The discourse surrounding pelvic floor issues is often centered around women, and understandably so. After all, according to Natalia Susul, a physical therapist at St. Mary Medical Center, pelvic floor dysfunction—which can result in urinary incontinence, constipation and pelvic pain—is more commonly found in women than men. This is especially true postpartum, as childbirth can weaken the pelvic floor.
“Men have a prostate that helps structurally support the bladder and so, because of that support, it is much easier for them to maintain continence versus women,” Susul says.
Still, men aren’t without pelvic floor issues, with Susul treating male patients on a regular basis. The two main causes are benign prostatic hyperplasia (BPH), or an enlarged prostate, and prostate cancer.
Regarding BPH, Susul says, “In men, we tend to see frequency of urination at night or during the daytime, but usually it’s at night. The prostate has enlarged to the point that it’s limiting how much urine can be stored in the bladder.”
Thus, they feel the sudden, frequent urge to urinate and struggle to maintain control over their bladder. As for men who are diagnosed with prostate cancer, the two main options for managing it are surgery or radiation, both of which—especially surgery—can result in pelvic floor issues.
“Cutting out or removing the prostate with a prostatectomy leaves you dependent on the musculature for support of urinary control. That’s when we would see urinary incontinence issues typically,” Susul says, adding that men may also experience constipation and/or pelvic pain post-surgery.
Pelvic dysfunction is usually found in men who are 60 and older, when the prostate is more likely to become enlarged.
When working with these patients, Susul always completes an external exam of the pelvic floor and sometimes an internal exam as well. From there, it’s all about strengthening the pelvic floor through Kegel exercises, which involve tightening the pelvic floor muscles and aim to help with incontinence.
Susul also aids patients in bladder retraining, which slowly expands their bladder capacity if they are urinating too frequently.
“It’s normal to pee one time every two to four hours during waking hours, or one to two times at night when we’re asleep. What we do is, we get an average. Let’s say you’re peeing every hour. We try to progress it by 15-minute intervals, slowly trying to increase bladder capacity to get to about every two to four hours during waking hours,” says Susul.
The physical therapy team at St. Mary Medical Center typically sees patients with pelvic floor dysfunction for about six to 12 visits over a three-month timeframe. On average, it takes six to eight weeks for the muscles to start strengthening, though some patients may experience results sooner if their coordination is improving. Susul recommends that patients continue with physical therapy beyond these initial visits for at least four to six months to get the most benefit.
For any men who are experiencing pelvic floor dysfunction and feel scared or embarrassed to seek help, Susul urges them to do so. A urologist can diagnose or rule out prostate cancer and come up with a treatment plan accordingly, allowing the patient to get his life back.
“Go to a urologist. Check things out,” she says. “It never hurts.”