Pelvic Health Blog

Q&A for men: second edition

6/4/2019

While drawing from her clinical experience, Becca Ironside, PT answers specific questions from men about their urinary, bowel, and sexual concerns.

This is Connect PT's second edition of the Question and Answer series.

Question from Marc: I have premature ejaculation. It has been part of my life since I was sexually active at 16 years old and I am now 33. Is this something that can be helped by pelvic floor physical therapy?

Answer from Becca: Marc, I would imagine that you may have been treated by psychotherapists for your issue. In the last century, many specialists have placed premature ejaculation into the category of a problem of the brain. However, pelvic floor physical therapists now treat your particular diagnosis in an entirely different manner. What we have discovered in treating men like you, is that those who experience early climax often have tight musculature in their saddle muscles (the muscles of your body that would be in contact with the saddle of a horse, were you seated upon one). In the ideal situation of arousal, these saddle muscles should expand and allow blood to flow into the penis and testicles. This blood should be retained in this saddle area to allow for an adequate time span during arousal and penetrative sex before ejaculation. In the case of premature ejaculation, the muscles of this saddle region are taut and cannot allow accumulation of blood to pool in the testicles and penis, which then creates an emergency expulsion of the seminal fluid from the penis.

This condition of premature ejaculation is treated in pelvic floor physical therapy. We assist men in reaching longer time durations of their erections by teaching them to lengthen their pelvic floor (saddle) muscles. We also instruct patients and their partners to increase the time of arousal and defer climax, thereby encouraging the blood flow necessary to prolong the sexual experience. In answer to your question, Marc, you can find help with a pelvic floor physical therapist.

Question from Steve: I suffer from chronic constipation. While that is terrible by itself, I also find that I cannot get fully hard during sex when I am constipated. Am I imagining this, or is there a correlation between constipation and erectile dysfunction?

Answer from Becca: Steve, I wish that more of our patients made this connection between the bowel and sexual function. The organs that sit within the relatively small cavern of the bony pelvis in men are the bladder, prostate, and the end of the colon (rectum). These organs are crammed into a very tight space. Which means that when one of these organ systems is a little bit off, the other systems invariably feel askew as well!

When the bowel is impacted with stool, as it is with constipation, this organ presses on the prostate and then the bladder. Also, the pressure on the perineum (the saddle region we discussed in Marc’s case), is created by too much fecal matter accumulating in the bowel. This excess pressure inhibits a full sexual response and limits full erections in men. The long-term discomfort associated in prolonged constipation can also distance a man from wanting to engage in sex.

The solution: pelvic floor physical therapists treat bowel dysfunction. We educate our patients in how to improve bowel regularity with stretches, exercise and lengthening of the pelvic floor muscles. What we find in treating patients like Steve is that when regular bowel movements are achieved, more satisfactory sex follows!

Question from Chen: I have trouble urinating from time to time. Sometimes, I think I am done peeing, I pull up my pants, and then I dribble urine. I am only 25 years old. Why is this happening and what can help?

Answer from Becca: Chen, I wish that you would start an online social media feed about your problem! Because it is so common and so very easily addressed. Many men come to pelvic floor physical therapy with complaints of leaking after peeing, or what we refer to in our line of work as “the post-void dribble.” Guys think there is something terribly wrong when this occurs, and because they won’t talk about it, they don’t know that many other guys have exactly the same problem!

Many men stand up to pee in urinals. This is the cultural norm in our society. But for men with tight pelvic floor muscles, or even men with moderate anxiety in a public restroom, the bladder cannot completely empty when a guy is in a standing position or when there are other men around him. What happens in this case is that the bladder cannot fully relax and the urine within it will not completely drain from the pelvis. Many guys shake their penises to try to get excess pee out of it. But this technique doesn’t always work to sufficiently drain the bladder. Hence, the dribble occurs after you think you are done peeing, Chen, and so many other men like you leave the bathroom to return to the tavern or sports arena, because they never allowed their bladders to fully empty.

Here is what a pelvic floor physical therapist may tell you, Chen.

Sit down when you pee. Go into a stall and don’t worry about what your friends think. This will allow your bladder to fully relax and empty, which might prevent the post-void dribble entirely.
Instead of shaking your penis when you think you are done peeing, take your fingers and press up into the space between your anus and your scrotum. Swipe your fingers towards the front of your penis. This will get that lingering pee out before you pull your pants back up.
Don’t wear tight pants or boxer briefs. If you have this condition, skinny jeans may not be for you. This type of clothing creates tension in the pelvic floor and prevents the penis from fully draining pee.
While these suggestions sound ridiculous, they are extremely effective. Moreover, wouldn’t you rather get back to your game? Because you will get back to that game, and you won’t leak urine anymore!

Finally, for Chen and the vast number of guys like him, view this PDF for the technique on how to avoid the post-void dribble.

Sleep solutions

3/7/2019

By Karen Bruno, PT, DPT

Many of our patients report that they have difficulty getting a restorative night’s rest and they are not alone. In the United States, 50-70 million adults have a sleep disorder (1). Insomnia is one of the most common sleep disorders, with short term issues reported by about 30% of adults and chronic insomnia reported by 10%. 3–5% of the overall proportion of obesity in adults could be attributable to short sleep (1). Sleep disorders are a common complaint among people with pelvic pain and chronic diseases (2).

According to a recent article published in the American Journal of Physical Therapy, “Research continues to reveal that sleep is not a period of physiologic inactivity; rather, it represents a critical period of recovery that supports cardiovascular, neurologic, and other life functions. Sleep is a basic human need, and recent attention on sleep by researchers and media are changing sleep attitudes and behaviors. Sufficient sleep was often viewed as a luxury, and reduced sleep time was often equated with increased productivity; however, attitudes are shifting to prioritize sufficient quality sleep. Quality sleep is recognized as a positive health behavior, and it has been recommended to consider sleep as another vital sign, as sleep can give insight into the functioning and health of the body (3)."

You may have noticed that getting a good night’s sleep helps you to feel better both physically and mentally and this helps you function better during your waking hours. Basically, getting a good night’s sleep is a game changer that enhances the quality of your life. “Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, and learning and memory. Impaired sleep can lead to obesity, mood disorders, constipation and heart disease” (3).

https://www.sleepassociation.org/about-sleep/sleep-statistics/
https://academic.oup.com/ptj/article/97/8/826/3831304
Siengsukon CF, Al-dughmi M, Stevens S. Sleep health promotion: practical information for physical therapists. Phys Ther. 2017;97(8):826-836.

Tips for Healthy Sleep
There is good news! There are many natural ways to improve the quality of your sleep and restore your sleep health. Scroll through the list below and try one or more of the tips, and see how they work for you.

Decrease stress - Try diaphragmatic breathing to help you wind down and de-stress. Breathing full breaths in through your nose for 4 seconds and exhaling through your mouth or nose for 8 seconds is calming to the nervous system.
Create your bedroom space as a peaceful sanctuary - remove electronics, TV’s, exercise equipment and anything that may remind you of any form of work. Reserve your bed for sleeping and intimacy.
Get to bed in enough time to enable you to get 7+ hours of sleep. Create a relaxing bedtime routine. Read a book or take a bath to help wind down.
Establish regular sleeping and waking hours
Avoid light-emitting electronic devices at least 30 minutes to 2 hours before bedtime; use amber glasses at night when watching TV or working on a laptop.
Find the right temperature for your bedroom. The general recommendation is to keep the bedroom temperature between 60-70 degrees.
Sleep in complete darkness. Use of an eye mask may be beneficial to keep light out. Use earplugs or a white noise machine to block out noises.
Consider applying a hot pack to your abdomen. This can be very calming. Keep the hot pack on for no more than 20 minutes. If you tend to have cold feet, wrapping a hot pack around your feet for 10-20 minutes can be warming and relaxing.
Consider using essential oils. Lavender, Roman Chamomile and Vetiver provide relaxing effects and calm the nervous system. You can diffuse them, put the oils on your pulse point, rub them on the bottom of your feet, lightly spray them on your pillowcase or add them to an Epsom Salt bath and take the bath before bedtime.
Find a comfortable, supportive, neutral sleep positions. Use of a neck roll or a lumbar roll, or a pillow between your knees when you are on your side as positioning supports.
Avoid taking naps to catch up on sleep.
Exercise can have a positive effect on deep sleep. Find the time of day that works best for you. Stretching, strengthening, yoga, aerobics or a combination of activities may be right for you.
Avoid alcohol, caffeine and other inflammation-causing foods, like sugary snacks, refined carbohydrates, or processed meats, late at night.
Support through vitamins and supplements may be useful. Please check with your doctor, nutritionist, pharmacist or herbal practitioner for what may be right for you. Some common sleep nutrients include ashwagandha, valerian, chamomile, passion flower, lemon balm, melatonin, L-theanine and 5-HTP or Tryptophan. GABA is helpful if sleep is disturbed by anxiety. Taurine and phosphatidylserine help to lower cortisol. Magnesium and magnesium glycinate are helpful in insomnia.
Move your energy through easy Energy Medicine exercises.

Energy medicine is a safe and natural way to manage your energies to meet the stresses and anxieties in your life by optimizing your energies to help your body and mind function at their best. This approach acknowledges your unique complex nature and how your whole body is connected. From the energy medicine perspective, sleep problems are seen as an energetic imbalance that can be resolved by activating the body’s natural healing ability to restore balance.

I hope you will join me on Wednesday, March 20, 2019 at 6 pm in our Hamilton office to learn some of these easy and gentle self-care Energy Medicine techniques. Get a jump start and sign-up by calling 609-584-4770 for this free presentation.

Did you know: nighttime urination

3/8/2018

40-70% of older adults suffer from insomnia, and the greatest cause for disturbed sleep is having to urinate in the middle of the night (nocturia). Read about it in the Journal of Clinical Sleep Medicine.

Contact your doctor if you are urinating more than once per night to see if medical conditions, medications, or food can be contributing factors. Otherwise, your local pelvic physical therapist may be able to help!

Perineal hygiene 101: how do I keep it clean?

1/15/2018

Written by Michelle Dela Rosa, PT

Keeping the perineal area clean is so important, especially for women, who are more susceptible to infections. Our skin is covered by a thin layer called the acid mantle, or barrier against microorganisms and anything that could make it too alkaline. It is our first line of defense against infection. Over-cleaning the vagina disrupts the pH balance with things like: douches, strong soaps, and wipes. We can also clog sweat glands and create dryness with items such as: deodorants, talcum powder, and antiperspirants.

So what’s the answer ladies? Water and mild soap. That’s it! The perineum can be patted dry afterwards. Read more to learn about conditions that can influence pH.

How Often Should I Be Peeing?

11/9/2017

Do you ever wonder if you are traveling to the bathroom too often – or too little? Six to eight times per day is the norm. That’s right, if you’re urinating above or below that:

Step 1 - Make sure you’re drinking close to the recommended eight cups of liquid per day.
Step 2 - See your doctor to rule out infection or other medical issues.
Step 3 - If medical tests come out negative, see your pelvic PT!

Did You Know: Urinary Void

6/6/2017

A healthy urinary void should last at least eight seconds with a moderate to strong stream.

A shorter void could be a sign of dehydration or going to the bathroom too often.

Did you know: yoga during pregnancy

12/8/2016

Connect PT therapists incorporate yoga into physical therapy for expectant mothers. Yoga is a well-known practice that provides exercise and mindfulness. A systematic review by Curtis et al (2012) suggests that yoga during pregnancy can lead to better outcomes for pregnancy, labor, and birth. The study reports that it may improve a mother’s “stress levels, quality of life, aspects of interpersonal relating, autonomic nervous system functioning, and labor parameters such as comfort, pain, and duration.”

Kathryn Curtis, Aliza Weinrib, and Joel Katz, “Systematic Review of Yoga for Pregnant Women: Current Status and Future Directions,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 715942, 13 pages, 2012. doi:10.1155/2012/715942.

Did You Know: Diastasis Recti Abdominis

10/20/2016

Diastasis Recti Abdominis (DRA) is an abdominal wall separation between the rectus abdominis muscles. 66% of expectant mothers have a DRA in the 3rd trimester. 53% continue postpartum, of which 36% remain at 7 weeks. A study by Coldron in 2008 showed that a DRA present at 8 weeks postpartum was still present at 1 year postpartum. Connect PT therapists can help reduce this separation with specific exercises, functional training, manual therapy, and taping.

Did You Know: Quercetin

12/14/2015

Quercetin, an antioxidant and anti-inflammatory, has been associated with a decrease in male pelvic pain in a double-blind, placebo-controlled trial (Shoskes et al 1999). Subjects given Prosta-Q (quercetin + bromelain and papain for intestinal absorption) reported up to 82% improvement in pain – better than quercetin alone (Herati et al 2013).

Herati A, Moldwin R. Alternative therapies in the management of chronic prostatitis/chronic pelvic pain syndrome. World J Urol. (2013) 31:761-6.

Shokes D, Zeitlin S, Shahed A, Rajfer J. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology. 1999 Dec:54(6):960-3.

Did You Know: Musculoskeletal Deficits

7/20/2015

Pelvic or lower abdominal pain can vary from person to person. Some common symptoms include: pain in the pubic bone, tailbone, or buttock; painful intercourse; urinary frequency; and/or painful bowel movements. Connect PT therapists are trained to perform an evaluation and determine if musculoskeletal deficits may contribute to symptoms of pelvic pain.

Did You Know: Fiber

1/28/2015

According to Medline Plus, the average American consumes 10-15 grams of fiber each day, well below the recommended 20-35 grams for adults. Fiber is an essential part of digestion, as described in an article by Eswaran et al (2013). The authors discuss how it influences the speed of digestion and stool consistency. Psyllium had the highest level of evidence as an effective dietary fiber supplement.

Adding fiber too quickly into the diet can cause discomfort, bloating, and abdominal gas. A fine balance is important for people with bowel dysfunction.

Eswaran S, Muir J, Chey WD. Fiber and Functional Gastrointestinal Disorders. Am J Gastroenterol. 2013 Apr:108:718-727.

Did You Know: Dehydration

5/13/2014

75% of Americans are chronically dehydrated. The signal for thirst is so weak in 37% of Americans that it is often mistaken for hunger. Even mild dehydration can slow metabolism up to 3%. Low water intake is the number one reason for daytime fatigue. One glass of water can halt night-time hunger cravings almost 100%.

Experts recommend drinking 1600 mL of liquid (~ 54 oz) every 24 hours, requirements that may vary according to a person’s size and activity level. Water is preferred, with other liquids substituted in moderation. Other signs of dehydration may include: headaches, muscle and joint soreness, dark urine, constipation, and kidney stones.

(The Importance of Water. Wilmette, Illinois: The Simon Foundation for Continence, 2014. Print.)

Did You Know: Vulvodynia Stats

6/2/2013

More than half of women with symptoms of vulvodynia do not seek medical care. Of those that do, less than 2% of them are given an accurate diagnosis.

(Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc. 2003 Spring;58(2):82-8.

Reed BD, Harlow SD, Sen A, Edwards R, Chen D, Haefner HK. Relationship between vulvodynia and chronic comorbid pain conditions. Obstet Gynecol. 2012;120:145-51.)

Did You Know: Smoking and Urinary Urgency and Frequency

11/18/2012

Thinking of kicking the habit? Women who smoke are three times more likely to have urinary urgency and frequency than women who have never smoked.

(Tahtinen RM et al., “Smoking and bladder symptoms in women”. Obstet Gynecol. 2011 Sep; 118(3): 643-8.)

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