Has your fella started sprouting a new look reminiscent of a 70’s gym teacher? Movember is an annual event involving the growing of mustaches to raise awareness of men’s health issues including prostate and testicular cancer. This modinth, we are taking the opportunity to discuss some of the pelvic health issues affecting men. Yes, men have pelvic floors too! Many people associate pelvic floor physical therapy being for women, but men have a lot of similar anatomy and can also suffer from pelvic floor dysfunction. Their symptoms may include pelvic pain, erectile dysfunction, urinary frequency/urge and constipation. Men can additionally experience symptoms related to the prostate gland which is more common with age. In this blog, we will go through the anatomy and function of the prostate, common diagnoses and some tips to keep your prostate (or your spouse’s prostate) healthy.
The prostate is a walnut sized gland which sits right below the bladder in men. It has ducts and glands surrounding it which aid in ejaculation and urination. The urethra runs from the bladder, through the prostate and to the tip of the penis. Both men and women have urethra, however, the male urethra also carries semen. The prostate, along with bladder sphincters, block the entrance of urine from passing during ejaculation. One of the main roles of the prostate is to add fluid to the semen which is very important for the survival of sperm on its way to fertilize an egg. This fluid makeup allows the sperm to be more mobile, provides energy source for the sperm, and alkalizes the fluid to withstand the acidity of the female vagina. The prostate also assists in forcefully expelling ejaculate via muscle contractions. From a hormonal point of view, the prostate breaks down testosterone into its bioavailable counterpart DHT, or dihydrotestosterone. DHT is important for secondary sex characteristics like facial hair, deep voice, etc.
By age 50, most men have some sort of benign growth of the prostate, called Benign Prostatic Hyperplasia (BPH). This can be diagnosed through a blood test looking at PSA (prostate-specific antigen) or a digital rectal exam. Prostatitis occurs when the prostate becomes inflamed or infected. Both of these situations can narrow the urethra as it passes through and make urination difficult, strained or painful. It may also lead to “stop-and-go” urination or the feeling of incomplete bladder emptying. Most men aren’t aware of any prostate abnormalities until it impacts urination or ejaculation.
Prostate cancer is the most common form of cancer in men after skin cancer, according to the American Cancer Society. 1 in 9 males will be diagnosed in their lifetime. There are various procedures which can help to diagnose cancer, including blood tests, biopsies, ultrasounds and MRI. Many patients and providers choose to treat conservatively with close monitoring and lifestyle modifications. Fortunately, prostate cancer tends to advance much slower than other cancers. If the cancer spread or prostate growth is impacting bladder function and quality of life, there are surgical options as well. A prostatectomy is the process of removing the prostate. These procedures can also be accompanied by chemotherapy, radiation and hormone therapy.
The prostate, in addition to adding fluid to semen, aids in continence. According to the Cleveland Clinic, up to 8% of men will develop urinary incontinence following a prostatectomy. In this case, it is important to note how beneficial and necessary pelvic floor physical therapy can be before and after surgery involving the prostate. With one strategy of urinary continence removed, we often have to compensate with strong pelvic floor and sphincter control. Treatment may include manual therapy to address any scar tissue buildup, trigger points and exercises to strengthen and coordinate the deep core muscles (which includes the pelvic floor). These symptoms can be improved with pelvic floor muscle strengthening and home programs.
As far as prevention, there's no surprise that exercise and a balanced diet are top on the list. There is also evidence that Vitamin D (whether by sun or by supplement) helps decrease the risk of developing prostate cancer. Lastly, regular screenings are key in prevention and early detection. Men at higher risk for developing prostate cancer include family history, African-American or Scandinavian descent.
If the men in your life are anything like mine, they avoid the doctors at all cost. My brother’s motto is “if it ain’t broke, don’t fix it!” When it comes to healthcare and prevention, I’d have to politely disagree. We grazed over prostate cancer, prostatectomy and pelvic floor physical therapy for men, but men’s health encompasses so much more! Especially in today’s climate, mental and physical health are essential. So buckle up for some itchy kisses and check in on your favorite fellas!
Health & Happiness for all,
Dr. Carly and Dr. Katie