When Men Leak

Men have pelvic floors too. And they can certainly have issues with their pelvic floors. The “pelvic floor” is a group of muscles that run from the pubic bone in the front, between the legs like a hammock and attach to the tailbone in the back. The pelvic floor is responsible for holding up the pelvic organs (bladder, testicles, rectum) and for helping to control urine and feces elimination. It also plays a roll in sexual function, but let’s stick to urinary tasks for now. Generally the male pelvic floor functions similarly to the female pelvic floor but there are some key differences.

Compared to women, men have fewer openings in their pelvic floor. There is an opening for the urethra and for the rectum (while women also have a vaginal opening). This means that the male pelvic floor is usually thicker and more muscular. Men also have a prostate gland. The prostate gland sits above the testicles and behind the penis. It wraps around the urethra, kind of like a donut, with the urethra running through the donut hole. While the prostate gland is responsible for the prostate fluid, it also acts as structural support around the urethra.

This is why, when the prostate gland enlarges and inflates, it can be difficult to urinate. The expanded prostate squeezes around the urethra, making it difficult to initiate or maintain urine flow, or to completely empty the bladder.

On the other hand, this is also why changes to the prostate can lead to urinary leakage (incontinence) in men. Treatment or surgeries aimed at reducing the size of the prostate, removing parts of the prostate or removing the prostate entirely can lead to a reduction in urethral reinforcement. For some men, this helps tremendously in the ability to easily urinate and fully empty the bladder. For others, this can contribute to urinary incontinence.

When you become accustomed to depending on the enlarged prostate to prevent leaking, and then the prostate is suddenly smaller or gone, the pelvic floor muscles better be strong enough to take up the slack. But for some men, the muscles are not strong enough. The muscles have been letting the prostate do all the work and during that time have become lazy and weak. This is what can lead to urinary (and sometimes fecal) incontinence. Often times it is a leak with a cough, sneeze, heavy lift or even getting out of a chair. It can be worse if the bladder is full.

This article is not meant to scare people. In fact most men regain their pelvic floor muscle strength, coordination and continence after healing from treatments and procedures. However there are some who struggle to use their pelvic floor muscles again. This is where pelvic floor physiotherapy can be a valuable tool. Improving strength and coordination through guided exercises programs can help with these symptoms.

When teaching men how to use their pelvic floor muscles I often ask them to think about lifting their scrotum (not the penis) while exhaling. You should not be able to see any other major muscles helping out. Buttocks, abdominals and inner thigh muscles should all remain relaxed and you should not be holding your breath. Once they can accomplish this I get them to also think about squeezing the rectum (not the buttocks though) while thinking about lifting the scrotum. This helps remind them to use both the front and back half of the pelvic floor muscles. This is all combined with breathing and the coaching sounds like this:

“Inhale and relax your muscles, exhale through the mouth while lifting the scrotum/closing the rectum.”

The squeeze is held for the duration of the exhale and then all the muscles relax on the following breath in.

For homework, I usually get men to practise this breathing pattern for 30 or 60 seconds, which is usually 10 – 14 breaths depending on lung capacity and fitness levels. Eventually treatment progresses to learning how to activate these muscles before a potential leak (before a cough, before getting up from a chair, etc). It usually takes a bit of practise and some time to develop the strength and coordination necessary to stop leaking.

If you think that you might benefit from learning how to use your pelvic floor muscles talk to your doctor about finding a pelvic floor trained physiotherapist.

 

Katie Kelly,

Physiotherapist,

BSc., MSc. PT

2017-07-19T12:58:12+00:00June 6th, 2017|