Men’s Health Assessment and treatment: What to expect
Men’s Health physiotherapy is a special branch of physiotherapy that deals with male pelvic pain and pelvic organ dysfunction. We are trained both in musculoskeletal physiotherapy and Men’s health physiotherapy combining a unique skill set to comprehensively assess and diagnose problems affecting the pelvis.
Men’s Health is an under talked about subject and no surprise since it relates to:
- Prostate cancer
- Prostatitis
- Chronic pelvic pain syndrome
- Hard Flaccid syndrome
- The male pelvic floor (yes gentleman, we have one!)
- Erectile dysfunction
- Pain in Perinium (between the testicles and rectum)
- Pain after sex
- Premature ejaculation
- Urinary and/or faecal incontinence
Who gets pelvic floor problems?
Problems affecting the pelvis or pelvic floor muscles could potentially happen at any age.However as we age the likelihood of pelvic problems increases. However, erectile dysfunction occurs in around 50% of men with reported problems in the 2nd decade with an incidence of around 13%. Over the age of 40 there is a reported incidence of 1/3rd of men suffering urinary dysfunction.
Pelvic pain or dysfunction is not only associated with older and less active men it is 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. However 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
Men Have a Pelvic Floor?
They have a very stable and strong pelvic floor! The pelvis is made up of three bones: The iliac bones and sacrum. The pelvic ring is fixed anteriorly (infront) via the symphysis pubis and also there is a large number of muscles within, passing through and attaching to the pelvis. 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. This isto maintain an erection, urinate and for bowel function. Therefore, a strong pelvic floor optimizes some of the most basic of life functions.
The Male pelvic floor should be considered as a muscle set, therefore similar to other areas of the body where muscles can behave differently, become dysfunctional, weaken, become sensitive and thus not optimally perform the task for which they were intended. The pelvic floor can weaken, become uncoordinated and even develop pain syndromes. Simple and normal daily tasks may become impossible.
Causes Of Pelvic Floor Problem In Men
What can cause pelvic floor problems in men?
- Surgery for bladder or bowel problems;
- Increased prostate size
- Pelvic pain (chronic)
- Recurrent pelvic infections
- Constipation
- Being overweight
- Heavy lifting
- Not being fit in general
Our pelvic assessment program 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 (in many cases) 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. We will always explain why we need to ask such questions and will use our knowledge of pelvic anatomy and skeletal models/diagrams to help with our explanation.
Examination will include 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. Gaining access requires palpation through the anus.
This is by no means an absolute necessity but remains the gold standard for assessment of the pelvic floor. Total understanding and a complete explanation, and only after consent in a written format are any form of internal examinations conducted. Dynamic ultrasound may also be used to achieve this. Internal examination, while useful, is not tolerated by all patients and is never forced upon a patient.
Once we have completed both phases of the examination we will then formulate an action plan with the patient and begin treatment.
The examination and treatment will last at least an hour. In some cases 1hr 30 minutes is necessary.
Treatment
What does men’s health physiotherapy treatment involve?
All management programmes are tailored to individual needs. 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 optimize 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.
- Relaxation Techniques: This includes specific breathing and mobility exercises to address overall muscle tension.
- Strengthening / Stabilizing Exercises: These exercises address specific imbalances around the hip and pelvic which can contribute to pelvic floor dysfunction.
