Written By: Dr. Danielle L. Moreau PT, DPT on October 24, 2022
People of all genders have pelvic floors.
Most pelvic physical therapists see a larger percentage of people with vaginas. This is because of the influence of pregnancy, childbirth, and conditions or diseases related to reproductive organs and tissues such as endometriosis, polycystic ovary syndrome (known as PCOS), or gynecologic cancers. However, people with penises also have pelvic floors and are a frequently overlooked population of pelvic physical therapy.
For the remainder of this article, we will take a deeper dive into pelvic physical therapy treatment for people who have penises. It is important to recognize that genitals do not equal gender. Medical providers, like pelvic physical therapists, have a responsibility to not assume gender based on a person’s anatomical parts. Therefore, I will reference external anatomy instead of gender throughout this article.
It may be surprising to learn that the anatomy of the pelvic floor muscles is remarkably similar for people with vaginas and people with penises. Both groups have pelvic floor muscles and have voluntary control of these muscles. While a contraction of the pelvic floor, commonly referred to as a “Kegel,” is typically thought of as a post-childbirth exercise, people with penises can voluntarily contract and relax the same group of muscles.
The outer layer of the pelvic floor muscles, those that lie just beneath the skin, are where we see the most differences. In people with vaginas, the muscles form a border around the vaginal opening whereas in people with penises, the muscles form the base of the penis itself. These muscles can be a source of genital pain and sexual dysfunction across all genders.
In the middle layer of muscles, we also see a slight difference in anatomy for people with penises. People with penises have a longer urethra (the tube through while urine and semen exit the body) compared to people with vaginas. They also have a prostate that sits between the internal and external urethral sphincters, which both control the flow of urine from the bladder.
Anyone with a pelvic floor can experience dysfunction in these muscles for a variety of reasons. These reasons may include, but are not limited to, direct injury or trauma, surgery, infection, cancer, chronic issues with bowel movements such as constipation, bowel leakage, painful hemorrhoids or fissures, or neurologic disease. Let’s explore some common diagnoses which tend to occur more in people with penises, and how pelvic physical therapy can help.
Prostate Cancer: According to the American Cancer Society, prostate cancer is the second most common cancer in American men, right behind skin cancer. Furthermore, one in eight men will be diagnosed with prostate cancer during their lifetime.1
A portion of people diagnosed with prostate cancer will undergo prostatectomy surgery, which is the removal of the prostate. It is extremely likely for people to experience bladder leakage, also referred to as urinary incontinence, after this surgery. Since the prostate itself serves as a bladder support and its removal impacts the internal urethral sphincter, the loss of this organ can decrease urinary control and cause leakage. Luckily, the pelvic floor muscles are completely capable of making up for this!
A pelvic physical therapist can offer exercises to improve awareness and coordination of the pelvic floor muscles so clients can more effectively use them during movements and daily activities, to avoid urinary leakage. Spoiler alert: these exercises aren’t just Kegels! A pelvic physical therapist can also teach clients to better manage the amount of pressure placed onto the bladder during movement, which is a common cause of leakage. Finally, physical therapists provide education about healthy bladder habits and lifestyle changes to reduce leakage. Combined, these treatment approaches can help survivors of prostate cancer ditch those pads and move forward in their lives without the fear of urinary leakage.
Prostatitis and Chronic Pelvic Pain Syndrome (CPPS): Acute bacterial prostatitis occurs when there is an infection within the prostate itself, which causes pelvic pain, urinary frequency, urgency, hesitancy, and burning, and can also cause a fever and chills. When someone tests positive for acute bacterial prostatitis, this needs to be addressed by a physician who can prescribe antibiotics to treat the infection. However, the same symptoms and pain can persist beyond the acute phase and without the presence of active infection. This is referred to as Chronic Prostatitis or Chronic Pelvic Pain Syndrome (CPPS).
According to a 2020 publication in the American Journal of Men’s Health, anywhere from 8-25% of men suffer from these persistent symptoms.2
Unfortunately, there is a lack of strong research for treatment within this population which has led to immense frustration by many individuals seeking symptom resolution. Recent recommendations state that an individualized approach carried out by a team of differently specialized providers is the most successful in treating the symptoms and impacts of prostatitis/CPPS.2 Pelvic physical therapy is an essential component of that team.
Patients presenting with chronic prostatitis/CPPS typically have increased tension in the pelvic floor muscles, which causes the pain to persist. Furthermore, the nerves in this region become very sensitive to threats of danger, meaning that pain may arise in the absence of actual tissue injury or damage. This also explains why individuals can experience persistent symptoms even once an infection has been fully treated. Pelvic physical therapists can treat both the muscular and fascial tissues that cause ongoing pain, as well as help clients find ways to calm the nervous system and decrease their pain. This can be achieved through myofascial release, exercise, relaxation and breathing, lifestyle changes such as sleep and stress management, and the supportive use of pain-relieving agents.
If you have seen multiple specialists for chronic pelvic pain or urinary tract symptoms with no resolution, please see a pelvic physical therapist!
Parkinson’s Disease: According to the Parkinson’s Foundation, men are 1.5 times more likely to have Parkinson’s disease than women.3 Constipation is a common complaint in people with Parkinson’s disease due to changes in the nervous system signals between the brain, the gut/digestive system, and the pelvic floor muscles. People with Parkinson’s Disease may also find themselves rushing to the toilet, only to produce a weak urine stream, or waking up several times per night to urinate, known as nocturia.
Pelvic physical therapists are uniquely and highly qualified to address these symptoms within this population. First, a pelvic physical therapist can help provide exercises to improve a person’s awareness and coordination of the pelvic floor muscles, which can help with both bladder and bowel symptoms. For constipation, it is important for people to learn how and when to relax the pelvic floor so that a bowel movement can pass easily. This can be achieved through exercise and postural adjustments during defecation. A pelvic physical therapist can also address the slowed speed of digestion that occurs because of Parkinson’s disease. Clients can learn ways to support the work of the colon through daily routines, lifestyle changes, and abdominal massage. For urinary symptoms, behavioral changes and relaxation techniques can help with rushing to the bathroom and decrease disruptive nighttime trips to the bathroom.
Spaulding Outpatient Rehabilitation of Care New England is currently offering pelvic health services for those with penises in the Providence and East Greenwich locations with Dr. Danielle Moreau and plans to expand these services to help more people with penises who are living with pelvic floor dysfunction!
To be seen by a pelvic physical therapist, you will need a physician referral. To learn more information or schedule an appointment, click here.
1. Key Statistics for Prostate Cancer. American Cancer Society. Updated January 12, 2022. Accessed September 7, 2022. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html
2. Zhang J, Liang C, Shang X, Li H. Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Disease or Symptom? Current Perspectives on Diagnosis, Treatment, and Prognosis. American Journal of Men’s Health. January 2020. doi:10.1177/1557988320903200
3. Statistics. Parkinson’s Foundation. Accessed September 7, 2022. https://www.parkinson.org/understanding-parkinsons/statistics
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