In case you missed it, males have pelvic floors too. In our June blog, I talked about male pelvic floor dysfunction that benefits from pelvic floor strengthening. Link is here: http://hudsonvalleypt.com/2019/06/24/men-have-pelvic-floors-too-part-1/

 

Many times, strengthening is not the answer, and can actually make problems worse. Pelvic floor “down training” or relaxation may be necessary.

 

While physical therapy referrals and overall awareness seem to be on the rise for female pelvic pain, we see a trend toward longer referral times to pelvic floor physical therapy for men. Whether it’s embarrassment about problems “down there”  or incorrect diagnosis, men can suffer for years. 

 

Why might a man need pelvic floor physical therapy? (Part II)

 

Prostatitis/ Chronic Pelvic Pain Syndrome

At HVPT, we see men with a diagnosis of prostatitis. Prostatitis, meaning inflammation of the prostate, is a bit of a misnomer because so much more than the prostate is at play. The terminology chronic pelvic pain syndrome (CPPS) has slowly started to replace “prostatitis”. 

 

There are four main classifications for prostatitis.

Is the prostate really to blame for “prostatitis”?

 

  1. Acute bacterial prostatitis: Bacterial infection causes inflammation of the prostate gland. This type of prostatitis along with type II affects less than 10% of men with a prostatitis diagnosis (Nickel, 2011). Type I comes on suddenly and responds well to antibiotic treatment. Physical therapy treatment usually is not indicated.
  2. Chronic bacterial prostatitis: Type II originates from bacterial infection. Unlike type I, onset is gradual and can last years.
  3. Chronic prostatitis/ CPPS: Individuals living with type III experience “prostatitis” like symptoms but in the absence of infection. The recommended course of treatment for type III includes pelvic floor physical therapy (Nickel, 2011). 
  4. Asymptomatic inflammatory prostatitis: As its name implies, type IV does not cause any genitourinary symptoms despite inflammation of the prostate.

 

Individuals with CPPS can benefit from pelvic floor physical therapy. The musculoskeletal system (MSK) and nervous system are the culprits behind the pain, sexual dysfunction, and urinary dysfunction these men suffer from. 

 

Symptoms of CPPS include: 

 

Pain

  • Perineal pain (area between scrotum and anus)
  • Penile
  • Low back pain
  • Groin pain
  • Scrotum 
  • Lower abdominal pain
  • Rectal pain

 

Sexual:

pain or burning during or after ejaculation

 

Urinary

  • Urinary frequency/ urgency
  • Urinary retention/ feeling of incomplete emptying
  • Pain or burning during urination
  • Difficulty starting or maintaining a urine stream
  • Weak urine stream

 

Levator Ani Syndrome

 

The levator ani are one of the muscle groups that make up the deepest layer of the pelvic floor. These muscles originate on the pubic bone in the front and travel all the way back to the tailbone. In levator ani syndrome, levator ani muscles go into spasm causing sometimes severe unpredictable bouts of pelvic pain.

The levator ani are the muscles surrounded by the blue line. There are three muscles that make up the levator ani: pubococcygeus, illiococcygeus, and puborectalis.

 

Constipation 

Pushing and straining to complete a bowel movement is not normal. A healthy pelvic floor should relax to facilitate easier bowel movements. When some individuals bear down, they actually tighten their pelvic floor muscles. This is called dyssynergic defecation. Pelvic floor physical therapy can help improve coordination of the pelvic floor muscles and abdominal muscles. A physical therapist can also work with a patient on sitting position on the toilet, creating a healthy bowel routine in the morning, and basic education about diet. 

 

Sciatica

 

The piriformis gets into a whole lot of trouble when we talk about sciatica. But the piriformis has a very close relative: another external rotator called the obturator internus. The obturator internus could be to blame for unrelenting sciatic nerve pain. The obturator is best assessed internally. At HVPT, all of our pelvic floor physical therapists are trained to evaluate and treat this very important muscle internally.

Yes, this is a female pelvic floor but you can clearly see the obturator internus, the close relative of the piriformis.
permission to use copyright image from Pelvic Guru, LLC

 

Typical treatment for the conditions listed above involves improving mobility and relaxation of the pelvic floor muscles. Strengthening of surrounding muscles may be needed to correct muscle imbalances as well. Comprehensive treatment includes (but not limited to):

Internal/external myofascial and soft tissue techniques

Postural retraining

Scar mobilization if applicable

Breath work 

Lifting mechanics 

Lower extremity range of motion

Thoracic/lumbar mobilization

Gentle nerve mobilization

Pain management

Use of biofeedback for relaxation training

 

For more information on our services for males call 914 831 9575 and visit http://hudsonvalleypt.com/.

 

-Megan Fosko PT, DPT

 

Nickel J. C. (2011). Prostatitis. Canadian Urological Association journal = Journal de l’Association des 

urologues du Canada, 5(5), 306–315. doi:10.5489/cuaj.11211