June is a busy month for health awareness and included both Men’s Health Week and World Continence Awareness Week. The question is – How can a chartered physiotherapist impact on men’s health and incontinence?
Chartered Physiotherapists see lots of musculoskeletal issues that effect men i.e. hip pain, knee pain, lower back pain which we know can be really useful. However, specialist pelvic health physiotherapists can look after issues of the male pelvic floor which is a not commonly known fact. And, yes men have pelvic floors! Unfortunately, hundreds if not thousands of men in Ireland suffer with pelvic floor related issues and don’t seek or maybe don’t know how to get the appropriate support. These men maybe suffering from chronic pelvic pain, urinary or faecal incontinence, frequent or urgent voiding or erectile dysfunction. A lot of these conditions can be as a consequence of prostate cancer surgery and treatment. This lack of awareness, embarrassment to discuss such issues or poor education from healthcare professionals means a lot of men suffer in silence with these which can lead to social isolation.
To maintain continence the muscles in the pelvic floor work along with the prostate and the sphincter to collapse the tube that carries urine from the bladder preventing leakage. However, the surgery and treatment for prostate cancer changes the dynamics as to how continence is maintained. In a lot of cases the treatment for prostate cancer is to remove the prostate completely meaning the pelvic floor muscles have to work harder and therefore need to be stronger to maintain the continence and prevent leakage. The floor of the pelvis is made up layers of muscles working like a hammock to support the pelvic floor from the tailbone at the back to the pubic bone at the front. These muscles can have two different fibre types – fast and slow twitch which have slightly different functions and need to be exercised differently. Therefore, it is really important to have a specific exercise program that is individualised to the persons symptoms and what their goals are.
Seeing a specialist Chartered Physiotherapist both before and after your prostate surgery or other cancer treatments can be really helpful in reducing the incidence and time effected by urinary incontinence and erectile dysfunction. The research has shown that if pelvic floor training was commenced prior to prostate removal, the man becomes drier sooner after surgery. However, it is good to remember that it is never too late to start regardless of how long these problems have been an issue. Exercises to strengthen the pelvic floor muscles can be easily taught by a pelvic health physiotherapist, worked on daily and progressed as required.
Tips for pelvic floor health;
- Learn where your pelvic floor muscles are and how to contract them properly. Get a rehabilitation program that is appropriate to your ability and work with a chartered physiotherapist to progress this achieve your goals.
- Maintain a healthy weight and eat a balanced diet. Your diet should be rich in non-processed foods and fibre as this will help avoid constipation. Constipation can put pressure on the bladder and make urinary problems worse.
- Exercise regularly to maintain a healthy weight and this will also help with bowel function.
- Avoid caffeine as this is a bladder irritant. Caffeine is found in tea, coffee, chocolate. Try cutting down or change to decaffeinated drinks.
- Alcohol can increase the amount of urine produced therefore making the bladder and pelvic floor work harder.
- Avoid carbonated, fizzy or acidic drinks. Water is the best drink followed by herbal teas, decaffeinated options.
- Drink plenty of fluids every day – aim for two litres (average 6-8cups). Not drinking enough water will make the urine more acidic therefore causing more irritation.