Reading and Tilehurst's Physiotherapy, Spinal, Sports and Pelvic Specialists

 

Tilehurst Clinic4 Chapel Hill, RG31 5DG
Reading Clinic Sports Park, University of Reading, RG6 6UR

 

0118 9310053

(phone and online services available 24/7)

email: info@corebodyclinic.co.uk

 

 

Men's & Women's Health Physiotherapy

Hard Flaccid

Hard Flaccid Syndrome is a condition affecting the penis and is of unknown aetiology among men.  However, hard flaccid syndrome is believed to be more prevalent between the ages of 18 and 35.  It is characterised by a change in penis size, shape and feel.  Penile stiffness or swelling when the penis is in a flaccid state and flaccid size is a common characteristic.  The penis is sometimes firmer to the touch, it is engorged and rubber in texture, and is often accompanied by a change in size or shape of erection.  There may be a loss in nocturnal erections, and it may require a greater degree of stimulation to achieve an erection.  There is often a loss in libido and a shattering of confidence.  However, the most common reason for someone seeking help when suffering from hard flaccid is because of alarming changes in penile shape and size.  Patients often self-diagnose hard flaccid from reading online forums.  It is different from peyronnie’s disease because there are no visible signs of tissue scarring and plaque formation. Nevertheless, hard flaccid is a distressing and poorly understood condition.  At Core Body clinic, our pelvic physiotherapists are experts in the treatment of Hard Flaccid syndrome. 


Until recently any male pelvic pain syndrome would fall under the umbrella term of Chronic non-bacterial prostatitis often leaving men in the no-man’s land of diagnostic labelling and therefore at a loss as to how their pain and symptoms could be rectified.

Hard Flaccid syndrome has largely been the subject of discussion and debate on male pelvic pain forums with little or no clinical information about the condition.  Therefore, diagnosis is difficult to the untrained eye and often clinicians are often at a loss about treatment.  Seeing a male pelvic physiotherapist who has expertise in male pelvic pain and pelvic dysfunction is the starting point.  It is often useful to be assessed by a urologist prior to booking. 

 

What causes it?

With little by way of clinical research concerning hard flaccid, much of the theories relating to the pathophysiology are based on our observations of the patients who present in clinic.  However, in combination with the knowledge of anatomy and pain mechanisms an understanding has been developed which has enabled us to provide treatment solutions.

Injury to the penis and stress are likely drivers for this condition.  Our own practice at Core Body Clinic has observed many patients who present having engaged in excessive masturbation, exhaustive sex or who have attempted penis enhancement stretching.  Such situations see the penile muscles in sustained contractile states leading to venous compression in the penis.  The blood vessels therefore failing to empty when in a flaccid state with blood remaining in the erectile tissue.  Erectile tissue fatigue occurs, as one would see in many other muscle tissues in the body.  An almost spasm like behaviour where the regulatory control of erectile function is lost, and the erectile tissue fails to disengage fully.  Likewise, in a continued semi stimulated state, the tissue struggles to fully erect because it has lost the normal feedback mechanism.  Autonomic and central nervous systems control erectile function and in states of fatigue the central and parasympathetic nervous system can no longer regulate this function.  Pain is common due to tissue injury and chemical irritation of nerve endings, caused by fatigue chemicals.  This further results in anxiety and distress. We know that psychological drivers transfer into biological processes.  Stress causes the release of cortisol, adrenaline and no-adrenaline resulting in increased blood flow to the pelvic area.  Exposing already traumatised blood vessels to increased blood flow only helps to drive the process and maintain a hard-flaccid state.

Tension in the pelvis is strongly linked to stress and this in turn will help to maintain the poor regulation of blood flow in the pelvic floor.  The origin of the penile muscles from within the pelvis allows for easy influence of the tight pelvic muscles on the penile erectile tissue.  There is often associated tension over the perineal and anus regions.

However, tightness can often be confused with strong muscles and to further confound diagnosis patient often present with voiding complications.  They may dribble after micturition, finish toileting only to feel like their bladder has not fully emptied or experience pain after voiding. While there may be tension in the pelvis, we have found the strength of the pelvic floor to be poor and on testing using our diagnostic ultrasound scanning we find movement of the pelvic floor is often limited.

 

What can we do about it?

At Core Body Clinic we have a lot of success in treating this condition with all our patients achieving a greater than 75% improvement**

Understanding the patient’s drivers and educating our patients about their condition helps with anxiety about the condition.  Information concerning the onset of symptoms is essential in removing any harmful behaviours or practices and emotional drivers.  Often this is a distressing and difficult time for the patient, and in some cases the cause is elusive and requires careful history taking to unpick the possible triggers.

Relaxation plays a significant role in re-establishing normal breathing patterns thereby facilitating appropriate abdominal movement.  Interruption of the normal diaphragmatic excursions during breathing is closely associated with pelvic tension.   Hard flaccid is distressing and leaves the patient in a state of anxiety causing shallow breathing, abdominal bracing and abdominal muscle fatigue.   

Physical therapies such as trigger point release and massage to the perienal area and internally within the pelvic floor helps to provide feedback to patient and clinician about tension in the pelvis.  With careful and skilled practice it is possible to remove this tension to alleviate pain and tissue tension.

Exercises to restore normal pelvic floor control is essential. Quite often online forums encourage the ‘Kegal’ exercise and many men attend the practice having done these only to end up in a worse state.  One would tend to focus on the ‘reverse kegal’.  This differs from the kegal by pushing the pelvic floor down rather than lifting it up. It aims to de-tension the pelvic muscles.  However, we must restore balance in the pelvis to ensure reciprocal operation of the pelvic muscles and therefore using diagnostic ultrasound feedback we teach the patients how to balance the normal rhythm of the pelvic floor muscles.  This is a highly effective technique for such conditions.  

Hard flaccid can also occur with weight lifting with patients believing that they have lifted excessively as the cause for the initial onset of symptoms.  Therefore, there is a reluctance to get back to training and part of therapy is to coach the patient about normal lifting practices and ensure their breathing pattern and pelvic muscle control is appropriate.

 

Hard flaccid is a difficult condition to treat.  Specific men’s health physiotherapy is highly successful in resolving this condition. 

Core Body Clinic is specialist center for the treatment of Hard Flaccid.    

 

 

 

 

 

 

 

 

 

** time frame to achieving outcomes varies considerably.

Male Pelvic Pain & Men's Health Physiotherapy

Male Pelvic pain and Men’s Health physiotherapy is a specialist branch of physiotherapy that deals with male pelvic pain (chronic prostatitis) and pelvic organ dysfunction.  At Core Body Clinic we are trained both in musculoskeletal physiotherapy, chronic pelvic pain therapy and men’s health physiotherapy combining a unique skill set to comprehensively assess and diagnose problems affecting the pelvis.

Incontinence

Our pelvic therapists at Core Body Clinic are experts in treating Incontinence. We understand it and we really care about helping you.   

Prostatitis and Chronic Pelvic Pain Syndrome (CPPS)

Chronic Prostatitis (or prostatitis 3b) or Chronic Pelvic Pain Syndome (CPPS) are often considered synonymous where pain in the pelvis is of a persistent nature.  

In Prostatitis, there is often as an infection affecting the prostate gland.  However, only about 5-10% are actually bacteria related with the vast majority related to inflammation or non-specific pain syndromes. Prostatitis can affect all men at any age and accounts for about ¼ of all pelvic pain conditions, genital or urinary conditions in young to middle aged men.  Where pain persists after a period of time and after medicine has failed to resolve pain, by process of elimination, CPPS or Chronic Prostatitis type 3b is a diagnosis often assigned.   

Diastasis Recti

Diastasis Recti - This is a term describing the separation of the abdominal muscles. The abdominal muscles consist of the rectus abdominus, the deeper transversus abdominus, and then the internal and external oblique muscles.

Erectile Dysfunction and Physiotherapy

Erectile dysfunction is a deeply personal and distressing problem that describes a condition where an erection is either not possible or is not sufficient for the desired task of sexual activity.  It is a condition that can have multiple causes and therefore you must discuss it with the GP. 

 

They will look for all medical reasons for this problem and advise you accordingly, conducting tests where necessary.  We know that smoking, alcohol, a poor diet and lack of exercise can have an impact (for some) on erectile function.  Physiotherapy can be very helpful where the pelvic floor is implicated.  We can also advise on exercise, diet and general wellbeing.   

Women's Health Physiotherapy

What is Women’s Health physiotherapy and how can it help me?

Women's Health Physiotherapy is a specialist branch of physiotherapy where the physiotherapist has undergone specialist training and competencies in pelvic anatomy, pathology, diagnosis and treatment. They are trained to assess and treat women suffering from pelvic floor weakness, problems with bowel and bladder, pain in the pelvis and women who have had a baby or who are pregnant and having problems.  At Core Body Clinic our physiotherapists are dual trained in musculoskeletal physiotherapy and Women's Health Physiotherapy.  They have a detailed understanding of pelvic anatomy and pelvic floor function and they are skilled in many techniques to treat pain and rehabilitate function. 

Prostate Cancer: Physiotherapy and Rehabilitation

Prostate Cancer touches one in eight men and many opt for surgery to the remove the prostate (radical prostatectomy).  Other treatments include hormone therapy, radiotherapy and in some instances chemotherapy.  It largely depends on the stage and grade of cancer.  It is accepted that if we live long enough all men will develop prostate cancer cells (you might have to live to 180!).  However, they are slow growing and often people die of other causes before the cancer is diagnosed.  Radical surgery has a 15 year survival rate of almost 90%.  The effects of having surgery can leave a man suffereing incontinence and erectile dysfunction.  

Sporting Pelvis and Groin Pain

Troubling groin or hip pain, unresolved by medical and surgical intervention, can be helped by evaluating the function of the pelvic girdle.  Our Sports Pelvis service is specifically designed to consider the sporting population with the pelvic girdle in mind.  With a background in elite football, we are all too familiar with niggling groin strains, unnecessary surgical procedures and post-surgical complications or pain that can ruin an athlete’s career. 

Pudendal Neuralgia

 

The pudendal nerve is a major nerve (like the sciatic nerve) arising from the sacral plexus.  It is an important nerve for differential diagnosis in cases of CPP (Chronic pelvic pain). The difference between pain arising from somatic structures (muscle, bladder, bowel etc) are that they are often achey or deep.  Nerve pain is different and will behave in a manner where manifestations of lancinating, sharp, throbbing or stabbing sensations are experienced. This is what we call neuropathic pain.  Pain is often felt along the pathway of the nerve.  However, it is not a common diagnosis and is often over diagnosed.