Society is getting much better at talking about Women’s Health – vagina’s, vulva’s, incontinence, prolapse… but men’s health remains an often silent matter with men generally delaying visiting health services to address concerns. Men’s Health Week provides an opportunity to raise the profile of men’s health needs and spread the word! Learning about bladder health and pelvic floor muscle training is just as important for men as it is for women.
The pelvic floor is a key part of our central strength but often men are not even aware that they have one! Unless something has gone wrong ‘down there’, men probably haven’t given their pelvic floor much thought. But having an understanding of the function of these muscles is important to maintain pelvic health and can have immediate implications on sex life with stronger erections and improved ejaculation control.
Men’s health – What can go wrong
Commonly men suffer continence issues and erectile dysfunction following prostate surgery but symptoms can affect men of all ages. These can include urinary symptoms such as increased frequency, urgency, reduced flow and incontinence. Penile, testicular, rectal or generalised abdominal or pelvic pain. Bowel difficulties with problems such as faecal incontinence, constipation or rectal prolapse (when the lining of the rectum can relax and even protrude) occurring from lifting excessively heavy weights at the gym or repeatedly straining on the loo.
The consequences of this can be devastating – with loneliness, isolation, avoidance behaviours, relationship breakdown, depression and anxiety reported. But there is a lot that can be done to help.
What is the pelvic floor
The male pelvic floor is different from the female pelvic floor in that it doesn’t have an opening (the vagina) and the urethra is longer which means the pelvic floor muscles sit in a much better position. Also, it isn’t subjected to the strains that pregnancy and childbirth can inflict.
Visualise the trunk as a cylinder with the diaphragm at the top, deep abdominal and back muscles making up the front and back and pelvic floor as the base. This base supports the pelvic organs and along with the sphincter muscles of the bladder and bowel. It is responsible for maintaining urinary and faecal continence. They are no different to any other muscle in the body except you can’t really see them. This makes it harder to know whether you are exercising them correctly. Physiotherapists specialising in the pelvic floor can be of assistance here.
How do you ‘find’ it
Imagine you are stopping urine or wind. You should feel a ‘lift and a squeeze’ inside your pelvis. The lower abdomen may flatten slightly, but everything above the belly button should remain relaxed, and breathe normally. If you stand in-front of a mirror with no clothes on you should see the base of your penis draw in and scrotum lift up as you tighten your pelvic floor muscles. When you relax your muscles you should feel a sensation of ‘letting go’.
How do you exercise it
To strengthen your pelvic floor try doing a contraction at about 70-80% of a maximal voluntary contraction (MVC) and holding this for 10 seconds. Don’t worry if the contraction drops off before 10 seconds, you can build up to this. Keep breathing while contracting and make sure you fully relax the abdominal and pelvic floor muscles between attempts. Aim for 10 repetitions of these, three times a day. The fibres that work to keep things from leaking when you cough, laugh, sneeze or lift something heavy are called fast twitch. To train these, try doing 10 quick pulse contractions at 100% MVC a few times a day as well, relaxing in between. Vary it – do the exercise lying down, sitting and standing.
Remember to relax
It’s important to balance all engagement of the tummy and pelvic floor with plenty of relaxation. An overactive pelvic floor can contribute to pelvic pain (sometimes wrongly diagnosed as prostatitis), bladder pain, painful intercourse, feelings of incomplete emptying from the bladder or bowel. This can exacerbate conditions such as pudendal neuralgia, anal fissures and erectile dysfunction. The chronic tension in these muscles can cause them to weaken and not be as effective when you actually may need them, such as recruiting them to lift a heavy box or prior to a cough or sneeze to prevent leakage of urine, gas or faeces.
Diaphragmatic breathing is a great way to relax the pelvic floor. As you breathe in see a gentle rise in your tummy and visualise the pelvic floor dropping. Keep the breathing gentle and slow and see the difference this makes.
Clare is a Pelvic Health Physiotherapist practicing at Complete Physio in Chelsea and Bankside. You can find out more at www.rephyio.com.
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