Men’s health is an area of physiotherapy that is gaining momentum and the evidence base is expanding quickly.
Physiotherapists have been successfully helping women with pelvic floor dysfunction for a long time. Men’s Health Physiotherapy is now slowly gaining momentum. With more research being done every year we are realising that interventions focused on the pelvic floor muscles can help with a variety of pelvic problems in men. Cohen et al, 2015 published a literature review that introduces the readers to the basic functional anatomy of a male pelvic floor, its relationship to sexual function and how pelvic floor muscle rehabilitation can help.
The Role of the Male Pelvic Floor Muscles in Erectile Function
An erection occurs due to a complex interaction between the vascular system, the parasympathetic, sympathetic, somatic and central nervous system with hormones and the muscular system also playing a significant role. An erection occurs when blood flows into the corpus cavernosa (tubes within the penis) faster than it can leave the penis and a closed hydraulic system maintains the erection.
All the pelvic floor muscles (superficial and deep) have shown to be active during the period of an erection and orgasm. The ischiocavernosus helps to maintain the rigidity of an erect penis and fast contraction of the bulbospongiosus muscles are important for ejaculation.
The role of the prostate gland has on erectile dysfunction is often overlooked, in particular the impact of prostate cancer surgery. Treatment options for Prostate Cancer all have their advantages and disadvantages but impacted sexual function is a common side effect regardless of the treatment approach taken. This is due to the close relationship of the prostate with the nerves, vascular structures and muscles that control an erection as well as other aspects of sexual function such as ejaculation and orgasm. Damage to these structures during surgery or from radiation therapy can result in debilitating sexual dysfunction that can negatively impact a man’s quality of life.
Sexual Dysfunction after Prostate Cancer
Muscular Dysfunction in Erectile Dysfunction
The pelvic floor muscles can become weaker or hypoactive or they can have a higher resting tone which is known as a hyperactive pelvic floor. Both can affect erectile function indifferent ways. Pelvic floor muscles can become weaker with age and inactivity. They can also become hypoactive from nerve damage such as post prostatectomy. If they are under active they will not be able to help maintain an erection or allow for ejaculation and orgasm. Pelvic floor muscles can become hyperactive in men with Chronic Prostatitis and Chronic Pelvic Pain Syndrome, This results in a higher resting tone or “tight” pelvic floor. It is thought that the when the pelvic floor muscles have a resting tone that is too high it may compress the lumen from the outside which will limit the blood flow to the penis thereby affecting the erection.
Retraining and Exercise
There is more and more evidence coming out that pelvic floor muscle retraining can be very effective in treating erectile dysfunction. A detailed assessment by a suitably qualified physiotherapist will determine if the pelvic floor muscles are playing a role. The most important part is to determine if the pelvic floor is hypoactive or hyperactive. Giving pelvic floor exercises will significantly improve erectile function in someone with an underactive pelvic floor but will make a hyperactive pelvic floor much worse. Men with overactive pelvic floor muscles need to work on down-training or relaxing their pelvic floor muscles rather than strengthening.
Kegel’s exercises are a great first step to take in learning about retraining and strengthening the pelvic floor.
How to Do Kegel’s
Find the right muscles:
- To identify pelvic floor muscles, stop urination in midstream. These are pelvic floor muscles. On contracting the pelvic floor muscles while looking in the mirror, the base of penis will move closer to abdomen and testicles will rise.
- Squeeze the ring of muscle around the anus as if you are trying to stop passing wind. Now relax this muscle. Squeeze and let go a couple of times until you are sure you have found the right muscles. Try not to squeeze your buttocks.
Perfect the technique: Once identified, empty bladder and lie on back with knees bent and apart. Tighten pelvic floor muscles, hold the contraction for three seconds, and then relax for three seconds. Try it a few times in a row but don’t overdo it. When muscles get stronger,
Progression:Try doing Kegel exercises while sitting- on a flat surface/ dynamic surface, standing or walking
Maintain focus: For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises. Repeat 3 times a day. Aim for at least three sets of 10 repetitions a day [4]. Increase the contraction time upto 8-10 sec.
Additional Tips:
- Quick contractions: After doing the slow contractions described above, do 5-10 very quick contractions (squeezes). This may help prevent an accident by quickly stopping urine leaks
- Remember to keep abdominal (stomach), back, and leg muscles relaxed during Kegel exercises. Feel only the muscles between legs (pelvic muscles), around anus, contracting. Try not to hold breath while doing these exercises
Clinical Lessons
While the ability to achieve and maintain an erection is multifactorial, pelvic floor musclesplay a vital role. Pelvic floor muscle training has been shown to be an effective therapy in the treatment of erectile dysfunction. They could even be the missing link for some men that are struggling and have tried other interventions.
This post was originally published April, 2019 and written by Mandy Roscher. The page has now been updated for freshness, accuracy and comprehensiveness.
References
- Cohen D, Gonzalez J, Goldstein I. The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Sexual medicine reviews. 2016 Jan 1;4(1):53-62.
- Rudolph E, Boffard C, Raath C. Pelvic Floor Physical Therapy for Erectile Dysfunction—Fact or Fallacy?. The journal of sexual medicine. 2017 Jun 1;14(6):765-6.