Men have pelvic floors too?

By Melissa Wong, Reg. PT

As pelvic health physiotherapists, we often have the same conversations with friends, family, and even with clients. It typically sounds something like this:

• so do you only treat females or do you treat men too?

• The majority of the people I see are female, but I see men too.

• Really?!? What do men need pelvic floor physiotherapy for? I thought physiotherapy is usually for issues after having babies.

Although a strong risk factor for developing pelvic floor dysfunction is pregnancy and child birth, pelvic floor issues do not affect mothers exclusively. In fact, male pelvic floor health issues, particularly regarding incontinence, were a popular topic of discussion at the International Continence Society held in Montreal in 2015 and continue to be gaining more spotlight in the media.

One area of male pelvic health that continues to be greatly overlooked is the topic of male pelvic pain. Male pelvic pain can be caused by a number of factors including but not limited to: trauma, infection, surgery, stress, muscle tension, low back pain, pudendal neuralgia, urethral strictures, and sexually transmitted infections.

Prostatitis, an infection of the prostate gland, accounts for 8% of visits to urologists and up to 1% of visits to family doctors (1).

There are 5 categories of Prostatitis as defined by the National Institutes of Health. They are:

• Category 1: Acute bacterial prostatitis

• Category 2: Chronic bacterial prostatitis

• Category 3: Chronic non bacterial prostatitis /Chronic Pelvic Pain Syndrome

A: Inflammatory

B: Non-inflammatory

• Category 4: Asymptomatic inflammatory prostatitis

The typical course of treatment for categories 1 and 2 prostatitis are antibiotics (2). Category 3B (non-inflammatory chronic prostatitis, or chronic pelvic pain syndrome), is generally more difficult for doctors to diagnose, and can cause more frustration for patients. The key to this type of prostatitis is that the pain is attributed to the prostate with no evidence of infection. Diagnosis is often based on exclusion of other urological conditions (2).

Symptoms of chronic prostatitis include urinary hesitancy, pain with with urination and/ or sitting, night time urination, frequency and urgency, decreased stream, feeling of poor emptying, and pain in any of the following regions: rectum, perineum, penis, tailbone, groin, during and after ejaculation, low back pain.  Symptoms may also include perineal pain, burning, itchiness, muscle tension, pain radiating into testicles, scrotum, perineum, anus, inguinal and bladder area as well as bladder symptoms.

One recent study found that the prevalence of prostatitis symptoms ranged from 2.2 to 9.7 percent of men (3), and another found that it occurred more often in men less than 50 years old (4). A meta-analysis, just published in July 2016 found that the overall prevalence of sexual dysfunction among men with chronic prostatitis was 62%. The prevalence of erectile dysfunction and premature ejaculation was 29% and 40%, respectively (5).

Given that simple tasks that we often take for granted such as sitting, urinating, achieving an erection, and having an orgasm can so greatly affect a person’s overall quality of life, the question of “what can be done for these men?” naturally comes to mind.

General consensus for the treatment of chronic prostatitis, is multimodal therapy with a combination of medications or possible adjunctive therapy with non-pharmacologic modalities, such as physiotherapy (2).

The approach of pelvic health physiotherapy for men is quite similar to how we would approach issues affecting women. Based on a thorough discussion of a client’s concerns and symptoms, a full physical examination would typically be performed. But different than a urologist or a family physician, a pelvic health physiotherapist would focus their assessment on muscles, ligaments, bones, and connective tissue in the abdomen and pelvis.

Based on assessment findings, the treatment program may include aspects of manual therapy, education on pain, relaxation techniques, and helping the client “cue in” to their pelvic floor muscles. A home program would be developed and may include aspects of the treatment program as well as stretching, gentle exercise, and mindful practice. As hopeless as it may seem at times, slow and steady progress can often be made with a full resolution of a client’s symptoms.

So the next time you find yourself having a conversation about pelvic floor physiotherapy with a friend, co-worker or acquaintance, you can now confidently respond with “Yes! Pelvic health physios can effectively treat men with pelvic floor issues too!”

1. Collins MM, et al. (1998). How common is prostatitis? A national survey of physician visits. J Urol. 159(4):1224-8

2. Sharp VJ, Takese EB, and Powell CR. (2010). Prostatitis: Diagnosis and Treatment. Am Fam Physician. 82(4):397:406. http://www.aafp.org/afp/2010/0815/p397.html#afp20100815p397-b10

3. KriegerJN, et al. (2008). Epidemiology of prostatitis. Int J Antimicrob Agents. 31(1):S85-90.

4. Nickel JC, Downey J, Hunter D, Clark J. (2001). Prevalence of prostatitis-like symptoms in a population based study using the national institutes of Health chronic prostatitis symptom index. J Urol. 165(3):842-5

5. Li, HJ and Kang, DY. (2016). Prevalence of sexual dysfunction in men with chronic prostatitits,chronic pelvic pain syndrome: a meta-analysis. World Journal of Urology. 34(7):1009-17