When I write about women's health, oncology (cancer related) and pelvic physio, it's a logical to assume that it's only women that we pelvic physios assess, treat and talk about. This is the first in a series of articles that will introduce you to the challenges that men face in their pelvic region, despite "being absolutely mortified to be discussing their private parts" (to quote Dr. Jo Milios, our lead teacher, a brilliant physio who had set up a non-profit organization in 2012 in Australia called PROST! Exercise for Prostate Cancer Inc.). Her passion is to educate all of us so that the everyday man on the street has better health outcomes and a much longer life.
Pelvic physiotherapy for men addresses loss of function in the pelvic region including prostate cancer pre-hab (prior to surgery and other treatments) and rehab, pelvic floor muscle dysfunction, urinary incontinence, painful urination, recurrent bladder infections, urinary frequency, bowel dysfunction, erectile dysfunction, chronic pelvic pain syndrome and Peyronie's Disease (a crooked or bent penis). Let's begin with the prostate. The prostate gland is a walnut sized donut shaped gland found right under the bladder and wrapped around the urethra (urine tube). Its job is to produce most of the fluid that makes up semen. The prostate can become inflamed (prostatitis, acute or nonbacterial) or enlarged (benign prostatic hyperplasia). Enlargement of the prostate doesn't mean it's cancerous and is usually noticed after age 40 during a regular doctor's visit. Prostate cancer is the most common cancer in North America and accounts for 11% of all cancer diagnoses in BC men; 1 in 9 males is expected to develop prostate cancer in their lifetime with 89% of them being over the age of 60 when they are diagnosed. There are some well known correlations (not causes) that may raise a man's risk of developing prostate cancer, including aging, family history, high levels of testosterone, being overweight, not exercising regularly and a poor diet. Large studies have shown that there is no correlation between having a vasectomy and prostate cancer. Yet again, Grandma's sage advice to exercise regularly, eat real good and maintain a healthy weight (for all cancers!) are actions that you can take to reduce your risk of developing prostate cancer. Your doctor (GP or urologist) or nurse practitioner may do a DRE (digital rectal examination) to palpate your prostate or you may have a PSA (blood test) to measure how much of a specific antigen is in your system. If you notice changes in your urination (stuttering flow, slow stream, painful, frequent, dribbling/double voiding, feeling the urge to bear down to start or finish, urge or loss of control, increased night time voiding or blood in your urine and/or painful ejaculation), please tell your doctor. Even though it's difficult or embarrassing to open up these conversations, your healthcare professional will want to know, will have had these conversations before and will make you comfortable sharing your story. Tell them! We pelvic physios become involved with men going through prostate surgery because most men (99%) will experience incontinence and erectile dysfunction. One of the prostate's secondary jobs it to support the bladder and to give neurological support of continence through the autonomic (involuntary) nervous system. The Cavernosal Nerves, responsible for erections, are wrapped around the prostate and they're usually damaged or removed in the process of the surgery. Each man will have varying degrees or severity and/or duration of physical side-effects of the surgery but please know that each man will generally improve over time. With pelvic pre-hab and rehab, complete resolution of both continence and sexual function is possible. It's all about restoring wonderful function and quality of life while reducing anxiety and depression, penile fibrosis and shrinkage and stopping the development of Peyronie's disease. Most importantly, men and partners who love men, talk with your doc if your experiencing pelvic dysfunction. In part 2 of this series, I'll share Dr. Milios' well researched brilliance after seeing >3000 men with radical prostatectomies, showing that, by using her protocol, men had less leakage (in amount and duration) with 1 in 6 men having no incontinence at all!
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