1. Physio and the Male Pelvic Floor
Beyond the SIJ
Irmina Nahon

2. Damage to the pelvic floor
Direct injury Indirect injury
• Groin strains • Spinal
• Bicycle seats • Pelvic #
• Blunt force trauma • PS, SIJ injuries
• Surgery • Abdominal/visceral
• Overuse
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3. Anatomy of the Pelvic Floor
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4. Innervation of the pelvic floor
• Peripheral
– pelvic parasympathetic nerves
– lumbar sympathetic nerves
– pudendal nerves
• Autonomic Nervous System
– Pelvic parasympathetic nerves: S2-4
– Sympathetic nerves:T11 to L2
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5. Pain in the .......
• Presents as pain in
groin, flank, testis, penis, pubic
symphysis, SIJ, hip, abdominus, back....
• Can come from all those areas and more
• Information will not necessarily be
volunteered. It must be elicited
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6. Treatment of pelvic pain
Treat the cause of the pain
• Trigger points
• Down training
• Tight structures
– Muscles
– Nerves
• Impingement
• Exercises
No evidence is currently available
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7. Incontinence
Clients may not come to see you because of
incontinence but it may stop them from doing
what you prescribe
• Urgency
• Frequency
• Stress incontinence
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8. Causes of incontinence
• Insidious causes:
– life habits
– Constipation
– OAB
• Prostatic causes:
– Benign prostatic hypertrophy
– Prostate cancer
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9. Treatment of incontinence
• Refer to continence advisor for insidious
causes
• LUTS need to be assessed medically
• Pelvic floor exercises for post prostatectomy
incontinence
– Strengthening exercises
– Functional exercises
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10. Cues for correct PFMT
• What does it feel like to tighten them
– Feel for movement at the base of the penis
towards the body and the testicles rise
– Like stopping wind
– To stop after the last drop
– Pull your balls in, cold air on the gonads
– Stop the flow of urine
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11. PFMT: Evidence
• Cochrane review of 10 RCT’s Hunter ‘09
– level 1 strong evidence for positive effect of PFMT
• Recent RCT of 300 patients Filocamo ’05
– PFMT vs control group (homogenous grps)
– PFMT resulted in earlier return to continence:
• benefit significant at 3/12 (74% cf 30%) and 6/12 (96% cf 64%)
• Decreased effect at 12/12 (99% cf 88%)
• Further evidence: Burgio ’06, Sueppel ’01 Bales ’00
• Overall strong support for inclusion of PFMT in Mx of
PPI but further RCT’s required
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12. Erectile dysfunction
• Becoming a bigger issue as more and younger
men are diagnosed with prostate cancer
• Can also have other causes
• Affects c 1million Australian men of all ages
Andrology Aust, 2003
• Ischiocavernosus and bulbocavernosus are
active during erection and ejaculation
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13. Physio Treatment for ED
• 3 maximum strength contractions
• Holding for 10 seconds
• Performed in supine lying, sitting and standing
• 3 times per day
• ‘50%’ contraction while walking
• Slow, rhythmic contractions during sexual
activity.
Dorey 2006
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14. ED: Evidence
• Sommer et al ‘02; 124 men,
– 3 grps; PFE, Viagra and placebo
– At 3/12, PFMT group had improved more than
Viagra
• Dorey ‘04; PFMT vs lifestyle changes, at 3/12
PFMT group: 75% cured, 8.3% improved
• Glass ‘03; 80% improvement with PFX cf
sildenafil (74%) Control (18%)
• Claes & Baert, 1993; Van Kampen et al, 2003
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15. Conclusion
• Men have muscles in their pelvic floor too
• Injury and weakness can cause significant
problems
• Physiotherapists have skills and knowledge to
treat these
• Pain, incontinence and erectile dysfunction
can all be treated in the male pelvic floor
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