Beyond the Prostate: Pelvic Physical Therapy for Men
by Dr. Keeli Gailes, PT, DPT, ATC
Everybody has a pelvis! Therefore men, too, can have pelvic health concerns that may need pelvic physical therapy. This is a reality that has been slow to gain visibility. Even within the physical therapy profession many pelvic PT’s still do not offer services to men. It wasn’t until 2019 when the section of the American Physical Therapy Association (APTA) that addresses pelvic health finally became the Academy of Pelvic Health Physical Therapy. Prior to this it has been the Section on Women’s Health (updated in 1995); and prior to that it was founded in 1977 as the Section on Obstetrics and Gynecology.
Ok, but it is just for older men right?
The main reason that men are currently referred to pelvic floor physical therapy by their doctor is for incontinence following a prostatectomy. The next most common reason is for urgency that increases with prostate enlargement. Other concerns such as testicular pain and erectile dysfunction (ED) are often not often being referred when they should be. This is because there continues to be poor understanding of what pelvic health physical therapy can treat (which was not helped by the previous names of our specialty). This means that many, especially younger, men are often not referred to pelvic health physical therapy as often as they should be. Many of their concerns are often overlooked or misdiagnosed and go untreated. Knowing what we do can help you advocate for yourself if/when needed!
But men don’t have babies, why do they need pelvic health physical therapy?
It is true that it is far less common for men to have continence issues than women. This is because they do not undergo the physical changes that women who have children go through with pregnancy and childbirth. There are MANY other reasons that a person can have pelvic floor dysfunction, however. In fact, many women have pelvic floor dysfunction who have never been pregnant.
Some of the same factors that drive dysfunction in women, can also lead to dysfunction in men. A few very common causes include:
- postural changes,
- surgery scars,
- leg-length difference,
- mild scoliosis,
- or muscular imbalance around the pelvis (such that might occur after an accident, surgery, or from repetitive motion at work).
Diet, sleep, and stress are also common triggers for pain, incontinence, and sexual dysfunction!
The nerves that go to your pelvic floor and pelvic organs come from your spine. They are concentrated around the two transitions from your thoracic spine to your lumbar spine and then from the lumbar spine to your sacrum (tail bone). Anything that affects the spine or abdomen could cause changes in the pressure on those nerve roots. It could, therefore, affect the function of the nerves that go to the pelvis.
When the nerves are affected, it will make it harder for your muscles and organs to get all of the information they need to do their job. This can lead to either over-activity or under-activity of the muscles and organs that the nerve innervates.
Men can have pelvic floor dysfunction at ANY AGE and they may or may not have anything to do with your prostate. Some of the types of dysfunction include:
- Pelvic, hip and low back pain
- Incontinence
- Chronic prostatitis
- Erectile dysfunction
- Painful ejaculation
- Urinary Incontinence (Stress Incontinence, Urgency/Frequency)
- Fecal Incontinence
- Urgency (Leakage/Seepage, Constipation)
- Painful Bowel movements
How does pelvic floor physical therapy for men work?
As physical therapists who practice functional, integrative, and lifestyle medicine (FILM), we do a thorough assessment of you as a WHOLE PERSON! This helps us identify what the root cause is of your complaint. It is not often just one thing that leads to dysfunction, but a combination of factors such as stress, sleep, nutrition, and hydration along with the physical components of muscular imbalances or poor coordination.
This means that to address the concern we will also treat you as a WHOLE PERSON not just a pelvis! We will assess and address muscular and postural imbalances within and surrounding the pelvis, abdomen and low back to re-establish balance and proper coordination. We use tools like:
- Rehabilitative Ultrasound Imaging (RUSI) to help you visualize and connect with your pelvic floor muscles so you can improve their ability to work for you.
- Advanced techniques like dry needling to help release spasms that may be putting pressure on the nerves that innervate the pelvic floor.
- Coordination training of the 3 diaphragms (vocal cords, breathing diaphragm, and pelvic floor) to improve help regulate pressures inside the body.
- Manual therapy to improve tissue length and mobility and decrease pain.
- Strengthening and stretching exercises to re-establish balance of muscles so your symptoms do not return.
And yes, we may do manual assessment and release of the pelvic floor muscles as well. When needed, this involves a single gloved digit (finger) that is inserted rectally and used to help identify and treat restriction of fascia and muscles of the pelvic floor to allow them to function better. With this and any type of treatment, you are always a part of the decision making process and we will make every effort to help you feel dignified and safe.
