ischiocavernosus, which is a major component of being able to achieve erections. In another study by Dorey and colleagues in 2005, men were given either pelvic floor physical therapy exercises or lifestyle changes to treat their erectile dysfunction. The men in the study who were given pelvic floor physical therapy did significantly better than men who performed lifestyle changes alone.

Bowel Issues

In all genders, pelvic floor dysfunction can affect your ability to have and expel a bowel movement. Dysfunction of the pelvic floor can result in both constipation and bowel incontinence in addition to abdominal discomfort and bloating. Skilled PT can work with you to help you improve the health of your pelvic floor, visceral mobility, and lifestyle habits and reduce your symptoms.

One usually thinks that weak pelvic floors cause bowel issues, which is true in some cases, but oftentimes, pelvic floors that are too tight can lack the strength to hold in a bowel movement, or the ability to feel that stool is building in the rectum. We often see a phenomenon called paradoxical contraction. When paradoxical contraction occurs, the pelvic floor will squeeze instead of open. It is easy to see how paradoxical contraction could very easily worsen constipation.

 

Final Thoughts

Hopefully, this article has provided you with a little reassurance that common pelvic ailments of folks with male anatomy can be treated by a skilled pelvic floor physical therapist. Pelvic floor dysfunction is an extremely common occurrence. Skilled physical therapists can work with you to both treat out your symptoms and the cause of your pelvic floor dysfunction. At physical therapy, your pelvic floor physical therapist will construct an individualized program tailored to your specific needs and goals. Pelvic floor dysfunction is by no means a life sentence and through teamwork with your pelvic floor PT, you can begin to feel a lot better!

SOURCES:
1. Ancona C, Haylen B, Oelke M, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction.Neurourol Urodyn . 2019 Feb;38(2):433-477. doi: 10.1002/nau.23897. Epub 2019 Jan 25.

2. Anderson R, Sawyer T, Wise D. Painful myofascial trigger points and pain site in men with chronic prostatitis/ Chronic Pelvic Pain Syndrome. J Urol. 2009;182(6): 2753-8

3. Aguilar M, Bhuket T, Torres S. Prevalence of metabolic syndrome in the United States 2003-2012. 2015;13(9)

4. Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

5. Arackal B, Benegal A. Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian J Psychiatry. 2007; 49(2):109-112

6. Derby C, Mohr B, Goldstein I, et al. Modifiable risk factors and erectile dysfunction: can lifestyle modify risk. Urology. 2000; 56(2): 302-06

7. Dorey G, Speakman MJ, Feneley RC, et al. Pelvic floor exercises for erectile dysfunction. BIJU Int. 2005 Sep;96(4):595-7

8. Giagio S, Salvioli S, Pillastrini P, et al. Sport and pelvic floor dysfunction in male and female athletes: a scooping review. Neurouol Urodyn. 2021 Jan; 40(1):55-64.
doi:10.1002/nau.24564 chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015; 116(4):509-25

9. Gareri P, Castagna A, Francomano D. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endcorinol. 2014 (2014)

10. Grover S, Mattoo S, Pendharkar S, et al. Sexual dysfunction in patients with alcohol and opiod dependence. Indian J Psycho Med. 2014; 36(4): 355-365

11. Kaya E, Sikka S, and Gur S. A comprehensive review of metabolic syndrome affecting erectile dysfunction. J Sex Med. 2015;12:856-875

12. Lavoisier P, Roy P, Dantony E, et al. Pelvic-floor muscle rehabilitation in erectile dysfunction and premature ejaculation. Phys Ther. 2014;94:12: 1731-43

13. Mayo Clinic: Diseases and Conditions: Erectile Dysfunction. Mayo Clinic Staff. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776. Accessed December 5,2015

14. Rees J, Abrahams M, Doble A et al. Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015; 116(4):509-25

15. Rajiah K, Veettil S, Kumar S et al. Psychological impotence:psychological erectile dysfunction and erectile dysfunction causes, diagnostic methods and management options. Scientific Research and Essays Vol. 2012; 7(4): 446-52

Pelvic Floor Disorders and Treatment

— Beyond Basics PT | Pelvic Floor Therapy NYC.

Frequently Asked Questions

What is pelvic floor dysfunction and why does it happen?
Pelvic floor dysfunction is extremely common and occurs when the muscles, tissues, or nerves of the pelvic floor are weakened, tightened, or injured by trauma, chronic strain, or overuse. Pelvic floor disorders can result from traumatic injury such as a fall, from sporting activity, surgery, or childbirth. They can also happen from more chronic issues, such as infection or chronic inflammation such as endometriosis. Pelvic floor disorders can be a consequence of poor alignment or posture, overuse, or improper movement. The pelvic floor muscles surround the urethra, rectum, vagina and prostate; therefore, if there is a dysfunction in these muscles it can result in urinary, bowel, or sexual dysfunction in people of all ages.
Who should I see to get a proper diagnosis?
Many healthcare providers don’t assess – or don’t know how to assess – the pelvic floor muscles and nerves, so it’s important to get a proper diagnosis from a practitioner who specializes in pelvic floor dysfunction and pelvic pain. Too often patients tell us that they’ve been to 10 different doctors and healthcare providers and their symptoms have not improved, or have worsened. Find a specialist right away and get on the path to healing as quickly as possible.
Why do healthcare providers miss (or misdiagnose) pelvic floor dysfunction?
Long story short, the medical practice is divided into areas of the body: Urology. Orthopedics. Gynecology. But the body itself doesn’t have walls; every system interacts with everything else. Sometimes providers are so laser-focused on what they treat that they miss the whole picture.

As more and more research emphasizes the importance of physical therapy as part of a complete treatment regimen, more and more physicians are learning how to recognize and treat pelvic floor disorder. In the meantime, if you’re not getting relief from your current treatment, make an appointment with a pelvic floor specialist to learn more.

How does pelvic floor dysfunction affect sex?
Pelvic floor muscles have a huge impact on sex. Muscles that are shortened or tight and are unable to elongate will not allow for good blood flow into the genitals. This can result in pain, weaker erections, diminished sensation, inability to orgasm, and even decreased lubrication. Pelvic floor PT can help with these issues by enhancing blood flow and improving muscle function.
How can pelvic floor dysfunction cause bloating?
Pelvic floor dysfunction, a condition characterized by the inability to correctly relax and coordinate pelvic floor muscles, can significantly contribute to bloating due to its impact on gastrointestinal functions. When these muscles are not functioning properly, it can impact the ease of emptying and make it difficult for your body to pass stool and gas through the intestines. This obstruction leads to an accumulation of waste and gas in the gastrointestinal tract, causing bloating and abdominal discomfort.
Is it true there’s internal massage?
There can be. We do perform internal soft tissue mobilization of the pelvic muscles that are inside your pelvis and are accessible only through the vagina or rectum. We never do internal treatment without your consent and understanding.
What makes someone a pelvic floor PT vs a regular PT?
All pelvic PTs get additional training in pelvic floor internal treatment through continuing education and at our clinic.

We pride ourselves on the level of training we provide, not just at the beginning but throughout the time our therapists spend at Beyond Basics. We know that learning is a life-long process. We also provide additional training in physiology of the GI system and urinary system as well as sexual health and function and nutritional training. Most PT programs and schools do not provide the depth and breadth of knowledge that we provide all our PTs at Beyond Basics.

What are the first steps I should take if I suspect I have endometriosis?
If you suspect you have endometriosis, it’s important to schedule an appointment with a healthcare provider who specializes in endometriosis. They can help you determine the next steps, which often includes imaging tests, symptom management strategies, and a referral to a pelvic floor physical therapist.
How can pelvic floor physical therapy help with endometriosis symptoms?
Pelvic floor physical therapy can significantly alleviate symptoms of endometriosis by targeting the musculoskeletal system, which can help reduce abdominal-pelvic pain, bladder and bowel urgency, frequency, retention, incomplete emptying, and sexual pain. By addressing these areas, pelvic floor therapy can improve the quality of life for those affected by endometriosis.
How often should I attend pelvic floor physical therapy sessions?
The frequency of pelvic floor physical therapy sessions varies based on the severity of your symptoms and your individual treatment plan. Typically, patients might start with weekly sessions and gradually reduce frequency as they progress.
What can I expect during a pelvic floor physical therapy session?
During a pelvic floor physical therapy session, you can expect a thorough assessment of your pelvic floor muscles, a discussion of your symptoms, and personalized exercises to help relieve pain and improve function. Your physical therapist might also use techniques such as manual therapy, biofeedback, and relaxation exercises.
Are there any at-home exercises I can do to complement my pelvic floor physical therapy?
Yes, your physical therapist will likely recommend specific at-home exercises tailored to your needs. These might include stretches, relaxation techniques, and strengthening exercises to support your pelvic floor health.
How long does it take to see improvements from pelvic floor physical therapy?
The timeline for seeing improvements varies among individuals. Some patients might notice relief after a few sessions, while others may take several months to experience significant changes. Consistency with physical therapy and at-home exercises is key to achieving the best results.
How do I know if my pelvic floor muscles are contributing to my endometriosis pain?
A pelvic floor physical therapist can assess your pelvic floor muscles to determine if they are contributing to your pain. Symptoms such as pelvic pain, painful intercourse, urinary issues, and bowel dysfunction can indicate pelvic floor muscle involvement.
Can pelvic floor physical therapy replace surgery for endometriosis?
While pelvic floor physical therapy is highly beneficial for managing symptoms, it does not replace the need for surgical intervention in cases where excision surgery is required to remove endometrial tissue. However, in many cases, physical therapy can significantly reduce symptoms so that individuals might no longer need surgery.
Is pelvic floor physical therapy covered by insurance?
At Beyond Basics, we are out of network with most insurance providers. This allows us to offer better care, including full-hour, one-on-one sessions without passing you off to aides. We create a treatment plan based on your specific needs rather than the limitations set by insurance plans, and we focus on functional goals that truly improve your life.

We accept out-of-network plans from Cigna, United Healthcare, Aetna, and Oxford. Our internal billing staff will work with you to submit claims on your behalf and walk you through your options. You can also make convenient monthly payments with various finance options through Care Credit, offering special interest-free financing of 6, 12, or 18 months, as well as discounted package rates.

If you have any questions about insurance coverage or financing, call our billing office at 212.354.2622, text us at 212.354.2622, or email [email protected].

Should I get an assessment before doing Kegels?
Yes, it is important to get a proper assessment from a pelvic floor physical therapist before starting Kegels, especially if you’re experiencing symptoms such as pelvic pain, urinary issues, or discomfort. Not everyone benefits from Kegels, and doing them incorrectly or unnecessarily can lead to further issues. A personalized assessment will help determine the appropriate exercises based on your specific condition.
Why might Kegels not be beneficial for everyone?
Kegels are often recommended to strengthen the pelvic floor muscles. However, they’re not a one-size-fits-all solution and might not be suitable or beneficial for everyone. Some people have overactive or hypertonic pelvic floor muscles, and Kegels can exacerbate their symptoms. A personalized assessment is crucial to determine the right treatment approach.
What are some signs that Kegels might not be the right exercise for me?
If you experience more pain, discomfort, or pressure in your pelvic region after doing Kegels, it’s a red flag. It’s important to consult with a pelvic floor physical therapist to find the right exercises for your condition.
What alternatives to Kegels might be recommended by a pelvic floor physical therapist?
A pelvic floor physical therapist might recommend several alternatives to Kegels depending on the individual’s specific condition and needs. Alternatives to Kegels might include relaxation techniques, breathing exercises, postural correction, and manual therapy.
How can a pelvic floor physical therapist help me?
Our pelvic floor physical therapists can provide a thorough assessment of your pelvic floor muscles and tailor a treatment plan specific to your needs. They use various techniques to address pain, and dysfunction, helping you achieve better pelvic health and overall well-being.

Get help now from a pelvic floor therapist.