Why has my urologist recommended I see a pelvic floor physiotherapist? 

Pelvic health physiotherapists often receive referrals from urologists for men for various conditions. These conditions often require a multidisciplinary approach, and pelvic health physiotherapists play a crucial role in managing symptoms, improving quality of life, and promoting recovery. Common conditions include:

• Urinary Incontinence: This is a common issue in older men, often due to prostate surgery, an enlarged prostate, or neurological conditions. It can be as stress incontinence, urge incontinence, or overflow incontinence.
• Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland can lead to urinary symptoms such as frequent urination, nocturia, urgency, and weak urinary stream.
• Post-Prostatectomy Rehabilitation: After prostate surgery, men may experience urinary incontinence and pelvic pain. Pelvic floor physiotherapy can help in the recovery process.
• Chronic Pelvic Pain Syndrome (CPPS): Men may experience chronic pain in the pelvic region, which can include discomfort in the lower abdomen, groin, perineum, or genital area. This condition can be related to prostatitis or other urological issues.

The assessment begins with a detailed conversation about your medical history. Your physiotherapist will also ask about your symptoms, such as pain, urinary issues, bowel problems, or sexual dysfunction, and how these affect your daily life.

After the initial discussion, the physical examination begins. The pelvic floor muscle assessment is a critical part of the examination. For men, this may include both external and internal evaluations. With your consent, an examination might be performed to assess the strength, tone, and coordination of your pelvic floor muscles. We also can use a real-time ultrasound machine that can be placed either on the lower abdomen or on the perineum that can assess the contraction and relaxation of the pelvic floor muscles.

Management by a pelvic health physiotherapist involves a combination of therapeutic approaches tailored to address the specific conditions and symptoms presented by the patient.

Pelvic Floor Muscle Training (PFMT):

• Exercises: Specific exercises to strengthen or relax the pelvic floor muscles, depending on the patient’s needs. This may include Kegel exercises, biofeedback, or real-time ultrasound guidance.
• Techniques: Training on proper contraction and relaxation of the pelvic floor muscles to improve control and function.

Bladder and Bowel Management:

• Bladder Training: Techniques to increase bladder capacity and reduce urgency and frequency, such as timed voiding and urge suppression strategies.
• Bowel Management: Advice on dietary changes, fiber intake, and bowel routines to manage constipation or fecal incontinence.
• Fluid Management: Guidance on appropriate fluid intake to optimise bladder function and avoid irritation.

Pain Management:

• Desensitisation Techniques: Gradual exposure and techniques to reduce pain sensitivity in the pelvic area.
• Relaxation Exercises: Methods to reduce muscle tension, such as diaphragmatic breathing, relaxation techniques, and mindfulness.

Lifestyle and Behavioral Modifications:

• Posture and Body Mechanics: Education on proper posture and movement to reduce strain on the pelvic floor.
• Diet and Nutrition: Recommendations to avoid bladder irritants, maintain a healthy diet, and manage weight.
• Activity Modification: Advice on exercise and physical activities to avoid worsening symptoms and promote overall health.

Debunking common myths is crucial for understanding and effectively managing pelvic health issues. Here are some myths and the truths behind them: 

Myth: Pelvic floor exercises are only for women.

• Truth: Pelvic floor exercises are beneficial for both men and women. Men, especially those experiencing urinary incontinence, erectile dysfunction, or chronic pelvic pain, can benefit significantly from strengthening or relaxing their pelvic floor muscles.

Myth: Urinary incontinence is a normal part of aging, and nothing can be done about it.

• Truth: While urinary incontinence is more common as people age, it is not an inevitable part of aging. There are effective treatments available, including pelvic floor muscle training, lifestyle changes, medications, and sometimes surgery. Consulting a physiotherapist can help identify the most appropriate treatment.

Myth: Strong pelvic floor muscles are always better.

• Truth: While having strong pelvic floor muscles is generally beneficial, they also need to be flexible and able to relax. Overly tight pelvic floor muscles can lead to pain and dysfunction, just as weak muscles can lead to incontinence. A balanced approach is key.

Myth: You should avoid drinking water if you have urinary incontinence.

• Truth: Reducing water intake can actually make incontinence worse by irritating the bladder lining and leading to concentrated urine. It’s important to stay hydrated and manage fluid intake properly. A healthcare professional can provide guidance on appropriate fluid management.

Myth: Pelvic health issues will go away on their own.

• Truth: Many pelvic health issues, such as chronic pelvic pain, incontinence, or pelvic floor dysfunction, require professional intervention for proper management and improvement. Ignoring symptoms can lead to worsening conditions and reduced quality of life.

Written by Gaaya Manohararajan.

Gaaya is a musculoskeletal and pelvic health physiotherapist at Inner Active Pelvic Health Physiotherapy, a practice that solely focuses on  pelvic health rehabilitation services helping to restore confidence and strength. She has a special interest in Men’s Health focsuing on physiotherapy for pre and post prostate cancer treatment.

References

Continence Foundation of Australia

DISCLAIMER This is general information only. For specific advice about your healthcare needs, you should seek advice from your health professional. Inner Active Pelvic Health and Physiotherapy does not accept any responsibility for loss or damage arising from your reliance on this blog, see a qualified a health professional.