Welcome to November…or should I say, “Movember”. Pay attention as the month goes on and you will notice some pretty impressive facial hair everywhere you look for “no shave November.” Between these two awareness initiatives, the month of November raises awareness for men’s health issues including prostate cancer, testicular cancer, and suicide prevention just to name a few.
It’s only appropriate that in this month of “Movember”, we provide a little education for all the males out there.
The male genitalia may be a bit more “out in the open” than the female vulva but that does not mean that men know all that much about their privates.
So let’s start with what’s visible.
The penis
Two types of connective tissue called the corpus spongiosum and corpus cavernosa make up the tissue. As its name implies, the corpus spongiosum is soft and “spongy” and surrounds the urethra. The corpus cavernosa fills with most of the blood during an erection. The tip of the penis, glans penis, is the most sensitive part.
There are two different types of tissue making up the inside of the penis. Permission to use copyright image from Pelvic Guru, LLC
To learn more about the erection process, I highly recommend taking a look at this blog post by Dr. Susie G on how an erection happens https://drsusieg.com/blog/come-too-soon-premature-ejaculation-part-1
The penis is a more than just passive tissue surrounding the urethra and reacting arousal. There are muscles “down there” too!
The muscles of the pelvic floor travel up to ⅔ of the penile shaft. The first layer of pelvic floor muscles assist in maintaining an erection, getting a better erection with optimal blood flow, assisting in ejaculation, and emptying the urethra with urination.
Are your muscles working properly?
The muscles of the pelvic floor need to be able to activate and relax. Relaxing is just as important as contracting the muscles. Are you walking around gripping your glutes or belly all day? If you are, there’s a good chance that relaxing down there may be a little tricky.
The muscles of the pelvic floor extend up the penile shaft.
Permission to use copyright image from Pelvic Guru, LLC
Why does this matter?
Most people don’t think much about their pelvic floors and genitals until something goes wrong.
Premature ejaculation is more complex than just being a bit too excited in the moment, and improving awareness and control of the muscles involved during the ejaculatory process may help.
Approximately 30 million men of all ages are affected by erectile dysfunction (ED). ED is the inability to obtain and maintain a satisfactory erection. You define what a satisfactory erection means to you. Onset of cardiac disease, diabetes, and other medical conditions may cause erectile dysfunction. Blood flow, hormones, psychological, and the pelvic floor muscles influence erectile function. It is necessary to seek help from a medical provider who can rule out serious disease when looking for treatment for ED.
But for the muscular component, improving pelvic floor muscle strength can help with erectile dysfunction. In a randomized control trial of 55 men with erectile dysfunction, 40% of men who performed pelvic floor strengthening exercise regained normal erectile function and 34.5% of participants improved their erectile function (Dorey et. al, 2004).
Kegels aren’t just for the ladies.
Try this at home.
Lay on your back and place on hand on the muscle under the base of penis and above the scrotum.
Take a gentle breath in. Exhale and squeeze the muscles you would use to stop your urine stream and hold back gas.
Take a breath in and let these muscles go.
Do you feel the muscles contract under your hand? Can you feel the scrotum lift and the anus close? Do you relax completely on the inhale?
You can try the same exercise standing naked in front of a mirror and watch what happens. This may be harder in the standing position.
Congratulations you have just performed a kegel or pelvic floor muscle contraction.
Just to note: the glutes, inner thighs, and abdomen live pretty close to the pelvic floor muscles and like to help out. These muscles should not be tightening or moving when you perform a kegel.
Are you unsure of what you’re feeling? Or do the muscles feel weak? Does is feel weird to relax on the inhale? You could benefit from an expert taking a look. As pelvic floor physical therapists, we are experts at improving strength, endurance, and coordination of the pelvic floor muscles.
The scrotum
The scrotum contains the testicles, part of the spermatic cord, and epididymis.
The testicles serve as the primary reproductive organs in the male. Sperm and hormones are made in the testicles and stored in the epididymis. The spermatic cord forms the highway that contains the nerves and structures that sperm will travel through to their final destination. It is normal for one testicle to be larger or higher/lower than the other.
Now what does the scrotum have to do with pelvic PT?
Male chronic pelvic pain syndrome affects nearly one third of men at some point in their life, meaning it’s likely that you or someone you know has likely suffered from CPPS.
Males experience pelvic pain too…. far more often than you think.
PC: People photo created by freepik – www.freepik.com
CPPS (chronic pelvic pain syndrome) is also caused chronic prostatitis (CP) which may be confusing. In 10% of these cases, bacterial infection causes inflammation of the prostate and pain. A whole 90% of these cases fall under the category of non-inflammatory CPPS and bacterial infection is not involved.
Unfortunately, we don’t know why male pelvic pain happens. Theories on GI system involvement, immune system, trauma, pelvic floor dysfunction, surgical side effects, and direct trauma may be at play. But, your PT can help a lot.
Many men with CPPS experience scrotal and testicular pain. The pain may be referred from surrounding muscles including the pelvic floor, hip flexors, and spine. In addition, posture, lack of movement, and especially breathing influences pain.
Pelvic PT can work with you to identify muscular sources of pain and give you the confidence to safely move in pain free ways again.
The prostate
The prostate gland sits on the urethra. It has three functions
- Produces part of the semen
- Assists in ejaculation
- Prevents retrograde ejaculation and urination
The prostate gland wraps around the urethra. Prostate cancer tends to grow from the outside – in.
In the United States alone, 1 in 9 men will be diagnosed with prostate cancer in their lifetime. Treatment options include radiation, chemotherapy, hormone therapy, and surgery. Many surgeons in the NYC tri-state area perform the robotic radical prostatectomy.
What happens from an anatomy/ PT perspective during a radical prostatectomy?
The prostate is removed. The internal urethral sphincter wraps right around the urethra below the bladder and helps keep the urethra closed to maintain continence. Prostatectomy usually affects this important sphincter. Surgeons reconstruct and repair the urethra following removal of the prostate. Ligaments are altered as well. The urethra also relies on pressure to remain closed. The changes/removal of ligaments, the prostate, and the sphincter affect urethral pressure. Pressure is very important.
What happens after surgery?
After a robotic radical prostatectomy (prostate gland removed), men can expect to rely on a catheter to empty the bladder. Leakage is very common post-op and ranges from continuous leakage to leakage only with movement. Adult diapers or continence pads may be necessary.
Unfortunately, catheter removal around day 7 doesn’t necessarily mean that everything is back to normal. In a study of 603 men who had undergone radical prostatectomy, 52% of participants reported urine leakage more than once a day post op (Sanda et. al, 2008).
The return of continence depends on factors including extent of surgery (was the internal urethral sphincter removed/ damaged?), continence pre-op, healing time around the urethra, and movement strategies.
That’s right; education on different ways to move can help with incontinence. Do you hold your breath when you lift? Are you putting extra pressure on your bladder and urethra as you get up from a chair?
Not sure? As a movement expert, your physical therapist is qualified to see if the way you move is making leakage worse.
In addition, you can improve the strength and coordination of the external urethral sphincter with pelvic floor muscle exercise.
A systematic review of 11 studies suggests that men who performed pelvic floor exercise pre-op regained continence sooner than men in the control group (Chang et. al, 2015). In another study, men who saw a pelvic floor PT pre- surgery took an average of 3.5 months to become continent. In the control group ( no pelvic floor education and training), less than 50% of men achieved continence by 6 months post-op (Burgio, 2006).
Who wouldn’t want to regain continence sooner?
A prostate cancer diagnosis is challenging enough. Men experience extra stress, anxiety, and embarrassment over incontinence.
Seek out the help of a pelvic floor PT pre-op to maximize your ability to conquer this serious quality of life issue.
Post-op and leaking? That’s okay too. You are not alone. Pelvic floor physical therapy can help you.
At Hudson Valley Physical Therapy, we treat men for all the conditions above and constipation, tailbone pain, difficulty emptying the bladder, urinary urgency, frequency and so much more.
Are you or a loved one experiencing any signs of pelvic floor dysfunction? Now is a great time to seek help. For the month of November, HVPT is offering FREE 15 minute discrete phone consults for men with questions. Discount offered on the first initial evaluation for men who chose to schedule a visit with us. Call 914 831 9575 for more information.
Happy & Healthy “Movember”
Best,
Megan Fosko PT, DPT
References:
Burgio, K.L., Goode, P.S., et. al (2006). “Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinece: a randomized control trial.” Journal of Urology 175(1): 196-201.
Chang et. al (2015). “Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis.” European Urology, 69(3): 460-467.
Dorey, G. (2002). Conservative Treatment of Male Urinary Incontinence and Erectile Dysfunction. London, England and Philadelphia, PA, Whurr.
Gronski, Susie. (2019). “Treating Male Pelvic Pain: a biopsychosocial approach.” Course Manual.
Herman and Wallace Pelvic Rehabilitation Institute.(2019) “Pelvic Floor Function, Dysfunction, and Treatment (Level 2A)”. Course Manual.
Sanda MG, Dunn RL, Michalski J, et al (2008). “Quality of life and satisfaction with outcome among prostate-cancer survivors”. N Engl J Med. 358:1250–61.