So, you have erectile dysfunction, pain, constipation, incontinence or another problem in the region where whitey tighties would cover, aka the pelvis. Your doctor may have referred you to physical therapy (PT), or maybe you did some research on your own to discover pelvic health physical therapy. What is pelvic health physical therapy and what can you expect? Let’s demystify it.
You may be wondering why a physical therapist is a great professional to see. The pelvis has a complex system of nerves, muscles and connective tissues. Male pelvic floor dysfunction is often musculoskeletal in nature — with pelvic floor muscles that may be tight, weak or injured — meaning physical therapy is the best option for treatment since PTs are musculoskeletal experts!
Issues in the pelvic region generally produce a lot of anxiety. Men do not typically have much experience having their pelvis examined. Yes, it can be awkward because ideally, as physical therapists, we want to look at and examine the area that you have your concerns. This might include the penis, testicles, perineum and anus. Did you shutter at the use of those words? If this makes you uncomfortable, know that you are in control. You get to decide with your physical therapist your level of exposure, as well as the scope of your examination.
Examples of male pelvic floor dysfunction or disorder include:
- Incontinence
- Urinary urgency incontinence / frequent urination or overactive bladder
- Urinary stress incontinence
- Bowel incontinence / fecal incontinence
- Constipation
- Erectile dysfunction (ED) / sexual dysfunction
- Pain
- Testicular pain / genital pain
- Pelvic pain / groin pain
- Low back pain
- Pain with intercourse
What is a men’s pelvic health PT appointment like?
Physical therapists approach men’s pelvic health visits just like any other PT visit.
Let’s explore what a typical Men’s Health Physical Therapy visit might look like.
The Interview
PTs start all initial visits with a thorough interview to get a better idea of the symptoms, onset, complicating factors, and history of the problem. We will also build goals for this specific episode of physical therapy. This interview may be the most important part of the initial visit since the information learned here will often guide what is done in the physical exam.
The Examination
The hands-on portion of a visit will start by evaluating overall health and physical condition, with a focus on the pelvic region. This may involve a comprehensive physical exam, an assessment of posture and movement patterns, and tests to determine the range of motion and strength in the hips and lumbar spine.
Pelvic pain and other pelvic dysfunctions are often the result of issues in the lumbar and sacral regions, abnormal breathing or stabilization patterns, or muscular tension.
For that reason, your PT may need to palpate the abdomen, lumbar and sacral areas, and structures of the pelvis as it relates to your concerns. The pelvic structures can include genitals, perineum, anus and deep pelvic floor muscles via an internal assessment.
What is an internal assessment? In some cases, pertinent medical information can be obtained from an internal rectal examination. This means your clinician inserts a finger into the rectum to palpate the deep pelvic floor muscles looking for pain, tightness and testing coordination of muscle contraction. This is not common on the first visit and only performed with consent and if deemed medically necessary to inform your physical therapist on a course of treatment.
As I mentioned above, you get to work with your PT to determine your comfort level and exposure during the examination. Some men decide they are not comfortable removing their underwear for an examination and decide to proceed with the exam over clothing. Though this can limit the information the PT can obtain during an exam, you are in control and determine what you are comfortable with and how the examination proceeds.
Finally, one of the greatest fears men have, but don’t speak about, is getting an erection during an examination. Yes, this happens all the time, and it’s okay. Sometimes being nervous or even exposure to air can result in an erection. You and your PT can discuss if you would like to pause the exam or how to proceed. It may feel embarrassing, but please know it is not unusual or concerning for clinicians.
Development of a Treatment Plan
Exam findings often include some combination of limited range of motion, poor posture, abnormal breathing, muscle weakness or irritated nerves. Based on these findings and discussion of goals, the PT will develop a customized treatment plan.
This plan may include exercises, stretches, manual therapy techniques, and other interventions aimed at reaching the goals established in the interview. Quite often, in pelvic health PT, education about anatomy and abdominal biomechanics is a crucial portion of the treatment plan.
Sometimes progress can be slow, but as long as you are progressing, your PT will continue to advance your treatment plan.
In some instances, progress towards goals may stall and other medical professionals may need to be consulted as part of the care team. This may include a urologist, physiatrist, proctologist or mental health professional. Your PT will be able to guide you on the next steps of treatment and who might be beneficial to bring onto the team.
Although it is less common for men to discuss these types of health concerns with their partners or friends, they are very common and can usually be improved.
A Home Exercise Program
Maintaining the progress achieved while working with the PT in the clinic requires more than just the time spent in the clinic. For this reason, a home exercise plan (HEP) is always provided. Though the famous Kegel exercises will likely be included in a treatment plan, the pelvic floor works in conjunction with all the core muscles. Comprehensive movement and strengthening activities help to overcome pelvic floor dysfunction.
Your HEP will include exercises and stretches that can be performed independently and will complement the activities performed during the physical therapy visit. Typical exercises include bridges, a variety of core activities, squats, and pelvic floor or leg exercises. Depending upon the specific needs of the patient, we will usually progress to higher intensity lifting, core stability or aerobic exercises. These changes will be reflected in updated HEPs to help you remember what to do!
Although it is sometimes difficult to be consistent with the HEP, patients are most likely to meet their goals when they regularly perform the HEP as instructed. Your PT will usually be asking about at-home performance, and work though any time, difficulty or motivation challenges that limit HEP performance. Sometimes making the exercises easier (or harder!) or brainstorming ways of developing a routine can help immensely with completing the HEP.
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Overall, a men’s pelvic floor physical therapy visit is a valuable experience for anyone experiencing pain or dysfunction in the pelvic region. With the help of a skilled and knowledgeable physical therapist, patients can expect to see progress toward their goals, feel better, and lead a more active, pain-free life!
Ready to learn more? In this video, physical therapist and men’s health specialist Brian Weiderman shares more insight about this unique service. Click to watch!
Frequently Asked Questions About Men’s Pelvic Health
It is common to have questions before your first pelvic floor PT visit. Below are a few of the most common questions people have before arriving:
What should I wear to a men's health PT appointment?
Clothes that don’t restrict movement and are not too bulky will help the PT to see how your body moves and allow for better palpation of painful areas.
Will I need to undress in the clinic during my PT appointment?
Although palpation over the skin can be beneficial, it is not at all required. Your PT will explain why disrobing may be helpful and will accommodate any concerns you have.
What if I ask something weird or something embarrassing happens during my pelvic health physical therapy appointment?
Your pelvic floor PT has heard and seen it all, I promise. Being able to ask all the questions helps you learn and clear up any misconceptions, both of which contribute significantly to your recovery.
How long will my pelvic health assessment take?
A typical initial evaluation will take around 1 hour. Follow-ups will usually be 40-60 minutes. Overall episodes of care vary, but will range between 3-8 visits depending on the situation.
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