The healthcare system and research has focused greatly on female pelvic health, including pelvic physiotherapy for those suffering from incontinence and pelvic pain pre and post-partum. Pelvic floor dysfunction, however, affects men as well. From incontinence post urological surgery, erectile dysfunction, chronic constipation and pelvic pain, men can also benefit from internal pelvic floor physiotherapy.
Urological Chronic Pelvic Pain Syndrome (UCPPS), a relatively new term, describes all pain syndromes associated with the bladder and the pelvic floor in both men and women. These may include:
- Bladder pain syndrome
- Interstitial cystitis
- Chronic prostatitis
- Chronic pelvic pain syndrome
New research is indicating that abacterial chronic prostatitis and chronic pelvic pain syndrome have less to do with the prostate but may in fact be more related to shortening, tightening or spasms of the pelvic floor musculature in men. In one study, over 95% of cases with UCPPS had no significant inflammation in the tissues of the prostate (Prostate histopathology and the chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. True LD et al. J Urol.1999). There are however, small trace amounts of inflammatory markers known as cytokines, found in all cases. In these cases infection is ruled out and researchers are concluding that these inflammatory markers may be secondary to neurogenic inflammation or inflammation of the pelvic nerves. This neurogenic inflammation is caused by over stimulation of the nerves of the pelvic floor which may be due to pelvic muscle spasm. These sensitized nerves release a substance that may irritate the urogenital tissues and worsen pelvic muscle spasms ultimately creating symptoms of UCPPS.
Research has also indicated there are some individuals who are more prone to hold their stress and anxiety in their pelvic floor musculature, similar to how some hold stress in their neck. Again, the persistent contraction of the pelvic floor may irritate the nervous system and urogenital tissues. This constant muscle spasm may also have an effect on the bladder, producing urinary frequency and urgency as well as referring pain to the bladder and urethra. Furthermore, an inability to relax these muscles can decrease flow rate, cause pain during urination or incomplete emptying of the bladder.
If one is unable to relax the pelvic floor musculature, the trigger points and sensation of pelvic pain can feedback into the central nervous system (spinal cord and brain) creating a chronic pain state. Pelvic floor physiotherapy, can help relax the pelvic floor musculature and break the pain cycle. With the use of manual therapy, mindfulness/imagery and exercise, pelvic floor physiotherapy can help to reduce symptoms of pelvic floor dysfunction and chronic pelvic pain in men.