Have you heard of men’s health physical therapy (MHPT)? If not, you’re not alone. The concept of MHPT is relatively new and poorly understood. So, what is it and why don’t all physical therapists treat men’s health conditions?
The pelvic floor
First, a little history. In 1948, Dr. Arnold Kegel – a gynecologist – developed an instrument designed to measure the strength of a woman’s pelvic floor contraction. This led to his conclusion that pelvic floor exercises could strengthen the muscles lining the pelvis. Through further research, he ultimately introduced the now-famous Kegel.
The Kegel was shown to improve strength and control of the pelvic floor muscles, decreasing urinary incontinence, organ prolapse and other medical conditions for women often due to aging, pregnancy, vaginal delivery and surgery.
In addition to weakness, pelvic floor muscles can also become hypertonic or chronically tight. In the same way someone carries stress or tension in their shoulders and neck, they can also unknowingly tense up or contract their pelvic floor muscles, which can lead to pain and dysfunction in the pelvis.
The role of physical therapy in men’s pelvic health
Women’s health physical therapy has deservedly been elevated as a specialty in physical therapy for decades; however, the concept of men’s health physical therapy is still relatively new. Like women’s pelvic floor muscles, men’s pelvic floor muscles can also become dysfunctional, weak, tight, or injured. Men can suffer from a wide range of pelvic floor symptoms including pain in the pelvic region, sexual dysfunction, post-surgical pain, and urinary and bowel incontinence.
When women experience incontinence, there is growing awareness that a women’s health physical therapist can help. This awareness does not extend equally to the male population. Physicians and other medical providers are not generally quick to prescribe physical therapy for men experiencing pelvic floor dysfunction, leaving too many men to navigate the medical system on their own or to believe they simply must live with the condition.
Studies show that men are more accident-prone, more susceptible to mental health challenges, and more likely to suffer from lifestyle-related health problems. Additionally, compared to women, men are less proactive in seeking professional medical assistance.
This challenge is compounded by a lack of widespread common knowledge that there are physical therapists educated and trained to assess the muscles and joints in the pelvis region for both women and men. In fact, it’s not uncommon for men to get referred around to different medical providers for months or even years before learning there are physical therapists who can help with their pelvic floor symptoms.
Physical therapy for incontinence
Involuntary loss of bladder and/or bowel control affects more than 13 million Americans each year, including women and men of all ages. Despite the prevalence of incontinence due to pelvic floor dysfunction, studies show that men wait an average of 4.2 years to seek help for this condition. Given the high success rate of physical therapy in treating pelvic floor symptoms – 70 to 80 percent –, it’s important to share patient success stories that illustrate the value of MHPT.
There are many ways physical therapists work with patients to help them achieve control of their bladder and bowels. Treatment plans vary based on individual situations. A particularly inspiring story involves a patient who had experienced 14 years of incontinence after a prostatectomy. Through a combination of education, instruction in the correct way to recruit and relax the pelvic floor, and manual therapy, this patient progressed quickly. His physical therapy team focused on the entire abdomen, from the diaphragm to the pelvic floor. He needed to decrease straining during functional tasks such as position changes from sitting to standing and lifting. He also needed to “make friends” with his pelvic floor muscles. After only two visits this patient went from using eight absorbent pads per day to ZERO!
Physical therapy for pelvic floor pain
Incontinence does not usually present with pain, but other pelvic floor dysfunction can present as pelvic pain. In these situations, it is not unusual for a patient to have deep abdominal, testicular, or penile pain that lasts from hours to months.
These cases are often more challenging but through a comprehensive evaluation and exam, a physical therapist can diagnose and treat a range of causes that drive pelvic pain.
For pelvic floor specialists, helping men overcome these types of life-altering conditions can be very rewarding, especially when they can help a patient avoid unnecessary surgery. This was the case when a patient was considering undergoing procedures to remove his tailbone after his doctors had told him that his agonizing pain while sitting was due to the angle of his tailbone. He had lived with the pain for years. Then, he learned about MHPT.
Through working with a pelvic health physical therapist, he learned that his pain was actually muscular, and came to understand how the pelvic floor muscles are just like our biceps or quads: they get tired, feel strain, can be weak, like massages, and require some practice to recruit efficiently. Through working with a PT, he was able to eliminate his pain.
Finding a men’s health specialist
At this point, you might be thinking “If men’s health physical therapy can be so helpful, why don’t more physical therapists treat men’s health conditions?” Simply put, they are not trained to. Physical therapy programs generally do not provide formal training and education on the examination or assessment of pelvis conditions for men or women. Physical therapists treating men’s health and women’s health have sought this out through continuing education and decided they want to learn more about and specialize in treating this region of the body.
Pelvic health physical therapy joins the other specialty areas of physical therapy such as vestibular therapy, temporomandibular joint (TMJ) disorders, PT for neurological conditions along with many others. While the number of providers who work with pelvic conditions/disorders is limited, particularly for men’s health, the benefits that result from understanding the pelvic floor muscles and how to do pelvic floor exercises are worth the effort to seek out a specialist.
Understanding what’s going on with your pelvic floor muscles is the first step to take on the path to healing. If you or the man in your life is experiencing unusual symptoms within the pelvic region, stop delaying and go see a medical provider. You can make an appointment with your family doctor, a urologist, or a men’s health physical therapist. Direct access to physical therapy means you can seek care from a PT first without a referral from a doctor. Most insurance companies cover direct access, though some still require a referral. Check with your insurance provider. We are also happy to help verify benefits.
It is important to note that many symptoms described above can also be signals of a more severe medical problem that warrants attention. If your symptoms are not medically concerning, your physical therapist can work with you to create a plan of care and get you to your goals as quickly and safely as possible.
Additionally, as doctorate-level medical providers, PTs are trained to ask the right questions, explore all possible causes, offer a clinical diagnosis, and let you know if a customized physical therapy treatment plan is right for you, or if you should seek additional insight from a different medical provider.
If you see your family doctor or urologist first, inquire about men’s health physical therapy. Remember, Kegels are not just for women!
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Our professional and caring staff have specialized training to meet the unique needs of all individuals throughout their lifespan. Through education, manual therapy, biofeedback and exercise, our goal is to improve your function, decrease your pain, and guide you on your personal path to improved health and wellness.
REFERENCE:
Huang YC, Chang KV. Kegel Exercises. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555898/
