Male pelvic floor therapy is not much different from female pelvic floor therapy in that not only the ‘floor’ but the ‘house’ that the pelvic floor is the ‘floor’ of needs to be assessed. The biggest mistake I see when it comes to the treatment of all pelvic floor dysfunction cases is that most therapists focus on the pelvic floor but how is all that hard work sustained if the ‘house’, which is your pelvis, is unstable? Understanding the anatomy of the area is important so let’s see what the ‘house’ looks like.

Pelvic Floor Anatomy

As stated in my blog written for women and pelvic floor dysfunction:

“The pelvic floor, unlike what most people think, is more than the area where the vagina or penis, anus, and the tissue in between is. The pelvic floor involves the inner lining of the pelvic inlet as well. The pelvic inlet is like a 3-piece-bowl and these muscles line the bowl holding the bladder, uterus, ovaries/prostate, and intestines which can get ‘squished’ or compressed by the pressure coming from above. This pressure is influenced by our breathing, posture (and postural distortion), spinal abnormalities such as Scoliosis, Pectus Excavatum (pushed in chest), and Pectus Carniatum (pushed out chest).

pelvic floor

Since the bowl has 3 pieces that meet as 2 joints in the back forming the Sacro-iliac joints (or SI joint between Sacrum and Ilium), and in the front to form the Pubic Symphysis or the pubic bone, the alignment and health of these joints play a role and in women, because of pregnancy and childbirth, they can get compromised.

Pelvis bones

Pelvis (courtesy of https://orthoinfo.aaos.org/)

The hips form a joint with the Acetabulum, or socket, and the lower back sits on top of the pelvis. Their direct attachment to the ‘bowl’, and the impact of the lower portion of the mid-back on the lower back directly influences the integrity and alignment of the bowl. If you are thinking that the pelvic floor is unstable and weak, that is not true by any means. The joints are reinforced by an intricate network of connective tissue and the flexibility of these joints is quite strong so you should look at it like an earthquake-resistant building that can withstand quite a bit but the building should be inspected after each jolt and if minor fixings are taken care of, it will be well prepared for the next jolt.”

Is Male Pelvic Floor Therapy Different Than Female’s?

Fundamentally, the treatment for male pelvic floor therapy is not different than that of females in that similar areas are treated. Of course, when it comes to internal manual work, in males, the only point of access is through the anus. Of course, internal manual work is not the only way to treat the area, however, it seems to be the go-to route that most pelvic floor therapists (who are not just physical therapists) go to. At our clinic, we focus on the ‘house’ (pelvis), which the pelvic floor is the ‘floor’ of. After all, working on the floor when the ‘house’ is unstable simply does not make sense.

Why Do Men Get Pelvic Floor Dysfunction?

I suggest you see my blog on Male Pelvic Floor Dysfunction and other blogs that I have written for men to understand what is going on in the world of pelvic floor dysfunction. The following is an excerpt from the blog mentioned:

“The pelvic floor is not suspended in the air and is influenced by all body parts that are connected to the pelvis itself. Your hips, the joints of the pelvis called SI joint or sacroiliac joints, the lower back, the lower portion of the mid-back, as well as the connective tissues connecting the joints to each other and to the pelvis all impact the integrity of the pelvic floor.

The pelvic floor is also influenced by the internal organs that are held in the “bowl”; which are the bladder, prostate, lower intestines, and bulbourethral glands. And their size and shape matter. For instance, an enlarged prostate can add more weight than the floor is able to handle. Over a course of time coupled with a pelvic tilt (due to poor posture) and gravity, may lead to symptoms such as pain with urination, incontinence, lower back, and/or SI joint pain.

Our lifestyle is another huge influencer of the pelvic floor and contributor to pelvic floor dysfunction. Our sedentary lifestyle dictates forward flexion which compromises our posture, leads to our lack of walking, compresses our internal organs which leads to their enlargement due to inflammation, and then there is gravity that certainly becomes our disadvantage. I have explored and dissected the concept of lifestyle and its influence on the brain and how that influences our movement in detail here.

Our breathing apparatus is another influencer of the pelvic floor and its dysfunction. When the pelvis, lower back, and hips don’t move as they are designed to (due to injuries, habits, and lifestyle for instance), then our posture is compromised and the basic requirement of effective breathing which we are born with is no longer in place. Breath is so important in keeping an even load of the internal organs within the pelvic inlet or the ‘bowl’ by engaging the abdominal and pelvic diaphragm properly. A dysfunctional pelvic diaphragm means a dysfunctional floor and its associated signs and symptoms.

Another influencer of the pelvic floor is the nerves exiting the lower back spine and going to not only the internal organs but the muscles of the area including the ones in charge of the sphincters. Anything that compromises those muscles may lead to pelvic floor dysfunction. Let me tell you, a disc bulge in almost all cases is benign, and not every disc herniation is doomed to end in pelvic floor dysfunction. This, therefore, varies from case to case and is the reason why it is crucial to see a health care practitioner who looks at your presentation with a wide lens.”

Remember, the first step to resolving your health issues is understanding what is going on, then how you got it to begin with, proceeding with correction, and finally learning how to prevent it from happening. That means that you need to be an active participant in your treatment and prevention. Give us a call if you have pelvic floor dysfunction and are not sure where to begin or have not received the satisfactory results you hoped for.

Dr. Shakib

Recommended Reading:

Does Pelvic Floor Therapy Work?

Pelvic Floor Exercises for Men