Pelvic health for men and women

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Pelvic health solutions for men and women

woman talking to female patient

Your pelvic floor muscles do a lot: they support the organs above them, control the bladder and bowel, and play a part in healthy sexual function. They also work with your abdominal and back muscles to stabilize and support your spine.

When something goes wrong with your pelvic floor muscles, it can lead to leakage, constant trips to the bathroom, sexual frustration and pain. Pelvic health is a big deal.

Though in the past resources have focused more on women’s pelvic health, awareness is growing about this being an issue for both men and women. With that awareness comes information on all the options available, such as physical therapy, for recovering and maintaining good pelvic health.

What is pelvic health physiotherapy?

Pelvic health physiotherapy (sometimes called pelvic floor physiotherapy or pelvic physiotherapy) is the assessment and treatment of conditions involving the pelvic floor and the symptoms that result from problems in this area.

It usually starts with an external and internal (vaginal and/or rectal) examination of the pelvic floor muscles and soft tissue, identifying imbalances and dysfunction that are causing your symptoms. If you have concerns or reservations about the internal examination talk to your therapist at the initial visit. Together you will decide when and if this exam is appropriate for you. Your concerns matter and will help to shape your treatment approach.

Your physiotherapist will then develop a customized treatment plan using a variety of approaches such as manual therapy, pelvic floor muscle facilitation and exercise programs, soft tissue release and more.

illustration of muscles on pelvis skeleton

Understanding pelvic floor muscles

Your pelvic floor is made up of muscles, ligaments, nerves and connective tissue. Pelvic floor muscles are a group of muscles that connect the front, back and sides of the pelvic bone and sacrum. They act like a hammock or sling, supporting the bladder, prostate (in men), rectum and uterus (in women), while wrapping around the urethra, rectum and vagina (in women). These muscles contract to prevent your bladder or bowel from releasing and relax when you’re ready for such a release. Being able to relax these muscles also helps with sexual intercourse.

The pelvic floor also contributes to core stability and strength.  Your core functions as a dynamic container which can adjust intra-abdominal pressure. The top of the container is created by your diaphragm, the bottom by your pelvic floor muscles. The front of the container is the transverse abdominals and the back is made up of spinal muscles called multifidus. As a functioning unit your core muscles give support to the spine and trunk allowing you to accomplish many tasks during the day (lifting, pulling, pushing etc.) These pelvic floor muscles work towards good health on many levels.

With pelvic health dysfunction, these muscles can present as overactive (short and tight and possibly weak) or underactive (long and possibly weak) leading to issues of control in this area.

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Symptoms of pelvic health dysfunction

There are a range of symptoms you may be experiencing if you have a pelvic health disorder, such as:

  • Pelvic pain
  • Pain in the lower back, hips, groin, buttock
  • Leakage when coughing, sneezing, laughing or exercising
  • Repeatedly waking at night to urinate (nocturia)
  • Increased frequency of urination during the day, interrupting daily routines
  • Pain or discomfort during or after sexual intercourse or other types of sexual stimulation
  • Erectile dysfunction
  • Pelvic floor spasms
  • Heaviness or pressure in the pelvic area
  • Chronic constipation
  • Pain with bowel movements and/or urination
  • Unable to completely empty bladder

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Causes of pelvic health dysfunction

There are many factors that can cause pelvic health dysfunction, such as:

  • Weight gain
  • Aging
  • Pregnancy and childbirth
  • Chronic cough or sneezing (from chronic conditions or lifestyle habits, like smoking)
  • Heavy-lifting
  • High-impact exercise (i.e. CrossFit)
  • Surgery on your reproductive system (i.e. hysterectomy)
  • Neurological conditions (i.e. Multiple Sclerosis or MS)
  • Metabolic disorders (i.e. diabetes)
  • Constipation
  • Urinary Tract Infections (UTIs)
  • Kidney stones
  • Tumours

Conditions treated with pelvic physiotherapy

Pelvic physiotherapy can treat a range of symptoms and conditions caused by pelvic floor dysfunction. It can address your hypotonicity (weak pelvic floor muscles, commonly associated with stress incontinence) and/or hypertonicity (tight pelvic floor muscles, commonly associated with urge incontinence).

Physiotherapy can also help relieve painful symptoms from conditions like endometriosis (a painful condition that occurs when tissue normally lining the uterus grows on other pelvic organs).

man holding crotch has to urinate

Two types of incontinence

Urinary incontinence is a major concern with pelvic health. There are two main types: stress urinary incontinence and urge urinary incontinence. You can be experiencing both at the same time, but each requires unique treatment.

Stress urinary incontinence (SUI) is associated with leakage from coughing, sneezing, laughing or exercising. Weakened muscles in and around the bladder and urethra make them unable to contract and stop the flow.

Urge urinary incontinence (UUI) is getting the sudden urge to urinate and feeling like you can’t hold it. Your brain tells your bladder it’s time to squeeze, when it isn’t. Urge incontinence is a symptom of an overactive bladder, sometimes caused by a temporary blockage or chronic condition.

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Physio treatment options

Following an assessment, your physiotherapist will develop a treatment plan that may involve a variety of the following techniques:

  • Manual therapy: Your pelvic health physiotherapist will use hands-on manipulations like stretching, soft tissue massage and mobilization. They may combine this with various types of release techniques such as myofascial and trigger point release.
  • Exercise: Various exercises like stretching, strengthening, proper posture and breathing techniques will be used to target the pelvis, thorax and lower limbs.
  • Hypopressive exercise: Using specific postures and breathing techniques, your therapist will have you create a lower pressure system in the abdomen and pelvic area, then activate your pelvic floor muscles. It’s helpful with urinary incontinence and pelvic organ prolapse.
  • Electrical muscle stimulation (EMS): Electrical impulses are used to activate the pelvic floor muscle, helping them contract and strengthen. 
  • Biofeedback: An electrical or mechanical device is used to give auditory or visual feedback on the use of your pelvic floor muscles, helping you identify how and when to activate muscles more effectively.
  • Percutaneous tibial nerve stimulation (PTNS): This neuromodulation stimulates the posterior tibial nerve at the ankle through an acupuncture needle that’s connected to electrical impulse device. It’s used to treat an overactive bladder, as well as symptoms of urinary urgency, urinary frequency and urge incontinence.
  • Bladder and bowel tracking: Going over your daily routines with your therapist will help you establish healthy bladder and bowel habits.
  • Education: Understanding the fundamentals of pelvic health will help you track symptoms and deal with chronic pain.
  • Pain relief: Your therapist may also provide pain relief with hot/cold treatments, trans-electrical nerve stimulation (TENS), breathing techniques and more.

woman doing hip lift exercise on a mat

Building pelvic health: Exercises you can do at home

Your pelvic health physiotherapist may also teach you at-home exercises you can do to strengthen or relax your pelvic floor and surrounding muscles, helping your recovery in between sessions. Exercises may include:

  • Kegels (works pelvic floor)
  • Squats (works glutes, hamstrings, quadriceps)
  • Hip bridges (works glutes, hamstrings, pelvic floor)
  • Split tabletop (works abs, hips, pelvic floor)
  • Bird dog (works abs, back, glutes, hips)
  • Knee folds (works pelvic floor, lower abs, inner thighs)

Always consult with a doctor or physiotherapist before doing exercises for pelvic health, to ensure you are targeting the correct areas. Otherwise, you could accidentally make your symptoms worse.