Men's Health Physiotherapy Pelvic Treatment

Original Editor - Stacy Schiurring based on the course by Pierre Roscher
Top Contributors - Stacy Schiurring, Kim Jackson, Lucinda hampton and Jess Bell

This page aims to provide an introductory discussion of men's health physiotherapy assessment techniques. Please note that further training is required through a reputable pelvic health education company before attempting the techniques discussed in this page. See the Resources section at the bottom of this page for links to pelvic and men's health special interest groups.

Clinical Reasoning after Assessment

The physiotherapy assessment is the most critical parts of a therapist's interaction with their patient. Assessment and reassessment occurs every session to develop a detailed clinical picture to guide the creation of a treatment plan of care. Every patient's clinical picture is unique, therefore comprehensive and ongoing assessment will ensure that the patient receives effective and efficient physiotherapy management.

For a review of men's health physiotherapy pelvic assessment, please read this article.

Pelvic Floor Muscle Rehabilitation

Pelvic Floor Muscle Training is the essence of “functional fitness,” training muscles to help in practical life activities. Because of its simplicity, safety, and noninvasiveness, it should be employed as a first-line approach.

Pelvic floor muscle rehabilitation can encompass a variety of issues: muscle overutilisation, muscle weakness, muscle dysfunction and or poor coordination. As when training any muscle group, it is important to properly assess the dysfunction prior to beginning treatment to ensure the patient is receiving the proper therapeutic interventions. A muscle must have the appropriate length, strength, and neuromuscular control to function properly.

ADD VIDEO RE: muscle length/strength relationship

The muscles of the male pelvic floor are all skeletal muscles and are therefore adaptable. 70% of the pelvic floor muscles are slow-twitch type 1 (fatigue- resistant fibres that maintain static tone) and 30% are fast-twitch type 2 (fatigue-prone fibres that are capable of active contraction). This ratio can change with aging, inactivity, and nerve innervation damage.. To learn more about muscle fibre types, please read this article.

Pelvic Floor Strengthening

When pelvic floor muscle strengthening is indicated, exercises can be performed to improve muscle endurance and or muscle agility. It is important to match the type of muscle strengthening with the patient presented issue.Many patients require a combination of the two types of muscle strengthening. For example: a patient with urinary incontinence. If this patient has an issue with urine leaking throughout the day, this is likely a muscle endurance issue versus a patient who leaks urine with a forced exhalation such as a cough which is likely a muscle quick fire issue.

Pelvic floor exercises are all about technique. With optimal motor learning of the pelvic floor, there is more potential for improved continence and erectile function. When performing pelvic floor muscle strengthening, it is helpful to either palpate the muscle or utilize real-time ultrasound to provide the patient with feedback.

Verbal cues can alter the degree of observable motion in pelvic floor muscles. Commonly used phrases to help elicit male pelvic floor contractions are “shorten the penis”, “elevate the bladder”, “elevate the scrotum”, “stop the flow of urine” and “tighten the anus.” Stafford et al. conducted a study in asymptomatic participants and in patients suffering from incontinence the cues “shorten the penis” and “stop the flow of urine” were considered the best to target the specific muscles involved in urinary continence. A popular colloquial cue rather than “lift your scrotum” that men seem to respond well to is “nuts to gut.” This cue particularly targets the important lifting action of the pelvic floor.

1. Endurance or slow-twitch fibres: Establish a maximum effort contraction of the pelvic floor muscles. Have the patient hold a 20% max contraction for a set amount of time, such as 4 seconds. Gradually increase the 20%max hold to 6 seconds, 10 seconds, et cetera, allowing the patient to gain control and endurance of the pelvic floor muscles.
2. Agility or fast-twitch fibres: Establish a maximum effort contraction of the pelvic floor muscles. Have the patient hold a 80% max contraction for a set amount of time, such as 4 seconds then relax. Repeat the 80%max hold for 4 seconds for a set amount of repetitions to perform pelvic floor "flicks."
3. Pelvic floor muscle "cross-training": a combination of the above, for example: mix 80%max and 20%max holds for set amounts of time for a set amount of repetitions.

When performing these strengthening exercises, it can be helpful to provide the patient with a chart or graph with the expected %max holds, hold times, and repetitions outlined to service as a guide during the session. This can also be provided as part of the patient's home exercise program.

ADD VIDEOS OF ABOVE EXERCISES ON US?

Pelvic Floor Inhibition

Increased pelvic floor tone can be a source of pelvic floor pain and sexual dysfunction.There are multiple techniques that can be used to decrease pelvic floor muscle tone or tightness.

1. Stretching
2. Breathing
3. Mindfulness
4. Internal treatments
5. Hip joint mobility treatments

Patient Education and Self Management

Every patient is different, but never assume that a patient cannot learn anything new. Your patient may be on top of issues relating to incontinence and erectile dysfunction, or they may be entirely in the dark. Never assume anything.

Resources

• Siegel AL. Pelvic floor muscle training in males: practical applications. Urology. 2014 Jul 1;84(1):1-7.