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

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).

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.

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.

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!