Many men are surprised to learn that they have something called a “pelvic floor”.
The pelvic floor is a hammock of muscles that runs from the pubic bone in the front, across the underside, to the tailbone in the back. It has an important role in bowel, bladder, and sexual function.
Because these are muscles just like other muscles in the body, they can get weak, or tight, or sore.
Problems with the muscles in the pelvic floor can result in various issues:
Of course, these issues can be caused by other things, so it’s important to work with someone that is also looking elsewhere to find the real driver. But it is surprising how often the pelvic floor muscles are a big part of the problem.
When men visit the doctor with symptoms like those listed above, the prostate is often considered a likely suspect. The prostate is a small gland at the outlet of the bladder. It normally increases in size over a man’s life, and when it gets big enough, it can start blocking the flow of urine. It can also develop other problems, like infection, that may require medical treatment.
Pelvic floor physical therapy is often prescribed following such medical treatments. However, most frequently, prostate trouble is ruled out, in which case it’s often the muscles of the pelvic floor that require attention.
A trained pelvic floor physical therapist asks a lot of detailed questions to understand the problems and symptoms. Then the patient is assessed as a whole. Sometimes the problem is actually driven by low back pain, a hip problem, an old groin strain, or some other structure.
Tests are done to understand how the pelvic floor works in conjunction with various postures and activities. A more in-depth pelvic floor exam determines things like how strong the muscles are, whether they can contract and relax, if their activity is coordinated, and if sensation is intact.
Just like other muscles in the body, the treatment for the pelvic floor depends on the actual problems that are found. Frequently, there are combined problems. Treatment often involves a combination of hands-on therapy, patient education, and home exercises.
A short, tight pelvic floor can contribute to many of the problems discussed above, and needs stretching. Exercises that move the tailbone away from the pubic bone help increase the length and reduce the tightness of the muscles. Interestingly, breathing exercises can also be quite helpful with this. Sometimes, the pelvic floor is both tight and weak.
A weak pelvic floor needs strengthening. Most of us have heard of Kegel exercises, and know that they’re often taught to women shortly after childbirth. But they can also be quite helpful in treating men suffering from things like incontinence, urgency, post void dribble, erection difficulties, and even premature ejaculation. A stronger, well-toned pelvic floor helps prevent bowel or bladder leaks, and can improve sexual function.
An irritable, overactive pelvic floor needs to be taught to relax. Pain is often the problem, but urinary urgency and frequency can also be present. Painful knots in muscles are released with hands-on techniques. Breathing and awareness exercises are often very helpful in settling down the muscles, reducing pain, and restoring function.
Sometimes there are habits or activities that trigger or contribute to the symptoms and need adjusting. With pain, sometimes prolonged periods of sitting is a factor.
Often, there’s an element of overuse from overdoing particular physical activities. Some men unconsciously clench these muscles when they are under stress (producing the proverbial “pain in the butt”!).
Certain foods or eating habits can irritate the bladder or bowels, and drive pain or voiding problems. Even our bladder and bowel habits (how long we choose to “hold it”, for example) can cause trouble.
A visit to the physician is a good first step if you begin to experience pelvic pain, or any sudden changes in bowel, bladder, or sexual function. Your physician can assess your general health, and run necessary tests to rule out medical problems, like infection. If no medical cause is found for the symptoms, then a pelvic floor physical therapy approach is likely to be helpful in treating the problem.
Some patients prefer to visit us before seeing their doctor. We welcome you to work with us directly, though we may refer you to a doctor if your situation warrants it.