While women have become increasingly aware of the importance of their pelvic floor muscles, and how physiotherapy can assist with the many related conditions and symptoms, the same isn’t true for men.

Yet, according to men’s health physiotherapist, Thomas Harris, there are several conditions that impact the male pelvic floor, with associated symptoms that would greatly benefit from targeted physiotherapy.

The most common is prostate cancer treatment, experienced by almost 17,000 men last year alone.

“Prostate cancer has a very high five and 10-year survival rate, meaning more men are living with the side effects of treatment,” says Ms Harris.

“One of the most common side effects is urinary incontinence, especially following radical prostatectomy (removal of the prostate), but also with radiation therapy.”

Pelvic floor muscle strengthening programs both before and after surgery have been shown to reduce both the severity and length of incontinence following prostatectomy.

Prostatitis is another common condition that can affect the pelvic floor muscles in men.

“Traditionally thought of as an infection, which can still be the case, if pain is persistent, it can often be due to overactivity of the pelvic floor muscles.

“We can also see pelvic floor changes in men with chronic coughs, chronic constipation, overactive bladder syndromes, and also erectile dysfunction.”

Research into the male pelvic floor is a long way behind that around the female pelvic floor, particularly in relation to the benefits of pelvic floor physiotherapy.

“Most of the knowledge around the male pelvic floor and when physiotherapy can be beneficial is still mostly related to men with prostate cancer.

“A lot of this has to do with most men only coming to know about their pelvic floor if they develop an issue with it.

“A significant number of women will learn about pelvic floor exercises when pregnant or after childbirth.

“For men, unless they develop symptoms and they are referred for pelvic floor physiotherapy, they often won’t learn a lot about their pelvic floor, except for the fact that it is working fine.”

Physiotherapists trained in pelvic health can assist men with numerous pelvic floor complaints.

This includes pre and post-operative pelvic floor training for men undergoing a radical prostatectomy, men with erectile dysfunction, bladder spasms, and other pelvic pain complaints.

“Men preparing for, or recovering from surgery will often be assisted by real time ultrasound pelvic floor muscle training, allowing men to visually see their pelvic floor muscles in action.
“Physios are also well suited to prescribing aerobic and resistance exercise to men with prostate cancer, undergoing varying forms of treatment, which is very important in improving and maintaining quality of life.”

Physiotherapists have an important role to play in men with persistent pelvic pain complaints, that may be related to pudendal neuralgia and/or chronic prostatitis (now known as chronic pelvic pain syndrome (CPPS)).

“These men will often need pelvic floor relaxation strategies and exercises, as well as an appropriate exercise program,” says Mr Harris.

“For men with erectile dysfunction, pelvic floor strengthening, and an aerobic exercise program can improve the condition.

“Each condition requires a detailed history taking of when the issues began, things that can make it better or worse.

“An objective assessment is then undertaken involving assessment of the pelvic floor and general mobility screen.

“Treatment is then determined on the outcomes of this assessment and discussion with the patient.”

While all physiotherapists graduate with a basic knowledge of the male and female pelvic floor, and can begin a general assessment and treatment plan, relatively few choose this field as a key area of interest.

The Australian Physiotherapy Association (APA) is currently finalising an education pathway to assist with upskilling more physiotherapists in this important area.

“In terms of specialist women’s, men’s and pelvic health physiotherapists, there are only a limited number across Australia, but a higher number of titled physiotherapists.

“There are also increasing numbers of physiotherapists who have been working in this field for a number of years who predominantly see men with pelvic health issues.

“But there is a growing need for more physiotherapists in this area who have been appropriately trained, particularly in rural and remote areas of the country.”

For Ms Harris, his decision to focus on men’s pelvic floor physiotherapy was made during university.

“We had around 10 to 12 hours of women’s health lecture content, but only one hour of men’s health lectures, of which less than a dozen male physios attended.

“During this lecture, we were instructed on how to activate the pelvic floor and I was left thinking, ‘if I’m about to graduate and I don’t know how to activate my pelvic floor, what help do the men on the street have?’

“We also had a close family friend have a prostatectomy a number of years earlier that profoundly changed him for the best part of a year.

“I wasn’t aware of it at the time, but he was heavily incontinent for the best part of that year, which has subsequent mental health issues.”
 
Since graduating, Mr Harris has completed a number of weekend courses in men’s health and works closely with a number of urolgosits.

“I am currently completing a graduate certificate in exercise medicine (oncology) at Edith Cowan University, and am working part time as a research assistant at UQ working on a large, randomised control trial on the role of pelvic floor training in men undergoing prostatectomy.

“And I’m also a member of the Queensland branch of the APA’s Women’s, Men’s and Pelvic Health committee.”

Mr Harris says he’d like to see more medical professionals get on board, to ensure men aren’t missing out on important and beneficial treatment.

“Often men will be referred to physiotherapy after numerous tests completed by their GP’s and/or urologists.

“And that is only if that clinician has formed a view that physiotherapy could assist.

“A significant number of men continue to miss out on being referred to an appropriate physiotherapist.”

Men can seek treatment from an appropriately trained physiotherapist by visiting https://choose.physio/find-a-physio and using the filter section.