Men's Pelvic Health
DID YOU KNOW….
1 in 9 Men suffer from Pelvic Floor Dysfunctions?
Physiotherapy can help with
- Post-Prostatectomy Incontinence
- Erectile dysfunction
- Pain including Chronic Prostatitis, Testicular and Penile pain syndromes
- Nocturia (frequent urination at night)
- Symptoms of retention which can often be associated with Benign Prostatic Hyperplasia (BPH) and/or a tight pelvic floor
- Chronic Constipation
A recent Meta-Analysis indicated that beginning a pelvic floor muscle training program before radical prostatectomy and immediately after catheter removal can significantly improve urinary incontinence (Journal of Urology 2021)
1 in 7 men will develop prostate cancer during their lifetime and 59% will have urinary leakage after surgical removal of the prostate.
The Cause of Urinary Leakage in this population is primarily due to RADIATION FIBROSIS (Tissue stiffness/increase rigidity and decreased elasticity) of the following areas:
- Muscle – compromised contractility and control of PFMs
- Urethra – Fibrosis/ Stiffness
- Vascularity – mucosal vascular changes
- Bladder – Fibrosis/ Stiffness ( decreased bladder capacity and decreased bladder volume at first urge 18 months post RT)
- Surrounding tissues – Connective tissue/scarring ( impacts mechanics of PFMs)
BUT EXERCISE MAY BE THE SOLUTION TO PREVENT FIBROTIC CHANGES IN PFMs AND MANAGE INFLAMMATION
- CPPS or Non Bacterial Prostatitis is the most common urologic diagnosis in men older than age 50 years and is the third most common diagnosis in men younger than age 50 years.
- The Pudendal nerve is the main nerve supplying the genitalia, bladder and rectum can become irritated due to prolonged cycling and/or sitting
- Is the result of the kidneys filtering too much bodily fluids
- High blood pressure and cardiac disease increase demand on kidneys
- Sugar and Sodium cause an increase in fluid retention for 2 hours before the kidneys will start to filtering the fluid. Therefore pay attention to what you are eating in your last meal before bed.
- Taking beta blockers can also influence bladder capacity, however we can’t change this one because patients require this medication to manage their disease
- Alcohol can significantly affect one’s sleep which inhibits the release of necessary hormones that prevent urine production through the night
VACUUM ERECTION DEVICES (VED’S) – PATIENT INFORMATION
Intended Audience : Post Prostatectomy Patients
- This treatment has been shown to be highly effective, regardless of what’s causing the erectile dysfunction (ED).
- Reported satisfaction rates vary between 35% to 84%.
- Can be a useful addition to PDE5i (Viagra, Cialis), and/or injection therapy following removal of the prostate, also known as a Radical Prostatectomy (RP).
- Work best if the man has had one or both nerves sparred during the surgery
- Improved results can occur when both parties have a positive attitude towards its use and receive sufficient instructions.
- Should be started 1-2months following RP.
- Penile Traction Therapy using VEDs can maintain the length of the penis by possibly improving erection mechanisms and preventing structural changes.
- Starting to use a VED one month after a RP can improve sexual function in the early stages and maintain the length of the penis through a process known as traction therapy.
Toussi, A., Ziegelmann, M., Yang, D., Manka, M., Frank, I., Boorjian, S. A., Tollefson, M., Köhler, T., & Trost, L. (2021). Efficacy of a Novel Penile Traction Device in Improving Penile Length and Erectile Function Post Prostatectomy: Results from a Single-Center Randomized, Controlled Trial. The Journal of Urology, 206(2), 416–426. https://doi.org/10.1097/JU.0000000000001792
Köhler, T. S., Pedro, R., Hendlin, K., Utz, W., Ugarte, R., Reddy, P., Makhlouf, A., Ryndin, I., Canales, B. K., Weiland, D., Nakib, N., Ramani, A., Anderson, J. K., & Monga, M. (2007). A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy. BJU International, 100(4), 858–862. https://doi.org/10.1111/j.1464-410X.2007.07161.x
- Bleeding disorders such as excessive bleeding, blood clotting/clumping, and sickle cell anemia.
- Concurrent anticoagulant therapy – taking more than one medication that helps prevent blood from clotting.
- Anastomotic Dehiscence – medical term that refers to the separation or opening up of a surgical connection between urethra (the tube that carries urine from the bladder out of the body) and the bladder neck after the prostate gland has been removed.
Possible adverse effects include:
- over-stretching/micro-tearing of the penile tissue
- Local pain
- Failure to ejaculate – for men who still have their prostates.
- Coldness of the penis
- Urinary leakage can occur during use of the VED if urinary control has not been achieved following RP
- Altered sensation
- Dysorgasmia (pain or discomfort during or after orgasm)
- Petechia (Small flat purple circular marks that appear on the shaft of the penis)
The VED constriction ring should not be worn for more than 30 minutes to prevent possible irreversible damage, and a break of at least 60 minutes should be taken between uses to allow full restoration of the penile blood supply. If a condom is to be worn, is should not be used during the vacuum process, but put on as a last step. It is also recommended that you consult your health care provider to rule out any underlying serious pathology. Please also note that if you have Peyronie’s disease (a curve or bend in the penis that results from the formation of plaque or scar tissue inside the penis) this device may not be suitable for you.
Children's Pelvic Health
Children’s Pelvic Health
DID YOU KNOW….
25% of all pediatric visits are for bowel and bladder dysfunctions?
The most common pediatric referrals are for:
- Constipation (Encopresis)
- Daytime or Bedwetting (Enuresis)
- Urinary Dyssynergia
- Hirschsprung’s Disease
- Imperforate Anus
For a diagnosis of Function Constipation, a child must posses 2 or more of the following:
- Two or fewer defecations per week
- at least 1 episode of incontinence per week
- history of retentive posturing or excessive volitional stool retention
- history of painful or hard bowel movements
- presence of large fecal mass in the rectum
- history of large diameter stools that may obstruct toilet
The longer FC goes unrecognized the less successful the treatment. Incontinence is one of the most common presentations of FC in children (up to 84%). Sometimes referred to as False Incontinence
The repeated passage of feces in inapproprate locations. Incontinence must occur at least once a month for a minimum of 3 months. The child must be at least 4 years of age.
53% of constipated children have non-relaxation or pradoxical contraction of the anal sphincter during attempts at defecation, associated with poor abdomino-pelvic muscle recruitment patterns. This is known as rectosphincteric dyssynergia. 17% of these cases are victims of sexual abuse.
A rare congenital disorder that affects a small part of the lower colon due to a lack of appropriate neurological input. The area behind the constriction becomes swollen and predisposed to the over accumulation of feces or inappropriate evacuation efforts. This occurs more often in boys.
Absence of sphincteric relaxation at micturition. When advanced, can cause bladder diverticulum, reflux, trabeculation. May lead to: Dysuria (painful or uncomfortable micturition), Overflow incontinence or Cystitis (inflammation of bladder).
AKA. Atresia, prevalence: 1/5000 births. More boys than girls. Lesion may be high or low. Congenital defect e.g. Currarino syndrome.
- Infra-levator. Puborectalis, striated and smooth anal sphincter are present.
- Supra-levator. Rectum, internal sphincter and vasculo-nervous bundles are absent. Puborectalis and striated sphincter are hypoplasic. Prognosis for continence less favorable.
SIGNS THAT CHILD IS READY TO POTTY TRAIN
- Having a BM around same time each day
- No BMs at night
- Dry diaper after a nap
- Dry diaper for at least 2 hrs at a time
- Gross MOTOR Signs
- Ability to low squat
- FINE motor Signs
- Able to do fasteners (buttons)
- Able to pull down pants/underwear
- Emotional Readiness
- Child must have an emotional stake in toilet training. If they don’t, try and increase their desire to do so. If child has an accident, have the child take the diaper and empty it in the toilet to reinforce positive behaviours
Women's Pelvic Health
DID YOU KNOW?
- 1 in 3 women suffer from urinary leakage
- 50% of women suffer from pelvic floor disfunction
- 30-50% of women have a minor pelvic organ prolapse, after vaginal delivery
Although these conditions are common, they are NOT normal at any stage in one’s life.
- Kegel exercises are performed incorrectly in over 30% of women
- Women in France are given 6 Pelvic Floor Physiotherapy sessions following childbirth.
Incontinence happens when the pelvic floor muscles (PFMs) are no longer strong enough to support the urethra (tube that carries urine out of the body) and bladder. The PFMs contract during coughing, sneezing and exercise to prevent leakage. However, after pregnancy and vaginal birth, or an extended period of obesity, chronic coughing, chronic constipation and heavy lifting the pelvic floor muscles become weaker and render them insufficient to maintain continence.
Pelvic Floor Physiotherapy should be your 1st line of defense before diapers, drugs or surgery.
If you have a sensation of heaviness, pressure or bulging in the vagina, or urinary symptoms such as a slowed stream, a sense of incomplete emptying, frequency and urgency with urination or bowel symptoms whereby you have difficulty evacuating stools and you sometimes add pressure on the vagina to help fully empty the rectum, then you may be experiencing a POP.
After vaginal delivery or once a woman reaches her post-menopausal years, the muscles, ligaments and fascia that hold the pelvic organs in their optimal positions become weakened. This can result in the descent of the pelvic organs and produce the various symptoms mentioned above.
POP affects approximately 1 in 3 women who have had more than one child. However, surgery is only ever necessary for 1 in 9 women and Pelvic Floor Physiotherapy can help the others. Reducing the amount of pressure acting on the pelvic floor muscles is a strategy that can certainly help reduce the intensity of your symptoms. Some examples include, weight loss, smoking cessation as this can result in chronic coughing, increase fiber/water/exercise to manage chronic constipation, learn appropriate heavy lifting techniques and avoid straining to evacuate stools or empty your bladder.
A urinary tract infection (UTI) can occur in the kidneys, bladder or urethra. It is often caused by the bacteria E.Coli as this bacteria is often present in the rectum. Due to the closeness of the vagina to the anus, these bacteria can easily entre the urinary system and cause symptoms of burning, frequency and urgency with urination. UTI’s are more common in sexually active women, during pregnancy, after surgery and post-menopause. The hormonal changes that occur during these times can increase a woman’s susceptibility to experiencing a UTI.
On the other hand, a large number of women will have ruled out the presence of an infection and will continue to experience frequency and urgency. This may likely be a result of the state of the pelvic floor muscles, in which case pelvic floor physiotherapy is an excellent option for determining the cause of your urgency and frequency
There are several different bodily systems that can contribute to the experience of pain during intercourse. These include; the muscular, hormonal, immune and nervous systems. Therefore, a detailed history taking will be necessary to reveal the systems contributing to your pain experience. A physical examination can further help reveal the source or cause of your pain. Some of the conditions to consider include the following:
- Genitourinary syndrome of menopause (GSM)
- Pelvic Inflammatory Disease
- Obstetric trauma (during delivery)
- Bladder or urethral pain syndromes
- Muscular Spasms
- UroGynecological Surgeries (hysterectomy/C-section)
The miraculous beauty of becoming pregnant and delivering a child is a unique experience for women. However, the beauty of this experience can sometimes be complicated by several factors and result in less than favorable outcomes. Delivering a child naturally is no easy feat and deserves the appropriate coaching and preparation. Learning the various ways that one can minimize their risk for obstetric trauma can enhance the experience. Proper prior planning prevents poor performance!
If you are currently pregnant book an appointment today to better prepare yourself for your big day! Thereafter, be sure to have your pelvic floor muscles reassessed by a pelvic floor physiotherapist to prevent the onset of pelvic floor dysfunction.