what can pelvic floor therapy do for male pelvic floor conditions?
There is frequently an over-emphasis placed on marketing pelvic floor physical therapy towards birthing people, which leaves a large gap in awareness that pelvic floor physical therapy treatment is also available for people who are assigned male at birth (AMAB) who may be struggling with pelvic floor issues and conditions.
do men have a pelvic floor and can they have pelvic floor conditions?
Yes, yes, and YES! If you are a human being with a pelvis, then guess what?! You have a pelvic floor. This means that for folks who identify as male or were assigned male at birth that you have a pelvic floor and, likewise, can struggle with pelvic floor dysfunction.
what do the pelvic floor muscles do for men?
Similar to people who are assigned female at birth, men (AMAB) have pelvic floor muscles that sit at the base of the pelvis and are incredibly important for helping to support the following functions:
Sphincteric control: prevents leaking of urine, stool, and gas. On the flip side, the pelvic floor muscles need to lengthen and release so you can empty your bladder and bowels completely.
Support: helps to keep your pelvic organs, like your bladder, bowels, and prostate, positioned where they’re supposed to be.
Sexual function: including being able to have an orgasm and pelvic penetration during sex and intimacy pain-free.
Stabilize: the pelvic floor muscles act as a direct extension of our “core muscles,” helping to give support to our lower back, abdomen, pelvis, and hips.
Circulation: the pelvic floor muscles help to move the blood and lymphatic fluid in the pelvis back up to the heart.
how common is male pelvic floor dysfunction
Research shows that around 16% of clients who identify as AMAB struggle with pelvic floor dysfunction.
Pelvic floor issues can affect men of all ages but commonly pops up during certain periods:
Tight pelvic floor muscles, commonly referred to as “overactive pelvic floor dysfunction,” frequently impact clients who are AMAB and are in their 20s, 30s, and 40s.
Weak pelvic floor muscles, which are also commonly referred to as “underactive” pelvic floor muscles, usually impact clients in their 40s, 50s, and 60s.
It is also common for the prevalence of sexual dysfunction to increase with aging, where around 40% of AMAB men in their 40s struggle with some form of sexual dysfunction.
what are common symptoms of pelvic floor issues in men?
Weak or slow flow of urine when peeing
Pain when peeing or with bowel movements
Prostatitis
Erectile dysfunction
Pain in the pelvic region including:
Pain when sitting that almost feels as though you are “sitting on a golf ball”
Pain at the tailbone
Scrotal and testicular pain
Groin or hip pain
Pain during or following sexual activity (such as during orgasm, erection, ejaculation, with receptive anal penetration, or following these activities)
Pain with rectal exams
Rectal pain during or following bowel movements or at night while sleeping (called “proctalgia fugax”)
Constipation or difficulties with emptying during bowel movements
what can increase the likelihood of men developing pelvic floor dysfunction?
Certain things can increase a person’s risk for developing pelvic floor dysfunction, including:
Aging
It is common for the pelvic floor muscles to become weak as we age, which can cause issues with urinary and fecal incontinence. Although pelvic floor dysfunction is common as we age, it is by no means normal and is not something that you have to deal with.
Stress and anxiety
Research shows that the stress hormone cortisol has a direct impact on the pelvic floor musculature as well as an up-regulation of the nervous system, which is in direct control of the pelvic floor muscles. This can lead to an increase in pelvic floor muscle tension, causing symptoms like pelvic pain, constipation, as well as discomfort with urination and bowel movements.
Chronic increases in intraabdominal pressure (such as coughing or straining when using the bathroom to pee or poop)
Long-term increases in pressure placed on the muscles and ligaments of the pelvic floor can cause weakness and decrease the integrity of the tissues in the pelvis leading to weakness which can cause issues with leaking of urine, poop, and gas, as well as pelvic organ prolapse.
Trauma or surgery to the pelvic region (such as with sexual abuse and cancer treatment, including prostate removal or radiation treatment to the pelvic region)
Trauma and surgery can both create scar tissue or an increase in the activity of the pelvic floor muscles, which can cause pelvic pain and other issues such as constipation, pain with pooping and peeing, and incomplete bladder emptying during urination.
Chronic hip and/or lower back pain
The hips and lower back directly attach to the pelvis, which impacts the functioning of the pelvic floor muscles. We frequently see increased pelvic floor muscle activity, as well as pelvic floor muscle tension, pain, and leaking of urine, in clients who are struggling with long-term back and hip pain.
Abdominal and/or glute weakness
Your pelvic floor muscles are a direct extension of your core or abdominal muscles and work together to help support intraabdominal pressure management, stabilize your pelvic organs and help maintain an upright posture. Whenever you experience weakness in your core or muscles in the buttocks, it is incredibly common for your pelvic floor muscles to try to “pick up the slack.” This can inadvertently lead to increased tension in the pelvic floor muscles, which can cause pain as well as bladder and bowel issues.
recommendations to help with pelvic floor issues for folks who are amab or identify as male
As a Board-Certified Pelvic Floor Physical Therapist, there are SO many things that we can do during pelvic floor physical therapy to help improve symptoms of pelvic floor dysfunction and issues. I am obviously biased and would always 100% recommend seeing a skilled pelvic floor physical therapist for an assessment to get specific recommendations for you and your body.
Here are some general recommendations in the meantime for some symptom relief for pelvic floor issues you may potentially be experiencing if you identify as male:
Stress management
I am a HUGE advocate of mental health as a pelvic floor provider. The pelvic floor muscles and stress, anxiety, and depression go hand in hand, and there is so much overlap when it comes to pelvic floor dysfunction and mental health diagnoses. I frequently recommend that clients who I am working with also work in conjunction with a mental health provider as we are helping to treat pelvic floor issues since the two complement each other so well.
I also love recommending different grounding techniques to clients, including diaphragmatic breathing and the “5, 4, 3, 2, 1” method. These methods help to calm down your sympathetic nervous system, which is the “store” or “flight” response of the body that goes into overdrive when we are feeling anxious or stressed and can cause increased tension in the pelvic floor muscles.
Diaphragmatic breathing is where you breathe in through your nose and carry your breath all the way down into your abdomen and between your “sit bones,” or the bones that you feel when you sit down in a chair before you breathe out through your mouth. You want to make sure you breathe out twice as long as you breathe in and that you pause for a few seconds at the top of your inhale to help further calm down your nervous system.
The “5, 4, 3, 2, 1” grounding technique is where you look around you and identify five (5) things that you can see, four (4) things that you can feel, three (3) things that you can hear, two (2) things that you can smell, and then one (1) thing that you can taste. It is important to do diaphragmatic breathing during this technique.
Toileting mechanics
It is so important to make sure that you are not straining when you go to the bathroom to poop or pee, which can cause further pelvic floor muscle dysfunction. For clients who are standing or hovering over the toilet seat to urinate, I frequently recommend sitting down on the seat and using a hygienic cover or toilet paper if cleanliness is a concern.
I also recommend using a step stool under your feet during urination and bowel movements if you are having a hard time feeling like you aren’t emptying completely or are straining with toileting. Positioning your feet above the level of the hips while using the toilet helps your pelvic floor muscles to lengthen and release more completely, which makes going to the bathroom much easier.
You also want to make sure you are not straining or pushing when you pee or poop. Instead, what you should do is a technique called “making your belly big and your belly hard,” which is basically where you gently push out your abdomen and keep it pushed out as you blow out through your mouth like you are blowing out birthday candles. This will help you to generate an appropriate level of intra-abdominal pressure during toileting while also keeping your pelvic floor muscles lengthened and released, which should allow you to empty more completely.
Address ongoing lower back and hip pain
I frequently work with clients struggling with hip or low back pain who then go on to develop pelvic floor dysfunction. Frequently, by addressing the hip or back pain first, we can make significant improvements in the issues within the pelvic region.
See a pelvic floor physical therapist!
If you are struggling with pelvic floor symptoms and identify as male, just know that it’s common but not normal and absolutely not something that you have to deal with. Working with a skilled pelvic floor physical therapist can help to improve your symptoms. The right pelvic floor therapist should be able to not only provide comprehensive pelvic floor treatment but be open to and competent when it comes to working with clients who identify as male (I promise we are out there!) so we can get a better idea of how your pelvic floor muscles are functioning and the root cause of your ongoing symptoms. Then, from there, we can come up with a treatment plan specific to you and your goals. So, if this sounds like you and you are located in Durham, NC, I would love to hear from you. Please don’t hesitate to reach out using the link below!
Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you identify as male, are looking for treatment for pelvic floor issues, and you’re located in Durham, North Carolina I would love to work with you! Reach out to me here to tell me a little more about what is going on so we can chat more and get the process started. Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor physical therapy treatment.
Struggling with pelvic floor dysfunction or pain or other pelvic floor conditions and having a hard time finding a provider who works with folks who identify as male? Check out my website here to see what other conditions I treat as a pelvic floor physical therapist.
Dr. Brook Orvis (she/her) is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
