By Melinda Fontaine, DPT, PHRC Walnut Creek
Did You Know….
- Pelvic floor exercises are equally effective as sildenafil (Viagra) in treating erectile dysfunction.
- Pelvic floor physical therapy can help incontinence, erectile dysfunction, post void dribbling, overactive bladder, premature ejaculation, and pelvic floor tension myalgia.
- Erectile dysfunction is associated with twice as much absenteeism, decreases in work productivity, and decreases in health related quality of life compared to people without erectile dysfunction.
- Young men visit their general practitioner (GP) less frequently than young women and tend to utilize primary healthcare services reluctantly.
- The prevalence of urinary incontinence after radical prostatectomy is widely reported, ranging from 2% to 60%.
Pelvic Floor Dysfunction and Men’s Health
- Symptoms patient experience:
- Erectile dysfunction, premature ejaculation, hard flaccid syndrome, painful erection or ejaculation, post-surgical problems, post-prostatectomy incontinence, urinary urgency, frequency of urination, incontinence of urine/feces/gas, constipation, penile or scrotal pain.
- Associated diagnoses:
- Interstitial Cystitis/Painful Bladder Syndrome, enlarged prostate, prostate cancer, overactive bladder, Irritable bowel syndrome, diabetes, cardiovascular disease, Peyronie’s disease, prostatitis, urinary tract infections.
- Examples of mechanisms for symptoms development, evidence-based if possible and scenarios:
- ED is an independent risk factor for cardiovascular disease (CVD).3
- Diabetes can lead to erectile dysfunction or urinary urgency and frequency.
- If your workouts overuse certain muscles and cause trigger points or knots to form in the muscle, that can refer pain to the genital area. See Robert’s case in the blog post: Scrotal Recall: A Case of Male Pelvic Pain. The same referred pain can occur if you develop trigger points for other reasons, say if a chronic cough makes your abdominal muscles work harder.
- Prostatectomy is a surgical treatment for prostate cancer, and recovery from the procedure may include treating urinary incontinence and erectile dysfunction, such as Ted in The Case of Post-prostatectomy Urinary Incontinence.
- Pelvic floor muscle weakness or tightness can affect the quality of an erection and the comfort level during sexual activity.
- Diagnostic Challenges
- People do not always know that it’s ok to bring up sexual health issues, what is within the range of normal regarding sexual function, or who to talk to about it. Once issues are identified, pelvic floor physical therapists can help create a treatment plan for many sexual complaints. It may surprise you to find out that pelvic floor dysfunction can create the variety of symptoms listed above. Pelvic floor disorders may exactly mimic medical conditions, such as urinary tract infections or prostate hypertrophy. If you have ruled out or already been treated for an infection or prostate dysfunction and still have symptoms, you should have a pelvic floor evaluation.
What is PFPT for Men’s Health and how can it help Pelvic Floor Dysfunction
Pelvic floor physical therapists are in a unique position to be able to discuss sexual concerns and bowel and bladder issues in detail. I can spend the majority of my day talking honestly about urination, bowel movements, and sex in order to make a difference in men’s symptoms. I can identify what contributes to your symptoms and create an individualized treatment plan to return you to normal function. For example, if you have pelvic pain and frequent urination, you may need a combination of manual therapy and home exercises to reduce stress and tension on the pelvic floor muscles and surrounding structures. You may also need a referral to a urologist to rule out or treat certain diagnoses. If you are facing erectile dysfunction or are leaking urine, feces, or gas, you may need to retrain your pelvic floor muscles to help you control your bladder and bowels until you reach a bathroom. If you struggle with constipation, you may need to retrain your pelvic floor muscles while making sustainable lifestyle modifications. Each person that has each session of pelvic floor physical therapy will likely include some reevaluation of your symptoms and your physical state, manual treatment, education on what to do at home, and recommendations on what other treatments may be complimentary.
Success Stories
Choosing the Right Tool for the Job: Scott’s Recovery from Pelvic Floor Dysfunction
Scrotal Recall: A Case of Male Pelvic Pain
The Case of Post-prostatectomy Urinary Incontinence
Why Does the Area Between My Balls and My Butt Hurt? Tyler’s Male Pelvic Pain Success Story
Additional Resources
- PHRC YouTube Videos
- PHRC Blogs
- Podcasts
Surgical Rehab & Prehab [Quick Recovery]
Male Pelvic Pain Physical Therapy
Shedding Light on Male Pelvic Pain and Sexual Dysfunction
Great Sex and Orgasms After Prostate Cancer
Pelvic floor physical therapy helps men after prostatectomy
Bladder Dysfunction – Pelvic Health & Rehabilitation Center
Sexual Dysfunction [Specialist & Treatment]
Pelvic Pain Syndrome/Male Pelvic Pain/’Prostatitis’ Resource List
Pelvic Pain Explained Webinar Part 4: Male Pelvic Pain by Elizabeth Akincilar
An Explanation of Hard Flaccid | Pelvic Health and Rehabilitation Center
Erectile Dysfunction and Your Pelvic Floor | Pelvic Health & Rehabilitation Center
Resources
- Dorey G, Speakman MJ, et al. Pelvic floor exercises for erectile dysfunction. BJU International. 2005; 96: 595-597. doi:10.1111/j.1464-410X.2005.05690.x
- Pelvic Floor Muscle Training in Males: Practical Applications. Siegel AL. Urology 84: 1e7, 2014.
- The association of erectile dysfunction with productivity and absenteeism in eight countries globally. Goldstein I, Goren A, et al. Int J Clin Pract. 2019;00:e13384
- Jeffries M, Grogan S. ‘Oh, I’m just, you know, a little bit weak because I’m going to the doctor’s’: young men’s talk of self-referral to primary healthcare services. Psychol Health. 2012;27(8):898-915. doi: 10.1080/08870446.2011.631542. Epub 2011 Dec 12. PMID: 22149462.
- Conservative management for postprostatectomy urinary incontinence. Campbell SE, Glazener CMA, et al. The Cochrane Library; 2012.
______________________________________________________________________________________________________________________________________
Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
Do you enjoy or blog and want more content from PHRC? Please head over to social media!
Like us on Facebook,
Subscribe to our YouTube Channel,
and follow us on Twitter, Instagram, Tik Tok and Pinterest!
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.