About 25% of the people Shari Berthold, PT, DPT, sees as a pelvic floor physical therapist are men.
Some see her for help gaining urinary control after prostate removal for prostate cancer. She teaches them muscle retraining, including Kegel exercises.
But there’s another group of men who also need pelvic floor physical therapy. And often, they don’t know it.
“Men with chronic pelvic pain syndrome are an underserved group,” says Shari, a UPMC Rehabilitation Institute physical therapist in Williamsport, Pa. Many of these men have chronic prostatitis, and “often, they’ve been given antibiotics, which aren’t effective.”
This is because most of the time, their prostatitis isn’t from an infection — it’s related to a pelvic floor muscle problem.
Unlike after prostate removal, the issue isn’t that their pelvic floor is weak. Instead, it’s far too tight, which causes a whole host of symptoms. In addition to pain, tight pelvic floor muscles can lead to urinary frequency, weak urine stream, and sexual dysfunction.
“Prostatitis can happen to one out of every two guys his lifetime,” Shari says. “It’s a very common problem, but men are embarrassed to talk about it sometimes.”
Shari wants to change that because men’s pelvic floor dysfunction is a highly treatable condition.
What Is Prostatitis?
Prostatitis is an inflammation of your prostate gland. The symptoms men notice most include:
- Pain when peeing or ejaculating.
- Groin or genital pain.
- Abdominal or low back pain.
- Trouble peeing (peeing too much, having a weak stream, or difficulty starting the stream).
Types of prostatitis
There are four types of prostatitis.
- Acute bacterial prostatitis — This rare type tends to happen in men in their 20s and 30s. Antibiotics are the best treatment for it.
- Chronic bacterial prostatitis — Also rare, this tends to affect men 30 and older. Antibiotics can treat it, too.
- Chronic prostatitis — The most common type, also called chronic pelvic pain syndrome. Instead of an infection causing pain, the muscles around the prostate do. Chronic pelvic pain syndrome can affect men of all ages, and antibiotics won’t help.
- Non-symptomatic inflammatory prostatitis — This type usually doesn’t have symptoms, and a doctor might find it while testing for something else.
If a man had an infection in the past, their primary care doctor might assume it’s another infection. Hence, they might prescribe antibiotics again without running a urine test. When the symptoms don’t go away, the doctor may refer them to a urologist.
At UPMC, the urology team works closely with the pelvic floor physical therapy team. “That’s often when we get involved with muscle training,” Shari says.
What Are Male Pelvic Floor Exercises for Prostatitis?
“Pelvic floor muscle training is about learning fine motor control of the pelvic muscles,” Shari says.
A healthy muscle contracts, relaxes, and lengthens. You need to do all three of these things with your pelvic muscles. Too often, men keep those muscles constantly contracted.
Tight muscles can spasm and cause pain and inflammation. All that tension can irritate the bladder, which can irritate everything nearby. “Everything is neighbors with everything else down there,” she says.
This can cause pain in any of the nearby organs, as well as urinary and bowel movement problems. It’s a cycle because the pain makes you contract your muscles. Constantly contracting only worsens the pain and inflammation.
It helps when she shows the muscles involved via ultrasound. The men she treats can see on the screen how a muscle responds to coughing, lifting, or taking deep breaths.
Her goal is to help them learn how they can control these muscles through a host of muscle identification and relaxation exercises. “Often, men are bracing their entire core,” she says.
What Causes Chronic Pelvic Pain Syndrome in Men?
Sometimes, the problem stems from the way men lift heavy weights. It’s an overuse of their glutes, made worse by tight hamstrings, abs, and hip rotators.
Other times, it’s a chronic stress response to whatever is going on in their life, and Shari plays detective. “I try to find out if they have anxiety,” she says. “How their sleep is, their work life, their home life, their overall stress.”
She takes a bio-psycho-social approach, trying to understand the whole picture. Sometimes, this is as simple as doing too many squats and not enough stretching, leading to overly tight muscles. But other times, it’s also a combination of personal, work, family, or financial stress — when you’re stressed, you clench, tighten, and tense.
From a physiological standpoint, she can teach breathing, relaxation, and stretching techniques within a few sessions. “Most guys feel better within about 12 weeks,” she says.
Shari may also refer people to counseling/behavioral therapy to help keep the problem from recurring.
What About Kegel Exercises for Men?
Kegel exercises involve squeezing the muscles you use to hold in urine or stop a bowel movement. You hold the contraction for five to 10 seconds and then repeat 10 to 20 times, several times a day.
Male Kegel exercises are very helpful for men who’ve had a prostatectomy to treat prostate cancer. Berthold teaches these types of exercises to men post-surgery.
But Kegels are the last thing a man with prostatitis should do. Pelvic floor exercises for men focus on relaxing, stretching, and letting the tension go.
How Do I Know if I Have an Enlarged Prostate or Pelvic Floor Dysfunction?
With age, your prostate can become enlarged. It starts putting pressure on your urethra and weakens your stream. That’s not a pelvic floor dysfunction issue.
However, without treatment, the enlarged prostate can cause other problems. Your bladder has to contract harder and harder to get urine through. The bladder wall gets thicker and tighter.
Medically, your doctor can prescribe medicine to relax the prostate and open the tube. But a pelvic floor PT can also offer behavioral strategies, although an enlarged prostate isn’t a primary reason to see a specialist like Shari.
“With enlarged prostate, you want to treat medically first,” she says. “If that doesn’t help, a PT can teach other strategies.”
As for how to tell the difference? An enlarged prostate is consistent and progressive, she says. “But if the problem comes and goes, it means the muscles are sometimes relaxing and sometimes not. And that is a pelvic floor issue.”
Don’t Put Up With Chronic Pelvic Pain Syndrome
“Just talk to your doctor and get a proper diagnosis,” Shari says. “Treatment really isn’t that complicated or expensive. It doesn’t require surgery, and often, it doesn’t even require medicine.”
Learn about pelvic floor physical therapy or find a UPMC Rehabilitation Institute location near you.