Men are unusual creatures – happy to talk poo size and floating ability, they stubbornly refuse to discuss pelvic health issues, preferring to suffer in tortured silence. The men need to step up and speak about pelvic issues!
When instructing a male to activate his pelvic floor muscles, the words
“Tighten, as if you are holding in a fart” are met with puzzled amusement,
“Why hold in a fart?” is the usual reply!!?
So when do we commonly see the boys? And what problems separate them from the men?
Common in boy-children – less common in men, who often have a very healthy relationship with their bowels! Whilst the role of food (diet) and fluid (water) cannot be underestimated, defaecatory technique (or ‘how to poo’) and tricks to ‘call the poo’ can be very beneficial in getting that gut going again. Visceral manipulations can help to restore appropriate colonic activity, whilst the focus is on establishing a healthy toilet routine. The role of stress and inhibitory behaviours are discussed. Please choose your poo….
Interestingly, boys take longer to achieve night-time continence than girls. Assessment is limited to a thorough history. Ultrasound is only performed when indicated, requested and consented to. There are many strategies, from relaxation and voiding techniques, to behavioural considerations, to options for calming an overactive bladder.
High impact and excessive training can lead to a number of overload scenarios – trigger points can develop in the pelvic floor muscles disturbing normal bladder, bowel and sexual function and cause pain:
- excessive rotational demands on the groin or buttock in football players
- excessive load of the low back in cricket players
- excessive stretch of pelvic nerves during loaded deep squats / leg press in weightlifters and crossfit enthusiasts
- excessive weight-bearing on the ischial tuberosities (sit bones) in cyclists
- excessive posterior pelvic tilt in rowers
Which sports are particularly vulnerable?
- Impact sports: Running, ball sports (marathon, triathlon, football, rugby, cricket, tennis, squash)
- Loading sports: Weightlifting, body building
- Seated sports: Cycling, rowing
- Excessive training: Better low weights high reps, than high weights low reps
- Changes in training load and conditions
When to consider a pelvic assessment in the management of your current symptoms:
Common in footballers and runners. Non-resolving, or as a consequence of rehabilitating another part of the pelvis e.g. a hamstring or SIJ (buttock) injury.
Non-resolving low back pain
Common in cricketers, golfers and rowers.
- If you have seen physios – bios, chiros – and it helps a bit, but then comes back again….
- If you have had cortisone injections, and they helped, but have worn off….
Buttock pain (non-resolving SIJ or hamstring)
Common in most of the sports listed above. Very similar to groin and low back pain above – afterall the pelvis is a ring and movement, tension or imbalance in one area can be shifted to another area.
Erectile function and dysfunction
There are a range of causes for erectile dysfunction. Of note: there is a normal age related decline, with erectile function at age 18 better than 38, and likewise 78 years old….
Whilst physiotherapy is not necessarily a first line management for many with erectile dysfunction, it should be considered in a variety of cases especially where there is other pelvic dysfunction. Post prostate cancer survivors, young men with a hard : flaccid presentation, Pyronies, and the inability to sustain an erection should all consider a pelvic physio assessment.
Hard : flaccid presents with a sense of diminished or disturbed sensation, and other erectile abnormalities of filling, shape and performance, usually in young men after penile trauma. Pyronies is a deviation of the penis, often with a degree of shortening.
The advent of nitrous oxide analogues (Viagra, Cialis and Levitra) have changed the shape of the your erectile future – but sometimes pills alone are not enough. Often, it is a combination of pharmacology (medication) and conservative treatment (vacuum erection device and pelvic floor muscle contractions for the men) that get you back in the saddle…..
Post prostate cancer,and other pelvic or hormone-sensitive cancers
Men are often blindsided by cancer; the treatment, and the consequences. Although experienced most commonly post radical prostatectomy, other cancer treatments e.g. radiotherapy or chemotherapy after testicular and breast cancer can also cause problems. Please do not underestimate the impact on pelvic function of testicular or breast cancer as hormone-sensitive cancers.
Man : fit and healthy, found his PSA shot up, cancer treatment initiated, short time later in nappies with no erection…. what just happened??!
Men have not needed a voluntary relationship with their pelvic floor muscles, and suddenly find themselves needing to contract, or knyp as we say in South Africa, almost continuously.
Common complaints include incontinence and erectile dysfunction. We use a variety of exercise modalities to get the pelvic floor muscles working, and strongly advise an vacuum erection device to maintain ‘housekeeping erections’ (normal nocturnal erectile function) for the first few months post cancer treatment.
Bowel cancer is a real threat to pelvic function. Although most cope well with the cancer aspects, the consequences of treatment, ranging from surgery, chemo and radio can have lasting and profound effects on and in the pelvis. Rehabilitation after stoma reversal is managed through two simple concepts namely i. “How do I keep it in?” and ii. “How do I get it out?“
Most men with pelvic pain are very disturbed by it, particularly if it shifts, or moves around.
Pelvic pain and dysfunction can behave strangely: starting as one thing e.g. tight bladder; morphing later in the day e.g. sensation of swollen testicle; and culminating in the evening in e.g. stabbing pain in rectum.
Don’t worry if/that your symptoms do not add up – to you, or your medical team to date; we ask very specific probing questions to establish patterns or signatures of physical (and psychological) dysfunction and imbalance. Complaints include penile or ejaculatory pain, chronic non-bacterial prostatitis, interstitial cystitis, frequency:urgency, anismus, proctalgia fugax, levator ani syndrome, – the list goes on.
Please get assessed by an appropriately trained physiotherapist.