Category: Pelvic Health Physiotherapy

Pelvic health conditions affecting men can be very distressing and are more common than you may realise. Bladder and bowel dysfunction, side effects from prostate surgery, chronic pelvic pain and erectile dysfunction are some of the common pelvic conditions men may suffer from at some stage of life. These conditions will often have a severe impact on ones lifestyle and physical and emotional wellbeing. Pelvic health physiotherapy can often treat these conditions successfully.

Prostate Surgery

Men who undergo prostate surgery are likely to experience a loss of bladder control (urinary incontinence). This is because the bladder control mechanism is impaired following surgery. Pelvic floor muscles can be trained to help compensate for this loss of control. Your pelvic floor physiotherapist will guide you through the correct, individualised exercises for you. It is best if these exercises are started prior to surgery, so a pre-operative appointment is recommended.

Common symptoms following prostate surgery include:

Urine Leakage

Urine leakage occurs following surgery, often with activities that cause an increase in abdominal pressure such as coughing, sneezing, moving from sit to stand and strenuous activities. The amount of urine leakage and the duration for which it continues following prostate surgery will vary between individuals. It is known to improve over time and research shows that pelvic floor exercises can assist with recovery and a return to continence. Improvement is often quicker if pelvic floor exercises are started prior to surgery.

Erectile Dysfunction

Men may experience an inability to form and/or maintain an erection following surgery. It is difficult to predict whether or not an individual will be affected, and also difficult to predict their degree of recovery. Pelvic floor exercises can help improve recovery.

Physiotherapy for Prostate Surgery

Pre-operative Physiotherapy

Research shows that there is a greater improvement in return of bladder control in men who commence pelvic floor exercises prior to surgery. A pre-operative appointment allows you to become familiar with your pelvic floor muscles as correct technique is important when completing pelvic floor exercises. Practicing pelvic floor exercises before surgery allows for an easier rehabilitation.

Pelvic Floor Exercises

A major component of physiotherapy will involve pelvic floor exercises. There are a number of bladder control mechanisms in males, some of which can be impaired following surgery. Pelvic floor muscles can compensate for this loss of control and therefore pelvic floor exercises are an important part of recovery. Each individual will vary in their ability and goals, and so an exercise program will be tailored for each client.

Bladder & Bowel Training

Bladder and bowel control and function is likely to be impaired following surgery. Urine leakage, soiling(bowel incontinence) and increased frequency in small volumes are all common following surgery. This will improve over time, however some retraining of bladder and bowel function is often required.

Return to Regular Activities

Following surgery you will be limited to light activities. No heavy lifting or strenuous exercise is recommended for several weeks. As you and your pelvic floor muscles recover, you can gradually return to your regular activities. Your physiotherapist can guide you through a safe return to activity program.

Bladder Dysfunction

Men may suffer from bladder dysfunction such as incontinence, increased frequency and retention of urine. Pelvic floor physiotherapy can often treat these conditions successfully.

If you experience any of the following signs or symptoms you may benefit from physiotherapy:

• Urine leakage with activities such as coughing, sneezing, sit to stand, heavy lifting
• Urine leakage on the way to the toilet
• Urine leakage when walking away from the toilet after urinating
• Rushing to the toilet with a very strong urge
• Going to the toilet to empty your bladder more than 8 times a day
• Waking more than once at night to empty your bladder
• Slow flow, difficulty starting flow or straining to empty your bladder
• Feeling like you don’t fully empty your bladder

Possible causes of poor bladder function include:

• Poor pelvic floor muscle strength and control
• Enlarged prostate
• Prostate surgery
• Excessive heavy lifting or strenuous activity
• Constipation
• Poor toileting habits
• Obesity
• Neurological conditions
• Medication

Physiotherapy for Bladder Dysfunction

Most bladder problems can be effectively treated with pelvic floor physiotherapy. You can expect the following from a physiotherapy session:

• A thorough assessment will be conducted to determine your bladder and pelvic floor function
• A treatment plan will then be established in accordance with your needs and goals
• Individualized pelvic floor muscle exercise program
• Advice on good bladder habits and training

Bowel Dysfunction

Men may suffer from bowel dysfunction such as constipation or incontinence. These conditions can be very distressing and have a great impact on many aspects of your overall health and well-being. Physiotherapy can often treat bowel dysfunction successfully.If you experience any of the following signs or symptoms you may benefit from physiotherapy:

• Straining to empty bowels
• Hard stools
• Soiling of faeces
• Rushing to the toilet to empty your bowels with a very strong urge
• No sense of an urge to empty bowels
• Accidently passing wind

Possible causes of bowel dysfunction include:

• Constipation
• Poor toileting habits
• Poor diet and/or fluid intake
• Poor pelvic floor muscle function
• Stress and anxiety

Physiotherapy for Bowel Dysfunction

Most bowel problems can be effectively treated with pelvic floor physiotherapy. You can expect the following from a physiotherapy session:

• A thorough assessment will be conducted to determine your bowel and pelvic floor function
• A treatment plan will then be established in accordance with your needs and goals
• Individualized pelvic floor muscle exercise program
• Advice on good bowel habits and training
• Advice on improving stool consistency

Chronic Pelvic Pain

Chronic pelvic pain in men is more common than many realize and can be very debilitating, affecting overall physical and emotional well-being and quality of life. Pelvic floor muscles are often a contributing factor to chronic pelvic pain. Physiotherapy can effectively treat many conditions.

If you experience any of the following signs or symptoms you may benefit from physiotherapy:

• Pain in the pelvic region, including pain in the penis, testes or anus
• Pain with erection or ejaculation
• Pain with a full bladder

Possible causes of chronic pelvic pain:

• Overactive, tense pelvic floor muscles
• Overactive, tense abdominal muscles
• Injury to the pelvic region
• Bladder infection
• Neural injury
• Psychological factors

Physiotherapy for Chronic Pelvic Pain

Pelvic floor physiotherapy can help improve pelvic floor muscle function and provide effective pain relief and management strategies.

• A thorough assessment will be conducted to determine your overall pelvic floor function (bladder, bowel and erectile function)
• A treatment plan will then be established in accordance with your needs and goals
• Individualized pelvic floor muscle exercise program
• Pain education and advice on management strategies
• Liaison with other health professionals in relation to your condition/s

Erectile Dysfunction

Difficulty achieving or maintaining an erection is more common than many realize and can affect men of any age. Erectile dysfunction can severely impact on ones self-esteem, relationships and overall quality of life. Pelvic floor physiotherapy can often improve erectile function.

If you experience any of the following you may benefit from physiotherapy:

• Difficulty achieving an erection
• Difficulty maintaining an erection
• Erections that can not achieve penetration

Possible causes of erectile dysfunction:

• Poor pelvic floor muscle function
• Some types of surgery (e.g. prostate surgery)
• Neurological conditions
• Psychological conditions

Physiotherapy for Erectile Dysfunction

Pelvic Floor Physiotherapy can assist with erectile dysfunction as strong pelvic floor muscles are associated with better function.

• A thorough assessment will be conducted to determine your overall pelvic floor function (bladder, bowel and erectile function)
• A treatment plan will then be established in accordance with your needs and goals
• Individualized pelvic floor muscle exercise program
• Pain education and advice on management strategies
• Liaison with other health professionals in relation to your condition/s

There are some conditions that are specific to women and can present at any stage of life. They are often associated with changes that occur during pregnancy, childbirth and menopause.

What is the pelvic floor?

The pelvic floor consists of a number of muscles, ligaments and fascia which support the pelvic organs (bladder, bowel and uterus). The pelvic floor muscles include two layers of muscle that sit at the base of the pelvis and also play a role in controlling bladder function, bowel function and sexual intercourse. Damage or weakness to any of the pelvic floor muscles, ligaments or fascia can lead to problems with bladder control, bowel control, sexual dysfunction, or pelvic organ prolapse. Often these conditions can be resolved with pelvic floor physiotherapy and rehabilitation.

Assessment

An initial Women’s Health assessment will involve extensive questioning about your main concerns. Usually this requires asking detailed information about your previous medical history, bladder and bowel function, sexual function and obstetric history. Some objective testing may involve observation of your movement patterns, real-time ultrasound or an internal vaginal assessment. Internal vaginal assessments are performed to check the function of the pelvic floor muscles and the position of pelvic organs. Assessments will only be conducted after a clear explanation and only with the patient’s informed consent.

Treatment

Following a thorough assessment and diagnosis, a detailed treatment plan will be developed to best suit the patient’s function and goals. Treatment options will vary depending on the individual and their diagnosis. We provide the following:

• Pelvic floor muscle rehabilitation for treatment of incontinence, prolapse, post-surgical and/or postnatal
• Pelvic floor muscle rehabilitation for treatment of pain and sexual dysfunction
• Bladder retraining for urgency, overactive bladder, night-time frequency and incontinence
• Bowel retraining for constipation and/or incontinence
• Pain management for pelvic and/or sexual pain and dysfunction
• Musculoskeletal manual therapy for pregnancy or postnatal related conditions
• Clinical Pilates and exercise rehabilitation for prenatal and postnatal women
• Mastitis treatment

Some of the most common conditions we treat include:

Incontinence

Incontinence refers to any form of involuntary loss of urine from the bladder or faeces from the bowel. It can result from various factors including;

• changes that occur to pelvic floor tissues during pregnancy
• childbirth or menopause
• excessive or repetitive stresses that are placed on the pelvic floor region including frequent constipation
• chronic coughing
• high BMI; or other conditions

Many women suffer in silence and believe it is a normal part of aging. They do not realise that it can be effectively treated with physiotherapy.

There are various forms of incontinence such as:

• Stress urinary incontinence – small leaks of urine from the bladder with activities that cause an increase in abdominal pressure. For example, coughing, sneezing, laughing, jumping, lifting, or high impact exercise
• Urge urinary incontinence – leakage of urine from the bladder with a sudden onset of a strong urge that can not be delayed
• Faecal Incontinence – involuntary leakage of faeces from the bowel. May be associated with a sudden urge

Incontinence can often be treated very effectively with bladder and bowel training and pelvic floor muscle rehabilitation.

Prolapse

A prolapse refers to the descent of one of the pelvic organs (bladder, bowel or uterus) into the vaginal wall. It often presents as a feeling of dragging or heaviness within the vagina or pelvic region, and/or a lump or bulge can be felt or seen. Prolapse may also result in difficulty emptying bladder or bowel, pain or discomfort with sexual intercouse. Normally the pelvic organs are held in position by fascia and ligaments, and supported underneath by pelvic floor muscles. Significant stress on these support structures and pelvic floor muscle weakness can lead to prolapse. Some risk factors include: pregnancy, childbirth, high BMI, high impact exercise/heavy lifting, constipation, chronic coughing.

Often lifestyle modification, pelvic floor muscle rehabilitation and healthy bladder and bowel habits can improve the symptoms and severity of a prolapse. A physiotherapist trained in pelvic floor rehabilitation is able to assess your prolapse and develop a treatment plan in line with your lifestyle and goals. Pelvic floor muscle rehabilitation and pelvic floor safe exercises are important in your recovery and ongoing management.

Pelvic Pain and/or Sexual Dysfunction

Many women suffer from various types of pelvic pain or sexual pain conditions such as vaginismus, vulvodynia, and endometriosis. These conditions can significantly impact on a woman’s overall physical and social health and wellbeing. Often there are a number of contributing factors causing the pain or dysfunction and therefore treatment may involve multiple strategies and members of other allied health teams.

Post-natal Rehabilitation

Common conditions that present during pregnancy include:

Lower Back Pain

An ache in the lower back often presents in the later stages of pregnancy as your baby grows, you gain weight, and your abdominal muscles stretch and weaken. This can place increased load on the muscles and joints of your lower back. Physiotherapy can provide manual therapy to help ease the pain and guide you through pregnancy friendly stretches and strengthening exercises that can assist with managing your pain.

Pelvic Girdle Pain

Many women will encounter pelvic girdle pain in the later stages of pregnancy. This can be due to increased weight from the baby, softening of ligaments and reduced strength around the core and hips. Often the pain will be felt with activities that are asymmetrical, for example, walking, stairs, turning in bed. Pain can be felt around the sacrum, bottom or pubic bone.

Resting from aggravating activities and learning how to alter your movement patterns can help alleviate the pain. Manual therapy, supportive belts and specific exercises can also assist in relieving symptoms.

Other Musculoskeletal Conditions

Rib pain, carpal tunnel, and abdominal pain may present during pregnancy. Physiotherapy can provide manual therapy, posture and movement strategies and appropriate exercises to help alleviate symptoms.

Post-natal Rehabilitation

Pregnancy and childbirth is an incredible stage of a woman’s life. There are significant changes that occur to the body as the baby grows and during labour. In particular, abdominal muscles and pelvic floor muscles are placed under stress and strain and require rehabilitation in the postnatal period.

Diastasis of Rectus Abdominus Muscle (DRAM)

Your rectus abdominis is the outermost abdominal muscle of your trunk (the six pack muscle). During pregnancy, as your baby, uterus and belly grow, this muscle can be stretched. Following childbirth, there is often a small separation of this muscle that can make simple tasks like sitting up out of bed and lifting rather difficult due to reduced core strength.

Over time, as your body recovers from pregnancy and birth, this will improve. However, there are ways you can assist the speed, and optimise the recovery, of these muscles. Too much too soon can hinder your recovery. Your physiotherapist can assess you and guide you through the appropriate exercises for you and your activity levels and goals.

Pelvic Floor Rehabilitation

The pelvic floor is placed under high loads during pregnancy and further so during labour. Many women will sustain a perineal tear during childbirth and may strain pelvic fascia and ligaments. While many recover well over time, some women will encounter pelvic floor issues such as prolapse or incontinence. This may be shortly after childbirth or several years later. Often these conditions can be prevented with correct advice and pelvic floor rehabilitation in the postnatal period. Your physiotherapist can assess you and guide you through the appropriate exercises for you and your activity levels and goals.

Mastitis

Mastitis, or inflammation of the breast tissue, can affect many new mothers. Often it is caused by a blocked milk duct. Pain, heat, redness and fever type symptoms may be present. Some women will require medical treatment so it is recommended you consult your GP if you think you have mastitis. Physiotherapy can provide ultrasound therapy which can help to clear a blocked duct and reduce pain and symptoms.

Musculoskeletal Conditions

Other musculoskeletal conditions which are common in new mothers include; upper back, neck or wrist pain. Physiotherapy can provide manual therapy, posture and movement strategies and appropriate exercises to help alleviate these symptoms