Men’s Health

--What are common problems men can experience with their bladder, bowel and sexual health?

Problems may affect any part of the pelvic region and they have a variety of causes.

Bladder leakage or a poor urine stream can indicate pelvic floor or prostate issues. Weak muscles around the anus can cause soiling. Erectile dysfunction can be caused by weak pelvic floor muscles. Pain in the penis or anus can be from pudendal neuralgia (the pudendal nerve which supplies the pelvis). Despite the range of problems and causes, many of these can be assessed by a pelvic floor physiotherapist.

Problems may occur gradually over time or be brought on suddenly. For example, after prostate removal or radiation for prostate cancer, urine leakage, erectile dysfunction or incontinence is common.  However, things like a poor stream may develop more gradually due to prostate enlargement, or you may find you need to visit the toilet frequently due to poor bladder habits that have formed over many years.

The common problems and their causes are outlined below:

Prostate problems

Prostate enlargement is normal for men over 50, but can cause bladder outlet obstruction or a slow, incomplete emptying.

After prostate surgery for prostate cancer, many men find that they have trouble with incontinence. As the prostate is removed, part of the mechanism that keeps men dry is also removed. The leakage may be very mild (eg, a few drops when exercising) or severe (eg, the bladder not storing any urine at all). In the weeks to months after surgery the leakage should reduce as the pelvic floor strengthens.

Bladder problems

Bladders are designed to store urine. Frequent emptying of the bladder or going ‘just-in-case’ will reduce its capacity. They need to be stretched regularly, which is achieved by ‘holding on’. Boys and men of all ages can unintentionally reduce their bladder function by not holding on, causing frequent urination, urgency and urgency incontinence.

Sexual function

Any damage to the muscles, the blood supply or the nerves of the pelvic floor can cause problems with sexual functioning. The penis is also a great indicator of male heart health. If erections are not as strong as they once were, it could indicate that the circulation has been compromised, with for example high cholesterol.

--What’s normal pain and what should I be worried about?

While pain in the pelvic floor after prostate surgery is common, pain in this area of the body that persists or comes on without surgery is not. Persistent pain in the pelvic floor can be caused by ill-fitting bicycle saddles, pelvic trauma or nerve entrapment. Pain can be in the penis, the testicles or in the anus.

Post-surgery

After surgery to the prostate, many men feel like there is a golf ball or grapefruit between their legs, behind the testicles. This is a normal effect of the swelling caused by the surgery and should ease over the first four weeks.

--How do I know if my condition requires physiotherapy or other medical attention?

Men over 40 who find their urine stream gradually slowing, or who feel they can’t empty their bladder completely, should see their GP for an assessment of their prostate. This is not necessarily prostate cancer, but prostate enlargement.

Pelvic floor physiotherapists can assess and manage persistent pelvic pain and pelvic floor dysfunctions such as incontinence. Persistent pelvic pain symptoms can be assessed and managed by both pelvic floor and musculoskeletal physiotherapists. Any sudden onset of pain, new incontinence or unusual bowel changes should be checked by a doctor. If there are no obvious medical reasons for the change in symptoms, then an assessment by a specially trained physiotherapist can help to find a diagnosis.

--Why should I get help?

Bladder and bowel dysfunction can really affect your day-to-day life. Being worried about where the next toilet is, whether you will make it or if you will have an accident, can take a toll psychologically and emotionally. On top of this, if the leakage of urine or faeces (poo) is left untreated it often gets worse, impacting your social life, work life and relationships.

Bladder and bowel dysfunction often stop people from exercising as well, causing general health issues such as obesity. Having problems such as incontinence or erectile problems can also be a leading cause of depression, anxiety and other mental health issues. Poor erections can also cause depression and relationship problems.

--How can physiotherapy help me get back to normal?

While it may be embarrassing to talk about your problem at first, a pelvic floor physiotherapist will help you to feel at ease and will be able to accurately assess your problem. Your specially trained physiotherapist will ask questions that may feel very personal but these are designed to tease out the symptoms you have and help to formulate a diagnosis. Based on this diagnosis your pelvic floor physiotherapist will discuss a treatment program with you. 

Find out how physiotherapy can help with various symptoms:

Poor bladder habits

Educating you about how the bladder functions will help you to develop bladder habits that encourage your bladder to store urine in appropriate volumes. You may be asked to keep a bladder diary to chart your progress.

Leakage after prostate surgery

After treatment for prostate cancer your pelvic floor physiotherapist will teach you the best way to exercise the pelvic floor muscles in a functional way. Advice on managing your incontinence while on the road to recovery will also be available.

Erectile dysfunction

Specific pelvic floor exercises can also help to improve erections.

Pelvic pain

Managing pelvic pain requires a very experienced pelvic floor physiotherapist. Education on chronic pain and how the mind and the body work together to perpetuate the problem is vital to learning how to manage persistent pelvic pain. Physiotherapists are a key part of the multi-disciplinary team that is required to manage chronic pelvic pain.

--How effective is physiotherapy for treating men’s health issues?

Prostate cancer surgery

There is a lot of high-level evidence encouraging men to see a specially trained physiotherapist before and after prostate cancer surgery. The combination of education, pelvic floor muscle training and psychological support that is provided has been shown to improve outcomes in continence, quality of life and psychological status.

Persistent pelvic pain

Managing chronic pelvic pain is a multi-disciplinary effort. While the evidence for physiotherapy in the management of persistent pelvic pain is still in its infancy, the techniques used by Australian pelvic floor physiotherapists are being emulated all over the world.

Sexual health issues

Pelvic floor exercises have been shown to improve erectile dysfunction, ejaculatory dysfunction and premature ejaculation, as well as improving incontinence. 

Other men’s health issues

The management of continence issues and other lower urinary tract symptoms in men has lots of clinical evidence but less empirical evidence. Conservative management (physiotherapy) is recommended as a first line treatment strategy in reviews and by the International Continence Society.  

--What can I do at home to help my condition?

Follow the advice your physiotherapist has given you.

In addition, make sure you focus on:

• developing good bladder and bowel habits. Not going ‘just in case’ but teaching your bladder to hang on will reduce bladder frequency. Constipation can be reduced with going when you get the urge rather than waiting till later. These are important to prevent pelvic floor, continence and erectile issues
• drinking 1.5–2 litres of fluid each day
• eating a diet high in fibre.

Pelvic floor exercises are best taught by a pelvic floor physiotherapist. Here are some pointers to remember when you’re doing them by yourself at home:

• imagine stopping the flow of urine and holding on without using your stomach muscles or your bottom
• once you can do this, you can try to do it while participating in the activity that causes you to leak (eg, while lifting or swinging a golf club).

If you haven’t seen a physiotherapist and would like more information on bladder and bowel habits take a look at Continence Foundation of Australia. 

--How long until I feel normal again?

This will really depend on what caused the problem. If you’ve had a prostatectomy it can be weeks to months before you feel completely recovered. Your pelvic floor physiotherapist will monitor your progress closely.

Bladder and bowel function issues often develop over many years. However, they can often be reversed in a few months if you work on them diligently.

Chronic pelvic pain doesn’t always get completely resolved. However a specially trained pelvic floor physiotherapist will help you to manage your pain over a few months. This will give you a new lease on life and allow you to do things you once used to.