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Floating around the system: the lesser known story of men’s pelvic health

Janet Davis B.Sc, PT

I became interested in male pelvic health when I encountered orthopaedic and post-surgical patients that weren’t improving with the typical manual techniques I had used in the past.

At the time, I didn’t realize the impact of medical interventions and emotional issues had on their ability to heal and resolve their symptoms.

 

Three years of pain

I’ve encountered situations like this far too often; Joe is a great example of an all too common situation. He was referred from the pain clinic with chronic abdominal pain radiating into the right thigh, penis and scrotum with intermittent urinary retention, coccyx pain and reported issues of fear of going on long trips because of extended sitting.

Symptoms had started three years before, after a routine inguinal hernia repair where the mesh was rejected. Due to the penile and scrotal pain, there was a full year with urologists taking every diagnostic test, all of which were reported as being normal. After one and a half years, he was referred to the pain clinic. There, he was prescribed various narcotic pain medications and nerve blocks with improvement in his symptoms or activities of daily living.

Exercise, including stretching, made him feel worse. He reported feeling constantly stressed; exercise had previously been his strategy to relieve these symptoms.

After a full pelvic health assessment and explanation of how a tight pelvic floor and secondary upregulated central nervous system correlated with his symptoms, he felt relieved to finally be starting a treatment that made sense to him. 

After a few treatments, his symptoms were reduced. This made him feel hopeful enough to start planning the Cuba vacation he postponed three years ago.

He continued to work very hard with the team and was discharged, pain-free, after four and a half months. He resumed his previous exercise routine and went on that long awaited vacation with his wife.

 

The same old story

Joe’s story isn’t unique. Because of my past interest in sports, I have treated many athletes: from rugby, tennis, running and cycling. Because I’ve worked in a sports and orthopaedic environment, I’m used to men discussing health concerns with me.

One of the most common experiences I’ve heard is that, like Joe, a male patient will have been in pain, floating around the medical system, visiting every specialist he can, looking for answers. This process can take anywhere from one to five years before they finally make it to our clinic.

Their constant pain has usually taken its toll on their family relationships, work, and has resulted in long term pain medication complications. When they finally arrive at physio, their conditions are usually far more chronic. Generally, the patient will be surprised to learn that he has a pelvic issue, but thankful that he finally has an answer to his pain. From treating enough of these patients, I’ve felt motivated to promote more awareness of male pelvic issues – and how physio can help.

 

The Men’s Health team

While I began my career as a Sports Physiotherapist and Manual Therapist, my interest grew in treating pelvic health until I decided to pursue my pelvic health education through Pelvic Health Solutions. This education has been useful in my work at Club Physio Plus, where we treat patients from all over Southern Ontario.

Part of my role includes treating pelvic health patients referred from chronic pain clinics, urologists, gynecologists, family doctors and physiotherapy colleagues.

I started to notice that men were making up 60 to 70 per cent of my pelvic health caseload. These numbers continue to rise as referral sources realize that pelvic health physiotherapy is an important part of the rehabilitation and resolution of symptoms in men's health issues.

Pelvic health can be complex and challenging – and therefore satisfying. I have had to educate myself on different procedures such as nerve blocks, abdominal surgeries and their effect on myofascial tensions, to name a few. This area of physiotherapy allows me to use all aspects of my training.

These experiences with my male patients have motivated me to team up with some of our physiotherapists and other health professionals to develop a Men's Health team at Club Physio Plus. The group consists of a team of clinicians who provide complete care for the pelvic health patient and the chronic pain patient. We treat pelvic health, lymphatic massage, acupuncture, biofeedback, osteopathic techniques, and cognitive behavioural therapy.

 

Common male pelvic issues

The most common men's issues we treat include:

  • Stress incontinence stemming from complications from prostate surgery
  • Medical conditions such as multiple sclerosis (MS), and
  • Weak pelvic floor muscles  
  • Chronic tight pelvic floor muscles causing coccyx, pelvic/abdominal pain, penile and scrotum pain is also very common. 

These conditions often involve the genitofemoral, and ilioinguinal and pudendal nerves. Digestive and bowel issues quite often are seen as a primary or secondary issue. 

Symptoms usually start with a traumatic event such as a work injury, surgery, or infection. However, conditions can also stem from longstanding pressure from poor posture and repetitive work or sporting activities.

Secondary symptoms of an upregulated central nervous system can be the component of the problem that is often missed by the medical system and can often be the reason the patient does not get pain resolution with typical pain meds and nerve blocks.

 

What men should know about physiotherapy

Pelvic health physiotherapy can be helpful in resolution of symptoms at any stage of symptom investigation.  

Close communication with other health professionals gives the patient reassurance that they are on the path to recovery.

For instance, we are starting to get a lot of patients referred in before prostate cancer surgery. They are taught how to use their pelvic floor muscles to help prevent post-surgery incontinence, and how to use deep pelvic breathing for pain management and mobilization of the abdominal scar tissue. 

I’ve treated some of these patients for sports injuries. That sense of existing trust and comfort in this type of clinical atmosphere helps to reduce the upregulating of the central nervous system issues that can contribute to depression and anxiety.

When men are actively participating in their pre-op program, it also empowers them and helps them reduce the anxiety associated with the cancer and the surgery. 

 

About Janet Davis B.Sc, PT

Janet began her career as a Sports Physiotherapist and Manual Therapist and continues to travel internationally to competitions as the Physiotherapist for National Level Rhythmic Gymnasts; she has a special interest in athletes with dance and gymnastic injuries. She has been involved in many sports such as rugby, tennis, and triathlons.

She has been a Stott Pilates and CALA aquatherapy instructor and certified acupuncturist for 20 years, and utilizes these skills, plus her manual therapy approach, to provide a comprehensive and customized treatment for her patients.

Janet is fully certified by Pelvic Health Solutions in the assessment and treatment of Pelvic floor dysfunction of both males and females. She developed the Club Physio Plus Pelvic Health Program which consists of a team of clinicians providing complete care for the pelvic health patient and the chronic pain patient.

Janet continues to keep current with her clinical tutoring in the University of Toronto Rehabilitation Department, Can Fit Pro Presenter, and CALA Presenter and continues to increase her knowledge to maximize the outcomes of her patients.

Follow Janet on Twitter at @clubphysioplus