Why men’s pelvic health matters

Men’s physiotherapy deals with male pelvic pain and organ dysfunction. The physiotherapy combines a unique skill set to assess and diagnose problems affecting the pelvis.

Who gets pelvic floor problems?

Problems affecting the pelvis or pelvic floor muscles could potentially happen at any age. As we age the likelihood of the pelvic problems increases.

However, erectile dysfunction occurs in around 50 per cent of men with reported problems in the second decade with an incidence of around 13 per cent. Over the age of 40 there is a reported incidence of a third of men suffering urinary dysfunction.

Pelvic pain or dysfunction is not only associated with older and less active men but it is also something that may strike even the most athletic of persons. Athletes may develop symptoms related to their pelvic floor as a result of their activity. Hip and groin problems are prolific in the amateur and elite football domain and poorly managed can lead to dysfunction in the pelvic region.

The pelvis anatomy

Do men have a pelvic floor? They have a very stable and strong pelvic floor. The pelvic floor is formed by layer of muscle and connective tissue formed and stretched like a cord from the tailbone at the back, to the pubic bone in front.

We need to move pelvic floor, stay upright, for effective and balanced agility, to maintain an erection, urinate and for bowel function. Therefore, a strong pelvic floor optimises some of the most basic of life functions.

The pelvic floor can weaken, become uncoordinated and even develop pain syndromes. Simple and normal daily tasks may become impossible.

Our pelvic assessment uses a subjective comprehensive examination where we will encourage dialogue from the patient to discuss their problem in as much detail as possible. The history of any condition as told by the patient reveals much more than any test or examination.

Therefore, this phase may take a little time to ensure we get all the important information down. Some questions may be of a sensitive nature. Examination includes the lumbar spine, pelvis, hips and pelvic muscles. Most of the examination will be external but may include direct palpation of the perineum or instruction to the patient to palpate their own perineum — saddle region between the anus and scrotum. We may also palpate on the inside of the pelvis.

This is by no means an absolute necessity but remains the gold standard for assessment of the pelvic floor. Dynamic ultrasound may also be used to achieve this.

Internal examination, while useful, is not tolerated by all patients and is never forced upon one.

Once we have completed both phases of the examination we will then formulate an action plan with the patient and begin treatment.

Treatment

What does men’s health physiotherapy treatment involve?

The following are examples of treatments and interventions used by our men’s health physiotherapist to manage symptoms of pelvic floor dysfunction:

• Pelvic floor muscle training (strengthening): This ensures correct pelvic floor exercise technique which involves addressing posture and breathing technique.

• Pelvic floor muscle release: This ensures full relaxation of tight pelvic floor muscles which can contribute to pelvic pain and pelvic floor dysfunction. This also addresses posture and breathing technique.

• Bladder retraining: This involves scheduled voiding techniques for the management of bladder control issues.

• Manual therapy/trigger point release: This helps to reduce tightness and optimise function of pelvic floor/hip/groin and back muscles.

• Postural correction: Posture is extremely important in addressing pelvic floor dysfunction.

• Core stability training: This involves specific training and re-education of pelvic floor and core co-ordination to provide optimal pelvic stability.