Men’s Health is physical therapy for uniquely male pelvic conditions, often occurring as a consequence of prostate treatment. That fact pelvic floor muscles exist may be news to many men. Not only are muscles in the pelvic area, but they are critically important to maintain sexual function, urinary continence, and lower back health. To meet these demands they must be trained like other muscles in the body (i.e. glutes, calves, biceps). When pelvic floor muscles are affected by surgery, trauma or repetitive stress, physical therapy may be indicated for one of many pelvic health disorders
Testicular Pain
Pain arising in the testicles could be from a variety of sources. When medical red flags are ruled out (cancer, kidney stones, hernia), a proper physical therapy diagnosis is warranted. This can involve examining the function of both the pelvic floor muscles as well as several muscles around the hips and back that can refer to the pelvis.
Erectile Dysfunction
Studies have shown that training of the pelvic floor muscles can decrease symptoms associated with erectile dysfunction. In the same way muscles in our hip are responsible for helping us move our legs, there are pelvic muscles responsible for maintaining pressure and blood flow necessary for an erection.
Urinary Incontinence
Due to surgical trauma to nerves or from age-related changes, the muscles of the pelvic floor can become weakened and lead to urinary incontinence. In these cases, proper physical therapy management is essential in retraining these muscles. Often this involves the utilization of sonography (ultrasound) to visualize and provide feedback to the patient.
Hard Flaccid Syndrome
Often misdiagnosed, sensory changes in the penis resulting in a constant semi-rigid penis. Because the penis is painful and “stuck in limbo”, it can have significant effects on sexual function and social life. Physical therapy can be part of the management of this disorder.
Athletic Pelvic Dysfunction
May times men with chronic hamstring and groin pain will be unaware the symptoms could be coming from the pelvis. In these cases, a thorough evaluation and proper diagnosis can lead to the resolution of persistent symptoms.
Male pelvic disorders are often an under-recognized source of physical and emotional stress in men. One in nine men will be diagnosed with prostate cancer. At Bethesda Physiocare we are determined to bring awareness to the community and promote the highest quality Men’s Health physical therapy.
A Headache in the Pelvis?
Anyone who has experienced pelvic pain can attest to the fact it can rival even the most intense migraine headache. There is a well-known book about pelvic pain entitled A Headache in the Pelvis (Wise, Anderson). The other similarity between headaches and pelvic pain is the phenomenon of referred pain. In simple terms, referred pain is a confused and oversensitive nervous system. Many times referred pain is a product of myofascial trigger points (taut muscle “knots”). When muscles refer to the head or pelvis, it can be hard to achieve lasting results when treating only the perceived area of pain. In these cases, it is important to treat the bigger muscles around the pelvis that possess a greater capability to refer pain. In respect to pelvic pain, this can include examining and treating the following muscles:
- Adductor Magnus, Longus, and Brevis: The adductor group (groin muscles) contains a fascial connection into the pelvic floor and are often involved in pelvic pain symptoms including vaginismus, endometriosis, painful intercourse, and pudendal neuralgia
- Quadratus Lumborum: Located in the side of the lower back, this muscle is often tender in patient’s with pelvic pain and can refer to the pelvis
- Abdominal Obliques: A fascial connection from the obliques can be traced into the spermatic cord and sartorius, which mimics the referred pain pattern.
- Rectus Abdominis: The entire “six-pack” needs to be examined with patients in pelvic pain, particularly the lower fibers with those with bladder symptoms and testicular pain.
- Hamstrings: Particularly the most proximal portion (right up near the sit bone), there are taut bands that can mimic pelvic pain symptoms
Addressing the referred pain can be a key component of pelvic health physical therapy. Many times this will eliminate the need to treat the smaller muscles in the pelvic floor. At the very least it will drastically reduce the sensitivity, allowing more tolerable internal treatment of the pelvic girdle
