Everything you need to know about Men's Health Physiotherapy

14th January 2019

Written by: Jessica Frydenberg (Men's Health Physio)

What is a Mens Health Physiotherapist?

Men’s Health (MH) Physiotherapy is a specialised area of Physiotherapy, focusing on pelvic health. Typically, Physiotherapists are thought of as therapists who treat the muscle and bone system of the body, correcting movement issues and rehabilitating patients following an injury. This is called a Musculoskeletal (MSK) Physiotherapist. A MH Physio is likely to assess and treat your muscle and bone system too, however has specialist training to treat muscle dysfunctions of the pelvic floor. For example:

  • Bladder dysfunction – such as urinary incontinence (loss of urine), urgency to empty your bladder or poor flow and difficulty emptying your bladder.
  • Bowel dysfunction – such as constipation or loss of bowel control.
  • Sexual dysfunction – such as premature ejaculation or erectile dysfunction.
  • Pelvic pain – such as pain at the tip of the penis, testicular pain or pain above the pubic bone.
  • Pre/post surgery (TURP or Radical Prostatectomy).  

Pelvic floor dysfunction in men is more common than you think, and can be very distressing for people. Our MH Physio understands the personal nature of these conditions, and you will be treated with empathy and sensitivity.

Here at the White Hart Clinic, we are lucky to have a MH Physio who works closely with GPs, urologists and pain specialists to improve your symptoms. If you suffer from a pelvic floor dysfunction, do not suffer in silence.

What can I expect at my first appointment?

At your first consultation, you will be asked about your condition and are likely to be questioned about your pelvic health generally. For example you may get asked about your bladder, bowel, and sexual health or if you suffer from any pain symptoms. Your session will then be guided around your personal goals and what you are hoping to achieve from physiotherapy.

Following this, you are likely to have an assessment of your muscle function. Some people will have an assessment of the global muscles and joints around the pelvis to ascertain any weaknesses there. However, the majority of patients require a pelvic floor assessment, which can be done as an external or internal (per rectal) assessment. This is only performed when you are feeling comfortable.

Do I have to have an internal examination?

The pelvic floor muscles are a complex set of muscles that sit between the pubic bone and tailbone at the base of your pelvis. The most accurate way of assessing the muscle function of the pelvic floor is to perform an internal examination. Therefore, if your symptoms indicate that there may be a dysfunction in the pelvic floor muscles (that is, weakness or tightness), an internal examination is likely to be offered to you at your appointment. Your MH Physio will not perform a pelvic floor examination if you are feeling uncomfortable or do not consent to the assessment. It is important to note, that if at any point you want the examination to stop, just tell your MH Physio and the assessment will be ceased immediately.

Which parts will you examine during a pelvic floor assessment?

The external assessment involves observation of the pelvic anatomy including the perineum, scrotum, penis and anus. During the assessment the MH Physio may ask you to cough, strain or perform a pelvic floor contraction to observe what movements occur around these areas to help determine if the muscle is functioning normally/abnormally.

The internal assessment will predominantly involve palpating the deep muscles of the pelvic floor and deep internal hip rotator.

Will it hurt?

An internal examination should not cause you pain, however it does in some cases. If the assessment is causing you pain, please make your MH Physio aware and the examination may be stopped. If you present with pelvic pain symptoms or it appears your muscles are tight during the external exam, you may not have an internal assessment, as it is more likely to be painful.

I think I’m going to be really uncomfortable with this but I know there’s an issue I need help with – what else can you do?

Thankfully there are other ways a MH Physio can help you without performing a pelvic floor examination. You may have an assessment of the global muscles around the pelvis, or have an ultrasound scan of your bladder to see how well the muscles are moving through this assessment technique. Your MH Physio will always talk through any concerns you may have and will only perform a thorough pelvic floor assessment if / when you feel comfortable.

What will you teach me?

Depending on what we find during the assessment, we might work on the breath, implement a pelvic floor muscle training (or relaxation) program, stretching / strengthening exercises, self release work and educate you on what you present with – whether that be bladder, bowel or pain education. Therefore, a whole range of things may be discussed and that will all depend on what is found during the assessment.

How many sessions will I need?

It all depends on your presentation. We will discuss and agree on a management plan with you, set realistic goals and from there a guide on the number of sessions may be more predictable. Sometimes one session is enough, often 4-6 sessions are needed, and for others, they require more sessions. We always work towards managing the condition at home, including a home program, however, this sometimes needs ongoing support.

What type of things will you get me to do at home?

Everyone is different, and will therefore get a different set of home exercises. However, most people will get pelvic floor muscle strength or relaxation exercises, diaphragmatic breathing or strength / stretching exercises. Depending on your presentation, we may ask you to keep a bladder diary, give you exercises for bladder retraining or a routine helping you to empty your bowels.

How much does treatment cost?

The first 1-hour assessment is £95, and a half an hour follow up is £65

Should I go to the loo before I see you?

It’s important not to get into the bad habit of going to the toilet “just in case”. So, if you need to go before the assessment, go. If not, there is no need to go to the toilet prior to seeing your physio.

Why are you so passionate about this area of physiotherapy?

Having control over your bowel and bladder function, having pleasurable sexual function and being pain free around the pelvis is important for your quality of life. Despite that approximately 30% of men who visit the GP have bladder symptoms, only a few seek help! Please know that if you are suffering with a pelvic floor symptom to speak to your health professional, and if you’re comfortable your friends / family, as together we can improve your symptoms and subsequently quality of life.

How bad do my symptoms need to be to make a session worthwhile?

The session can be worthwhile for anyone, even without obvious symptoms. A screen can be a good preventative measure, to ensure you’re drinking enough and urinating / defecating normally. If you do have symptoms, even if you believe they’re mild, it is definitely worth educating yourself and implementing strategies to improve your condition.

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