Spilling the secret: Men – and male athletes – need pelvic floor therapy, too
A Division I college football player was having hip issues that wouldn’t subside and, after multiple consultations with medical personnel, he was sent to a physical therapist who specializes in pelvic floor therapy – or pelvic health.
One of the questions she asked was whether he was experiencing erectile dysfunction. The 20-something athlete was flabbergasted and quickly responded, “How did you know?”
The physical therapist explained erectile dysfunction is common in men dealing with issues in the pelvic floor – the muscles that run from the pubic bone to the tailbone – and dysfunction there can be a contributor to back or hip pain.
His relief was twofold. One, there might be a new avenue to treat his injury. Secondly, when the therapist inquired about erectile dysfunction, he was terrified word had gotten out on campus about his sexual difficulties. He was thrilled she wasn’t following up on a rumor.
It’s a true story.
And a telling one in multiple ways.
Due to their sensitive nature, pelvic floor issues are often not at the forefront of medical conversations or diagnoses.
Secondly, they can be embarrassing to admit, especially for those at the pinnacle of masculinity: fit, male athletes in their late teens and 20s.
Additionally, sexual dysfunction and bladder- and bowel-control struggles are not discriminatory by age or gender. They can – and do – affect adult men and women of all ages.
An important men’s health component
Although men have come a long way when it comes to discussing their own mental and physical health, some issues are still a bit too personal. Men are not sitting around the bar or working out in the gym and chatting about their latest issues with constipation, urine leakage or sexual dysfunction.
Frankly, many doctors aren’t bringing it up, either.
June is Men’s Health Month, an appropriate time to address the natural and common ailments and disorders that can be improved with pelvic health physical therapy and why male (and female) athletes are particularly susceptible to issues in this anatomic region.
The pelvic floor is one of four sections of the body’s core: The diaphragm is at the top and is essential for breathing and serves as a core stabilizer; the transversus abdominis, the deepest abdominal muscle, is at the front and stabilizes the spine and protects internal organs; the multifidus are the muscles at the back of the core, along the spine; and the pelvic floor is at the core’s bottom.
The pelvic floor has five primary functions, all beginning with the letter S: support of internal organs; stability of the spine; sexual function; sphincter function; sump pump or circulating lymphatic fluid through the pelvis and torso.
When the pelvic floor, which is connected to the hip and back muscles, is too weak or too tight and doesn’t have full range of motion, the following issues may occur:
- Incontinence, bladder or bowel
- Urinary urgency
- Urinary frequency
- Difficulty or pain emptying bladder or bowels
- Constipation
- Erectile dysfunction
- Pain during or post-orgasm
- Genital pain
- Back pain
- Hip pain
Strengthening and training the core
Physical therapists specifically trained in pelvic floor issues – including our certified, pelvic health clinicians – understand the importance of those core muscles.
When some clinicians instruct patients to strengthen their core, they often focus on abdominal and back muscles. But strengthening the pelvic floor is equally important.
Athletes, in particular, tend to correlate core strengthening with abdomen work, ignoring the other core parts.
Pelvic health physical therapy focuses on strengthening exercises and can also include manual therapy if patients are experiencing spasms similar to what they’d encounter their necks or backs.
Another important element of pelvic health therapy – especially involving athletes – is assisting patients in correctly managing their breathing.
The common perception is athletes with pelvic floor issues, such as incontinence or leakage, are more likely to be runners or those involved in constant movement or abdomen stress, and that the issue is more prevalent in women.
One study of elite track athletes, indeed, showed 52% of women demonstrated some urinary incontinence, but 18% of men did as well. It’s not just runners or jumpers, either.
Lifting heavy weights can also be a major contributor to pelvic floor issues. Powerlifters and CrossFit athletes, in particular, are susceptible to pelvic floor dysfunction due to improper mechanics and breathing.
Many involved in heavy lifting – including high-level football players – don’t exhale properly during sets, holding air in and then pushing it down through their abdomens and into their pelvic floors, causing intense pressure and potential dysfunction. Pelvic health therapy can help patients manage that breath properly through exercises and education.
The goal is for the muscles and functions of a body’s core to work as one unit and move in concert, which would alleviate the need for one section to overcompensate for another, reducing the possibility of injury.
What to do if you think you have pelvic floor issues
Because the pelvic floor is the forgotten – or taboo – cousin of the core, athletes who are dealing with issues like incontinence or sexual dysfunction need to advocate for themselves – as embarrassing as those concerns may be to voice aloud.
The first step is being honest with yourself.
Are you experiencing urine leakage or constipation and do you just deal with it hoping it goes away? Well, it could be symptomatic of a more serious problem, and one that could be remedied with proper treatment.
Is your hip or back pain not improving no matter how many clinicians you see? Maybe it’s the pelvic floor that is directing the discomfort.
Once you accept your “private area” issues are real and limiting, go talk to a trusted medical professional: a team athletic trainer, a physical therapist or family doctor.
During that discussion, bring up your interest in trying pelvic health therapy. It may not be a medical professional’s first thought – diet and medication often are – but there is plenty of research showing the benefits of physical therapy for such issues.
Make sure you seek out certified, pelvic health specialists or your treatment. Pelvic health therapy is a burgeoning specialty, but the majority of physical therapists aren’t versed in it.
The bottom line is there is nothing manly about dealing with private physical issues when they are affecting your sport and your life. Because one embarrassing discussion with a medical professional can lead to a much smoother future – on the field and at home.