Mens Health – in 5 minutes.
I thought I would find 5 minutes to talk a bit about Mens Health. Over the last year I have had the opportunity to be taught by some of the big wigs in the Mens and Womens Health Physiotherapy world. Last month I had the privilege of being taught by Bill Taylor, Dr Ruth Jones, and Cameron Angus. It was an amazing experience and has really helped be move into the world of Mens Health Physiotherapy world. It was also great to find another 5 lads on the course. Last year I had the pleasure of attending a 1 day introduction to Mens Health with Michelle Lyons (Brilliant!). However, I was deserted by a good pal and was the only fella on the course. Still, an awesome learning experience with some super brilliant physios who were all willing to share their knowledge.
Mens Health: What is it? and, why I am talking about it?………as a sports physiotherapist???? This is a quick blog while the website information is being developed.
Men's Health is an umbrella term that relates to the problems or pains in the pelvis. These can include pain emanating from structures inside the pelvic gridle: CPP (Chronic pelvic pain) or prostatitis, pain from the pudendal nerve (pudendal neuralgia), dysfunction of the male pelvic floor, the function or dysfunction of the male sexual organs and problems associated with systems used for toileting. For most of us, well, probably about half of us over 35, we don’t even think about how this area functions – we just know it does!
The in-depth anatomical function of the pelvis is not always covered on the physio undergraduate program. Crazy really, it is packed full of muscles and connects the trunk with the lower limb. As physios we only really think about the psoas or piriformis muscles yet there are loads of others inside the pelvis, all of which have the potential to cause pain.
Most of us guys don’t even think we have we have a pelvic floor. We definitely have! Try clearing your throat! Do you feel a sensation in the bit between your legs? Well, that is your pelvic floor region. Now try lifting your ‘nuts into your guts’ – just the nuts, don’t suck in the whole abdomen. Imagine walking into the sea. What’s the first thing you suck back in? This Is the pelvic floor contracting. Anatomically the female and the male pelvis, aside from the obvious, share similarities with regard to muscular arrangement. Fortunately, us guys have less holes and thus we are a little more stable. Well, we should be.
Why do we need to talk about Mens Health? Unfortunately, the reality is that 1/3rd of men over the age of 40 suffer from some form of urinary dysfunction. This could be related to the prostate or post-prostate surgery, or may be related to other sources of pain or changes in muscles function. This means that having a pee can become problematic with a range of possible symptoms manifesting in leakage, incontinence, urgency or the inability to pass water. As we age this appears to become more of an issue. Another prominent problem in the pelvic health of a man is Erectile dysfunction (ED). Not something we freely talk about. What about premature ejaculation? pain during or after sex? It happens and is a real concern for some guys. These are all problems that can be assessed and in the vast majority of cases they can be cured. Often with some simple changes to lifestyle and exercise.
Womens Health Physiotherapy is a much more freely talked about subject but still faces taboos from society. As a young physio I would always steer clear from this discussion with a female patient. However, this was limiting in my ability to adequately differentially diagnose a woman’s problem. I am not a Women’s health physiotherapist but I need to be able to identify a problem in both male and female patients, so developing my knowledge in mens health has helped me to better understand how I can offer advice and direction to my female patients. I have treated loads of professional footballers over the years, but when I started 15 years ago i didnt have a clue where the ischiococcygeus muscles was! Knowledge is key!
As a society we have come on leaps and bounds with our comfort in talking about Women’s health problems, but we have yet to even begin talking about Mens Health. In this YouTube (https://www.youtube.com/watch?v=VdL4U39J0ao) Elaine Miller does a hilariously sobering talk about Women’s, and Men’s, Health. She highlights the frieghtening financial implications of not addressing Women’s and Men’s health issues. The UK government (G)estimates it to cost the taxpayer some £200+ million a year. In Australia, with a population a ¼ of that in the UK, the cost is considered to be in the region of £42 Billion. The higher cost in the Australian governments estimation reflects an acknowledgment of the knock on effect relating to co-morbid factors for people having pelvic health issues. They will invariably abstain from activity, social events and even suffer depression. This could lead to weight gain, diabetes and cardiovascular disease. Therefore, in the UK we still lack a comprehensive appreciation of Women’s and Men’s Health. Perhaps globally, therefore this is our opportunity to reach out, educate people and help those who feel alone or who are in pain.
Prostate cancer is a well-known and talked about disease and affects most guys, if we live long enough! The prostate sits around the urethra, under the bladder. It has an important function in the supply of seminal fluid to carry male sperm out of the urethra. However, as we age this increases in size and may become cancerous. An increase in size will essentially squeeze the urethra meaning the bladder could have problems emptying thus increasing the frequency of going for a pee. If you are having trouble then SEE YOUR GP!
In patients who have had their prostate removed nerve damage is a possible consequence. Post-surgical complications can include incontinence, pain and ED. Post-surgical and even pre-surgical (before an operation) pelvic floor exercises can go some way in helping to reduce these problems by ensuring appropriate muscle activation is developed and mastered. Physiotherapy can really help with instruction and retraining of the muscles and is now becoming a more widely recognised care pathway for patients undergoing prostate surgery.
In the context of the whole pelvic floor and not just the prostate, any prolonged contraction of a muscle could cause pain and therefore teaching the pelvic muscles how to relax and contract is vitally important. Just like the shoulder and lower back, the pelvis can be subjected to in-coordinated muscular activation. Again, physiotherapy is highly effective for this.
The information to go on the website is under construction but hopefully this has been a little taster of what Mens Health is all about.
If you are suffering from symptoms of pelvic floor dysfunction, have undergone prostate surgery and still have problems, or you suffer from pelvic pain then it is best to get in touch with your GP to get things checked over. At Core Body Clinic we are now starting to offer a Mens Health service and we are treating men who suffer from pelvic pain, prostatitis, post prostate surgery and other forms of pelvic health dysfunction. We are well placed having worked in professional football and treated a wide range of lower back and other musculoskeletal problems to enable a comprehensive differential diagnoses care pathway allowing us to identify those patients with problems amenable to physiotherapy.
Other useful differential diagnosis to consider include: