Pelvic Floor Disorders and Prostatitis
Pelvic floor disorder is one of the largest chronic prostatitis causes and may be responsible for about half of the chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) cases. Both men and women have a pelvic floor. In men, the pelvic floor consists of the muscles, tissues, and nerves that support the bladder, rectum, prostate, and other pelvic organs. The muscles form a hammock-like support. These muscles work together with other pelvic organs, properly contracting and relaxing to help men urinate or defecate and even enjoy sexual intercourse. If the muscles spasm, are weakened, or do not work like they should, we call it pelvic floor dysfunction.
Symptoms of pelvic floor disorder may vary per patient but include pain, pelvic pressure, urinary incontinence, other urinary problems, sexual problems, pain with orgasm, and even problems with bowel function such as constipation and the sensation of not having emptied the rectum when having a bowel movement. This can also lead to bowel incontinence if residual stool leaks out of the rectum. Men with this condition may have discomfort from sitting for long periods of time. Pelvic floor disorder can lead to sexual dysfunction and have other detrimental effects on a man’s quality of life. It can greatly affect a man’s self-esteem and cause depression.
Your doctor can often diagnose a pelvic floor disorder when diagnosing prostatitis. Through a digital rectal exam, the doctor can feel the muscles on either side of the prostate to determine if the muscles are hard, which may indicate a pelvic floor spasm. Related pelvic floor disorders can include neuromuscular tension, chronic tension disorder, myofascial pain syndrome, and stress and emotional health causes of prostatitis.
Men can usually find relief for pelvic floor disorder through relaxation and alternative prostatitis treatments such as trigger point release therapy for prostatitis, prostate massage for prostatitis, biofeedback therapy for prostatitis, and pelvic floor rehabilitation for prostatitis. Many of these therapies and others are part of holistic therapeutic programs such as physiotherapy with The Renew XY Health Program for Men and the whole body NPAT program, which was developed by Dr. Geo Espinosa, a naturopathic urologist. NPAT stands for natural treatments, phytotherapy, alternative treatments, and total body.
Even though Kegel exercises can strengthen pelvic muscles, men with chronic prostatitis and pelvic floor disorders should NEVER do Kegel exercises because they can increases tension in those already tight muscles.
Excerpts from Ending Male Pelvic Pain, by Isa Herrera, MSPT, CSCS. (Copyright 2013, All Rights Reserved)
TO KEGEL OR NOT TO KEGEL
The term Kegel, developed by gynecologist Dr. Arnold Kegel, is used to describe a set of exercises designed to improve the function of the pelvic floor muscles. The problem is that there are subtle nuances to Kegels that, if not taken into account, can actually produce worse results for men with pelvic pain, incontinence, erectile dysfunction and urgency and frequency of urination. Typically, basic Kegels are prescribed for men suffering from incontinence and are designed to help strengthen the PFMs, improve coordination, continence and sexual function by reducing laxity and decreasing weakness.
When I evaluate a typical man suffering from pelvic conditions, I frequently find that in addition to PFMs weakness, the PFMs usually have excessive tone, increased shortness, extreme tension, spasms and multiple trigger points in them, rather than just laxity. I also often find a lack of flexibility and trigger points in the muscles that attach to the pelvis such as the inner thighs, hip flexors, gluteal, low back and abdominal muscles. The PFMs are normally in a relaxed state, and they respond to what is happening in your body and mind. They can respond to thoughts, past experiences, trauma, visceral problems, abnormal breathing patterns and pain. Usually, their response to any of the above is to become tense. This tension can go on for years, resulting in shortened weakened muscle fibers filled with spasms, trigger points, and myofascial restrictions.
Once the muscle fibers get shorter and tenser, they are typically weaker. The weakness is not due to looseness, as in the typical incontinence. Instead, the weakness s caused by muscles which are too tight or hypertonic. The shortened muscle has the ability to contract, but the contractions are weak because there is a decrease in the fiber’s ability to move. This type of weakness leads to urinary leaking, urge and frequency of urination, and erectile dysfunction, typical complaints of my patients with pelvic pain. To effectively treat these hypertonic and weakened muscle fibers, they first need to be lengthened and relaxed before they can be strengthened and toned. Thus, the prescription of regular Kegels, where you simply draw up your muscles to prevent leaking or pain, does not work. In fact it can lead to more pain and weakness as muscle fibers become even shorter, and more hypertonic. As a result, the PFMs often develop more trigger points in them leading to more pelvic floor muscle dysfunction and more symptoms.
In order to accomplish the release, I recommend that my patients do a daily, reverse Kegel relaxation/release program first and then embark on a Kegel strengthening (contract/relax) program for their pelvic floor muscles. The Kegel uptraining contract/relax program should be initiated only after you master the muscle relaxation and release Kegels. With men who have undergone prostatectomy surgeries it might be necessary to start with the contract/relax program first, but the principle of reverse Kegel is embedded into the program for men with prostatectomies. Many men who have undergone prostatectomy surgeries develop pelvic pain initially due to the internal scar tissue and healing. If you have pain and discomfort, start with the reverse Kegel program and then progress to the contract/relax program. Reverse Kegels are important for men who have undergone prostatectomies, as the PFMs oftentimes respond to scarring and pain of the surgery by becoming tense and hypertonic, contributing to post-surgical pelvic pain. Having first lengthened the pelvic floor muscles, the fibers can then be better strengthened, leading to reduced pain, improved continence, and enhanced sexual response.
The Kegel programs I have created are to be performed on several levels, beginning with the reverse Kegels to relax the muscles, followed by strengthening with the contract/relax, and the quick-flicks Kegels once you have mastered the reverse Kegel series. This order is necessary because the release is needed first before you can strengthen both slow twitch and fast twitch fibers of the PFMs. By understanding some of the nuances of the types of Kegels that I will describe in the following paragraphs, you can achieve better success and gain better control over your pain. Read more