Pelvic Floor Physical Therapy Isn’t Just for Women
Did you know? Pelvic floor disorders don’t just happen to women after childbirth. They cause bladder leaks in the male population, too. That’s why we interviewed Kristen Maike, a pelvic floor physical therapist at Beaumont Health Center’s Adult Physical and Occupational Therapy practice in West Bloomfield, Michigan. Experienced in treating bladder leaks in both men and women, she shared the typical causes of urinary incontinence in men and a pelvic floor therapy approach for treating it.
Maike told us that men don’t typically seek pelvic floor physical therapy for several reasons. “Men are much less likely to talk about it. They’re scared. They don’t know what it’s going to be like. They’re more embarrassed than women and they finally come to us when they don’t want to deal with that embarrassment anymore.”
Most Bladder Leaks are Treatable
“There’s a perception that leaks are a normal part of aging or a normal part of prostate health; that if they have prostate issues or surgery, they’ll automatically have leakage. Most of the time now, the surgeries are very ‘nerve-saving.’ The reality is that bladder leaks are typically caused by a muscle weakness or inefficiency.”
When working with her male patients, Maike always requests that they start with a full medical exam. “We have to make sure their bladder and prostate are healthy, then we approach urinary incontinence from a few different perspectives.”
A pelvic floor physical therapist like Maike will typically discuss lifestyle and dietary intake during the initial appointment. For example, cigarettes, alcohol, caffeine, citrus fruits and dehydration all contribute to urine concentration, which can cause bladder irritation and lead to both urinary frequency and urgency.
“We also talk about how often they are going to the bathroom. Your bladder is run on reflexes, so you can train your bladder to hold more or less liquid. If you’re urinating every hour, you’re training your bladder to hold less,” Maike explained. “The opposite is true, too. If you continually hold your bladder, then it gets too full. As you’re constantly making urine and drinking liquids, you get a bigger bladder. At some point, that amount of fluid and pressure will overpower the strength of the urethral sphincter and you’ll leak.”
Why Do Men Leak?
When it comes to the pelvic floor, there are two primary reasons for leaks – a neurological deficit or muscle weakness.
A neurological deficit happens when the nerve signal to the pelvic floor muscles isn’t strong enough. It can happen with back issues, nerve compression or anything else that disrupts the communication between the brain/spinal cord and the muscles.
Muscle weakness can be caused by either disuse or too much use. It sounds conflicting, though if muscles get weak, or alternately, muscles get too shortened or tight, they can’t contract the urethral sphincter muscle enough to hold back the flow of urine.
“With men, we see a lot of tight pelvic floor muscles, especially with high stress careers or lifestyles,” Maike explained. “When someone has a high stress lifestyle, or they’re always afraid of leaking, they may hold their urine. We call them ‘butt clenchers’ because they’re typically under high stress and subconsciously hold their muscles really tight. Part of our treatment is bringing that habit to a conscious level so they can relax.”
Those tight pelvic floors are just one of the reasons that doctors and physical therapists don’t tell everyone to “just do Kegels” on their own. “We need to make sure that they’re doing them correctly or they could make things worse for themselves,” Maike shared. “We teach them about the functions of the pelvic floor and how to isolate it.”
Maike told us that most of the patients she sees are dealing with more than one issue that contributes to their leaks, “A single issue is a rare find.”
“When a man comes in, he may come in for dribbling or because he can’t start his stream. As we talk, I find out he’s also having some urgency, pain and more. Unless he’s had prostate surgery, it usually points to nerve or muscle issues with contributing behavioral issues like diet, holding their urine all day or butt clenching.”
The First Appointment
Maike starts her new patient intake with an interview, asking them to complete a bladder diary over two or three “typical days. Then we have a discussion about what may be contributing to the leaks.
“People do what they’re ready for, so my stance is ‘how much of a lifestyle change are you willing to make? How ready are you to try something different?’ For example, nobody wants to give up coffee, so I suggest they try it with cream or drink equal amounts of water at the same time to dilute the irritant. I make it my mission to have a huge bag of tricks to give my patients so that they’re able to – at least – try something to make a difference.”
To assess the function of the pelvic floor muscles in men, Maike does a manual rectal exam so she can feel the pelvic floor and determine if there is pain or tightness in any of the muscles. Then she does a surface Electromyogram (EMG) test. The EMG stickers are placed on the skin above the muscles that connect to the pelvic floor. These stickers are then connected to a computer, which measures the nerve impulses to the muscles. This form of biofeedback is used to teach the patient to do Kegel exercises properly.
Why You Should See a Specialist
“If a patient is having any kinds of issues – pain, constipation, sexual or urinary dysfunction – it’s very important that you see a specialist, a doctor, or a pelvic floor physical therapist. In those cases, doing Kegel exercises on your own can either worsen or prolong the leaking problem,” Maike advised. “It’s really not a big deal. We make you NOT feel crazy. I’ve never had a patient regret coming to see me. They’ve been nervous. They have varying degrees of improvement. And they may not eliminate all of their symptoms. But everyone says they wish they would have come to us sooner.”
And for a little extra motivation? Maike tells us that men who get pelvic floor physical therapy usually improve their sexual function, too.
What about you? Have you tried pelvic floor physical therapy? How did it work for you?
Kristen Maike PT, WCS is a board-certified clinical specialist in women’s health with a concentration in pelvic health. She has been a physical therapist for 25 years with 16 years as a pelvic floor therapist at Beaumont Health System. Kristen treats men, women and children with abdominopelvic and pelvic floor dysfunction including incontinence, pelvic pain and sexual dysfunction.