“I thought only women need Physical Therapy for the pelvic floor???” This is a question/declaration I hear almost once a week. Sometimes it’s from men, sometimes it’s from women, and occasionally it’s from other health care providers. Men have pelvic floor muscles too. This means that they can suffer from many of the same problems that women experience. Men have incontinence, rectal pain, constipation, ejaculation problems, urinary urgency and frequency issues, and painful intercourse. Many men present with incontinence issues after surgery for prostate removal or treatment for enlarged prostate. In fact, pelvic floor dysfunction in males is much more common than once believed.

Studies show that 95% of cases of chronic prostatitis in men is nonbacterial1, and could indeed have a musculoskeletal origin. Pelvic floor dysfunction and spasm can create symptoms that mimic prostatitis by causing pain and urinary symptoms. Often symptoms are described as pain that is sharp, shooting, stabbing, burning, dull, and/or achy in the area of the genitals, abdomen, back and/or hip region. These symptoms, which are similar to what men describe with type III B prostatitis or non-bacterial prostatitis, are commonly the result of a musculoskeletal disorder2,3. One reference states “a number of patients who were diagnosed with prostatitis were prescribed antibiotics. After months of this pharmaceutical regimen-and no relief-they were referred for physical therapy and found both an end to their pain and a cure”4.

As specialists in the musculoskeletal system, physical therapists treat pelvic floor weakness through strengthening and biofeedback. We also treat hypertonic (increased tone) pelvic floor problems. The increased tone or spasm may result in reduced range of motion and/or pain in the pelvic region. Because these muscles surround the urethra, anorectal area and prostate, a dysfunction in these muscles can disrupt normal urinary, bowel and sexual function. Physical therapy treatment commonly includes manual therapy, nerve glides, skeletal (structural) alignment, postural re-education, ultrasound, electrical stimulation, biofeedback, behavioral training and therapeutic exercise. My average treatment caseload is a 50/50 split between women and men. Often I find that men needlessly suffer for long periods of time before being seen in Physical Therapy. Most, if not all, report that they wish they had come for treatment sooner.

Kristen Digwood, DPT, CLT Elite Pelvic Rehab/Elite Spine and Sports PT

References:

1. Nickel, J.C. et al. Prevalence of prostatitis-like symptoms in a population based study using the national Institutes of Health chronic prostatitis symptom index. J Urol, (2001)165: 842. 2. Schmidt, R., Tanagho, E. Urethral Syndrome or Urinary Tract Infection? Urology (1981) 18: 4: 424-427. 3. Schmidt, R., Vapenk J. Pelvic Floor Behavior and Interstitial Cystitis Seminars in Urology (1991) 9: 2. 154-9 4. Stein, A. Heal Pelvic Pain. McGraw-Hill, (2008). p. 154.