By Laurie Bickerton, PT

As a follow up to our blog on ‘Pelvic Pain in Males’, this entry will review some of the urinary and sexual concerns that may arise in male pelvic health.

Leakage with Movement, Cough or Lifting

The pelvic floor assists the sphincters of the prostate in controlling the flow of urine. With obesity, inactivity, constipation, chronic cough, or poor lifting habits, the muscles will weaken. This allows leakage of urine with activities that increase the pressure in the abdomen. Coughing is the most common, but heavy lifting or quick movements are among the other common complaints. Learning to contract the muscles of the pelvic floor and then strengthen them corrects this problem, and can help with post-void dribble as well.

Leakage after Surgery

Post-prostatectomy and other pelvic surgeries including cancer in the abdomino-pelvic regions can leave men with stress urinary incontinence (leaking urine). When the prostate has been removed, or the pelvic floor operated on, exercise to strengthen can make a real difference (1). Relearning to control these muscles takes patience so that correct co-ordination with the other core muscles is regained. Men have sometimes had a habit of holding the breath, and this can weaken or de-facilitate the pelvic floor muscles. Muscle biofeedback with or without electrical stimulation is a substantial help when muscles are slow to strengthen. If possible, learning to contract the pelvic floor muscles before surgery may be an even better approach (2).

Erectile Dysfunction

Erectile dysfunction (ED) has many causes, and some patients have more than one factor. Usually a man will have visited a physician before coming for pelvic physiotherapy to rule out or control diabetes, heart problems, obesity, and hormone deficiencies. Tension and fatigue are also major factors in achieving and maintaining an erection, so counselling or sex therapy may be recommended.

Once those factors have been considered, the musculoskeletal contributions are considered: there may be tension or compression on the nerves to the penis, tight muscles affecting nerve function, or decreased blood supply. Improving tone and flexibility in the muscles of the pelvic floor can improve nerve function and blood supply, improving performance (3). One needs to consider the muscles at the base of the penis in particular ischiocavernosus as it helps support the base of the penis and control blood supply to the erectile tissues (4). Exercises for the pelvic floor is something that can be done at home to contribute to overall success.

References:

1) The role of pelvic floor exercises on post-prostatectomy incontinence. Parekh AR, Feng MI, Kirages D, et al. J Urol 2003; 170(1): 130-133

2) Improved continence outcomes with preoperative pelvic floor muscle strengthening exercises. Sueppel C, kreder K, See W.Urol Nurs 2001; 21 (3): 201-210

3) Pelvic floor exercises for erectile dysfunction. Dorey G, Speakman MJ, Feneley, RC, Swinkels A, Dunn CD. BJU Int 2005 Sep;96(4):595-7.

4) Pelvic-floor muscle rehabilittion in erectile dysfunction and premature ejaculation. Lavoisier P, Roy P,  Dantony E, Watrelot A, Ruggeri J, Dumoulin S. Phys Ther 2014 Dec; 94(12):1731-43.