Men’s Pelvic Health: The Problems Men Don’t Talk About

Men are generally pretty good at talking about football, rugby, work, cars and whether the referee had a clue.

Pelvic health? Not quite as much.

But men have pelvic floors too, and problems with bladder control, bowel function or pelvic pain are much more common than many men realise, and these problems aren't limited to one age group.

We see very fit, active men coming to us with issues such as pelvic pain, constipation or difficulty relaxing the pelvic floor. In older men, we more commonly see problems related to pelvic floor weakness and bladder control, particularly following prostate surgery.

But symptoms such as urinary urgency, pelvic pain and erectile dysfunction can occur at different stages of life and for many different reasons.

The important thing to know is that you don't simply have to put up with these symptoms.

What does the pelvic floor actually do?

The pelvic floor is a group of muscles at the base of the pelvis. They help support the bladder and bowel, control urine and bowel movements, and play an important role in sexual function.

They're also part of your wider system of muscles that help manage pressure and movement when you lift, run, cough, sneeze or exercise.

And, like any other muscle, they need to be able to contract, relax and coordinate properly.

It's not simply a case of “make them stronger”.

And when things might need help…

Bladder urgency, frequency and leakage

Perhaps you're suddenly finding that you need to know where every toilet is.

You may need to pass urine more often, experience a strong urge that's difficult to control, or leak when coughing, sneezing, lifting or exercising.

Urinary symptoms can have many different causes and can occur at different stages of life.

If they're affecting your confidence or making you avoid activities, it's worth getting them checked. Our Pelvic Health Physios can guide you through bladder training as well as help with some causative factors. They’ll also advise if you need to be referred on for further investigations or help. 

Constipation and difficulty emptying your bowel

Constipation isn't always just about what you eat.

Your pelvic floor needs to relax properly to allow the bowel to empty. If the muscles are overly tense or poorly coordinated, you may find yourself straining, spending ages on the toilet or feeling that you've never quite finished the job.

Constipation can, of course, have many causes, so persistent or unexplained bowel changes should be discussed with your GP.

But if pelvic floor tension or poor coordination is contributing, Pelvic physiotherapy can really help. 

Pelvic pain

Pelvic pain in men can be felt around the lower abdomen, groin, penis, perineum, buttocks or tailbone.

It may be worse with prolonged sitting, exercise, urination or bowel movements.

Pelvic pain has many possible causes and shouldn't automatically be blamed on the pelvic floor. However, sometimes the pelvic floor muscles become overactive and tense, contributing to ongoing pain.  Pain that has been a problem for a long time can become complex in nature, long after the initial injury has healed and the nervous system gets sensitised. To learn more about moving on from persistent pain see  our blog: Pain Doesn’t

Always Mean Damage: Understanding Persistent Pain Bodyright Blogs - September

A physiotherapy assessment can help establish whether the pelvic floor, surrounding muscles, movement of the pelvis or indeed a sensitised nervous system may be contributing and finding solutions to help. 

Following prostate surgery

Urinary leakage is a common part of recovery for some men following prostate surgery.

Pelvic floor rehabilitation can help you regain strength, coordination and bladder control as you recover.

Recovery is different for everyone, so your programme should be tailored to you rather than simply being a case of doing as many pelvic floor exercises as possible.

Do men need to do pelvic floor exercises?

Sometimes.

But more isn't necessarily better.

If your pelvic floor is weak, strengthening exercises may be appropriate.

If the muscles are already tight or overactive, however, constantly squeezing them may not be helpful and could potentially make things worse. 

The pelvic floor needs to know when to switch on and when to let go.

A men's pelvic health physiotherapist can assess your symptoms and help determine what you actually need.

What about sexual health?

The pelvic floor plays a role in sexual function, and pelvic pain or pelvic floor dysfunction can sometimes contribute to sexual difficulties.

Erectile dysfunction can have many different causes, including vascular, neurological, hormonal and psychological factors, so it shouldn't automatically be attributed to the pelvic floor.

However, pelvic floor rehabilitation can be useful for some men, depending on the underlying problem.

If changes in sexual function are bothering you, it's worth talking to your GP or an appropriate healthcare professional rather than simply hoping they'll disappear. We get referrals from urologists to treat erectile dysfunction when more serious causes have been outruled.  

When should you see a pelvic health physiotherapist?

It's worth seeking advice if you're experiencing:

• Bladder leakage

• Urinary urgency or frequency

• Difficulty controlling your bladder

• Constipation or difficulty emptying your bowel

• Pelvic or perineal pain

• Symptoms following prostate surgery

• Pain associated with sitting or exercise

• Pelvic symptoms affecting sexual activity

• Symptoms that are stopping you doing things you enjoy

You don't need to wait until the problem becomes severe.

What happens at an appointment?

If you're feeling slightly awkward about booking a pelvic health appointment, you're certainly not the first man to feel that way.

Your physiotherapist will start by talking to you about what's happening and what your goals are. 

Depending on your symptoms, we may assess your breathing, abdominal and pelvic movement, strength and functional movement. An internal pelvic floor assessment may sometimes be appropriate, but this will always be explained beforehand and discussed with you.

The aim is simple: understand what's happening and work out what will help.

Men's pelvic health physiotherapy in Drogheda

At Bodyright Physio in Drogheda, Co. Louth, we provide men's pelvic health physiotherapy for problems including bladder symptoms, pelvic pain, bowel difficulties and rehabilitation following prostate surgery.

We know these aren't always the easiest things to talk about. Our approach is professional, private and completely judgement-free.

You don't have to become an expert in pelvic floors.

You just need to know that if something isn't quite right, there is help available.

And yes, that includes your pelvic floor.