Men’s Health physiotherapy is a specialist branch of physiotherapy that deals with male pelvic pain and pelvic organ dysfunction. At the Reading Men’s Health and Sporting Pelvis clinic based at Core Body Clinic 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
- 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
Therefore, not the subject you might talk about to your friends. In fact, we are so reluctant to talk about men’s health issues that it can take on average 7 years for a man to chat to his GP about these issues.
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 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. Unfortunately, in the UK male pelvic health is poorly provisioned for and therefore leads to unnecessary suffering. With such a large incidence within the population there is a need to address this shortfall.
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 pevic 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 or lead to the development of CPP.
Other conditions frequently seen at the Reading Men’s Health and Sporting Pelvis clinic include: chronic pelvic pain (CPP), prostatitis, erectile dysfunction (non-related prostate) and pudendal neuralgia. However, we are also able to treat patients with ongoing and poorly diagnosed hip and groin problems. Because of the close proximity of the hip, groin, lumbar spine (lower back) and pelvic girdle structures there is often a close association between these regions. Therefore, we have set up a specialist clinic to cater for the male pelvic girdle and the sporting pelvic population.
Quite often patients attend the clinic with a known diagnosis or having had a surgical procedure. However, some patients may attend because of non-specific pelvic pain syndromes for which medical and surgical assessments have been unable to adequately assign a specific diagnosis. Combining our knowledge of pain and pelvic anatomy, coupled with our musculoskeletal and sports knowledge we are well placed to offer patients a solution to their problems. Our unique approach to Men’s health problems allows us to assess unresolved groin pain or pelvic pain syndromes that have not responded to conventional strengthening or manual therapies. The main problem for most patients attending the clinic is pain. However, these conditions may be accompanied by reduced libido, pain during sex or post ejaculation, or urinary dysfunction. On occasions there has been an exhaustive regime of testing and medical intervention with little impact on pain or dysfunction.
The Pelvis Anatomy
Men Have a Pelvic Floor?
We 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 via the symphysis pubis and 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 andstretched like a hammock from the tailbone at the back, to the pubic bone in front.
We need to pelvic floor to move, 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 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.
Imagine holding a weight in the hand and maintaining a bicep curl, what about tightening your fist and clenching it as hard as you can? How long could you hold it for before fatigue sets in? How do they feel after? Sore? Tired? Painful? Imagine the same situation in the pelvis only this time you can’t let go. This is a more simplified picture of pelvic floor and intra pelvic pain syndromes.
What can cause pelvic floor problems in men?
- Surgery for bladder or bowel problems;
- Increased prostate size
- Pelvic pain (chronic)
- Recurrent pelvic infections
- Being overweight
- Heavy lifting
- Coughing that goes on for a long time (such as smoker's cough, bronchitis or asthma)
- Not being fit in general
Men’s Health Assessment and treatment: What to expect?
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. We will use differential questioning to hone in on the possible causes of your problem. 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.
We may also use a questionnaire which helps to identify an objective marker so that we can accurately identify progress.
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 will last at least an hour. In some cases 1hr 30 minutes is necessary.
Muscles can be rehabilitated and retrained and at the Reading Men’s Health Clinic we are specifically trained to identify pelvic floor dysfunction and apply a bespoke regime of motor control exercises to remedy such dysfunction. Specialised manual therapy techniques for the pelvic floor can be incorporated to reduce muscle sensitivity and facilitate appropriate muscle activation.
Treatment (might include):
- Hands on manual therapy treatment to your low back and pelvis, getting the joints moving correctly
- Trigger point therapy: Getting the muscles working properly and rid of the overactive parts in both the low back muscles, hip muscles and pelvic floor muscles. You will also be taught how to do this yourself also.
- Pelvic floor exercises to release your pelvic floor
- Specific hip, spine and pelvis exercises to get you and your pelvic floor moving better, think yoga poses and squatting
- Specialised Breathing and relaxation work
- Re-education of the pelvic floor, hip and abdominal musculature
- General exercise
- Pain management education (essential to understanding WHY the pelvis hurts).
- Advice re sexual and toileting practices
Should you wish to discuss your problems then please call the clinic and ask to speak to Adrian Wagstaff, Male Pelvic and sports physiotherapist.