BPH

Pelvic Floor Dysfunction in Men: Signs & Symptoms

Your pelvic floor is a group of ligaments and muscles that support the bladder, bowel, and uterus. The pelvic floor is the base for muscles we refer to as our “core.”

The core muscles reside in our pelvis and stretch like a hammock from the pubic bone at the front to the coccyx or tailbone at the back and from side to side. Men also have a pelvic floor, and it supports the bladder and bowel. 

Problems affecting this area can have a major impact on your quality of life. In this post, we are going to shed light on pelvic floor dysfunction. What is it? What causes pelvic floor disorder? How to treat it? Get answers to these questions below. 

What is pelvic floor dysfunction?

The term pelvic floor dysfunction refers to the inability to relax and coordinate pelvic floor muscles.

It is a broad constellation of symptoms and changes associated with abnormal function of the pelvic musculature. Although this common disorder usually affects women, men can also develop it.

The pelvic floor acts as a sling to support organs in the pelvis, including the bladder, rectum or external anal sphincter, prostate, or uterus. You control bowel movements and urination by contracting and relaxing the pelvic floor muscles.

Pelvic floor dysfunction makes you contract these muscles instead of relaxing them. That’s why bowel movement becomes more difficult. 

Pelvic floor dysfunction in men and women

Men and women experience pelvic floor dysfunction differently. In men, pelvic floor dysfunction can coexist with other conditions that affect males. These include:

  • Male urinary dysfunction

  • Erectile dysfunction

  • Prostatitis

In women, pelvic floor muscle dysfunction can affect reproductive health. This is especially the case after pregnancy and childbirth due to diastasis recti (a separation in abdominal muscles that weakens the pelvic region). The condition can also contribute to sexual dysfunction in women. It manifests itself in the form of painful sex. 

It’s important to mention that pelvic floor dysfunction is not the same as pelvic organ prolapse. The latter is just one type of the condition, and it occurs when the muscles holding women’s pelvic organs in place loosen and stretch out. As a result, organs can protrude out of the vagina or rectum and may require a woman to push them inside. 

Types of pelvic floor dysfunction

Not all cases of pelvic floor dysfunction are the same. Types of this condition include:

  • Coccygodynia – pain in the tailbone that worsens after a bowel movement

  • Cystocele – bladder dropping and pushing into the vagina

  • Enterocele – small intestine descending and pushing into the vagina

  • Levator syndrome – spasming of pelvic floor muscles after a bowel movement.

  • Obstructed defecation – stool enters the rectum, but the body is unable to fully evacuate the bowels.

  • Paradoxical puborectalis contraction – a pelvic floor muscle that contracts, making it difficult to pass the stool

  • Pelvic organ prolapse – pelvic floor stretching and the pelvic organs protruding. Pelvic prolapse can happen due to childbirth, age, and collagen disorder.

  • Proctalgia fugax – painful spasms of the rectum and pelvic floor muscles

  • Pudendal neuralgia – irritation or damage of pudendal nerves, which support the function of the pelvis

  • Rectocele – tissue from the rectum protruding into the vagina. The stool can get caught in this “pocket” and form a bulge in the vagina.

  • Urethrocele – urethra passing into the vagina

  • Uterine prolapse – uterus descending and pushing into the vagina. 

Unmanaged, pelvic floor issues can lead to complications such as discomfort, infection, and long-term colon damage.

Symptoms of pelvic floor dysfunction

Pelvic floor disorder manifests itself through numerous symptoms. Symptoms of pelvic floor dysfunction are often interrelated between gynecologic, urologic, and colorectal concerns such as constipation.

The most common signs and symptoms of this condition include:

  • A bulge in the lower back area

  • Bowel strain or chronic constipation

  • Discomfort during sexual intercourse (for women)

  • Involuntary leakage of stool

  • Lower back pain

  • Muscle spasms in the pelvis

  • Pressure in the pelvic area or rectum

  • Stress urinary incontinence, i.e., a small amount of urine leaking from the body due to an activity such as coughing or sneezing, exercising, laughing, etc.

  • Urinary symptoms such as painful urination, incomplete urination, and urge incontinence

It’s useful to mention that overactive bladder in some people results from pelvic floor dysfunction. 

What causes it?

More research is necessary to uncover all causes of pelvic floor disorders and their mechanisms. No specific inciting event or factor has been identified as an etiology for pelvic floor dysfunction. Hypertonicity symptoms, linked with voiding and defecation, could be related to learning poor evacuation techniques.

Pelvic pain may develop due to posture, gait, and skeletal asymmetry. On the other hand, degenerative muscular disease, spinal nerve injury, lower back injury, or surgery may contribute to weak pelvic floor muscles.

In most cases, people develop pelvic floor dysfunction due to:

  • Pregnancy, childbirth, multiple deliveries, large babies

  • Nerve damage

  • Traumatic injury to the pelvic region

  • Pelvic surgery

  • Being overweight or obese

  • Advancing age

  • Overusing the pelvic muscles, e.g., pushing too hard in the bathroom

  • Systemic diseases

Pelvic floor dysfunction can run in families. The potential genetic cause of pelvic floor disorders requires further research.

Various factors can contribute to or aggravate pain in pelvic floor disorders. They include:

  • Irritable bowel syndrome

  • Endometriosis (happens when the lining of the uterus grows outside of the uterus)

  • Interstitial cystitis (a common bladder condition that produces pain in the bladder and pelvis)

Diagnosis

Symptoms of pelvic floor dysfunction are uncomfortable and have a major impact on a person’s quality of life. That’s why you shouldn’t ignore them. If you experience the above-mentioned symptoms, you need to schedule an appointment to see your doctor. While it’s easy to look up symptoms online, you should not self-diagnose. 

The doctor will review your medical history and ask questions about your symptoms. During the appointment, the doctor will also perform a physical examination to check for muscle spasms or knots. The physical evaluation also serves to check for muscle weakness. 

The doctor may perform an internal exam to check for pelvic muscle control and pelvic muscle contractions. To perform this exam, the doctor needs to insert a perineometer into a rectum or vagina. Perineometer is a small sensing device.

There’s also a less invasive method to perform this exam – surface electrodes. It includes placing electrodes on the perineum to determine if a patient can contract and relax pelvic muscles. The perineum is an area between the scrotum and anus in men and between the vagina and anus in women.

In order to check how anal sphincters are working, the doctor will perform anorectal manometry. This painless test checks pressure, muscle strength, and coordination. 

Other tests may include:

  • Defecating proctogram – the patient gets an enema of a thick liquid that can be seen with an X-ray. The doctor uses a video X-ray to record the movement of the muscles as a patient attempts to push the liquid out of the rectum. The test shows whether a patient can pass a bowel movement or any other causes for pelvic floor dysfunction.

  • Uroflow test – shows how well a patient can empty the bladder. Weak urine flow and stop-and-start urination point to pelvic floor dysfunction

Treatment options

The good news is that you can treat pelvic floor disorder. In many cases, the treatment is easy. The exact course of treatment depends on the cause of the condition. Once the doctor diagnoses pelvic floor dysfunction and determines the underlying cause, they will recommend the most suitable treatment approach.

In most people, a combination of different treatments works best as opposed to a single treatment route. The most common treatment approaches include:

  • Biofeedback – the most common treatment for pelvic floor disorder. A physical therapist can use biofeedback in different ways to retrain the muscles. For instance, they may use special sensors and a video to monitor the pelvic floor muscles as you attempt to clench and relax them. Then, the therapist gives biofeedback and helps you improve muscle coordination. This painless approach helps about 75% of patients feel better. It usually comes in combination with pelvic floor rehabilitation. 

  • Medications – the doctor may recommend daily medications to keep bowel movements soft and regular. Some medications are available over the counter and may include stool softeners such as Colace, MiraLAX, Senna. Follow doctor’s orders here. Do not self-medicate or discontinue the use of medications without consulting your healthcare provider. Not all laxatives are equally effective, so always listen to your doctor’s advice. The doctor may also prescribe a muscle relaxant to address symptoms of pelvic floor dysfunction. The role of muscle relaxants is to prevent muscles from contracting. 

  • Pelvic floor physical therapy – pelvic floor therapy usually comes in combination with biofeedback. The therapist determines which muscles in the lower back, pelvis, and pelvic floor are tight. Then, they teach you pelvic floor muscle exercises to stretch the muscles and improve their coordination. 

  • Pessary – a type of device that helps treat numerous symptoms of pelvic floor dysfunction. It is available for women, and doctor or nurse inserts pessary into the vagina to support prolapsed organs. It is often a non-surgical treatment approach, but it is also performed on a patient while awaiting surgery.

  • Relaxation techniques – meditation, warm baths, exercises, yoga, and acupuncture can also help you relax and aid the management of this condition. 

Women have a 50% risk of developing pelvic organ prolapse in their lifetime. About 11% to 19% of women have a lifetime risk of undergoing surgery for prolapse or incontinence. The U.S. surgeons perform about 200,000 surgical procedures for prolapse every year.

Surgical treatment of this condition is possible, but it is a last resort. The doctor will recommend surgery only when other approaches are ineffective. Keep in mind that a specific surgery for pelvic floor dysfunction doesn’t exist. The doctor may recommend a surgical procedure to address certain symptoms. 

Surgery is also necessary when pelvic floor dysfunction results from a rectal prolapse or rectocele. 

Surgeons perform minimally-invasive procedures whenever possible. Pelvic reconstruction surgery may include vaginal surgery, laparoscopic surgery, and robotic-assisted surgery. Advantages of minimally-invasive procedures include:

  • Faster recovery

  • Lower risk of infection

  • Less pain

  • Shorter hospital stay

  • Smaller abdominal incisions (or no abdominal incisions in case of vaginal surgery)

  • Earlier return to normal activities 

Surgical procedures may include the following:

  • Bladder sling (midurethral sling) – performed through the vagina with two small incisions at the mons pubis (pubic hair area) or along the inner thigh. During the procedure, a surgeon places a small strap or surgical mesh under the urethra to support the bladder opening and prevent leakage. A bladder sling is most suitable for the treatment of stress incontinence. 

  • Sacral colpopexy – suitable for patients whose uterus or vagina has prolapsed out of the body. Surgeons can perform sacral colpopexy through an abdominal incision or via minimally-invasive techniques such as robot or laparoscopy. During the surgery, surgical mesh is used to create a strap. The strap helps reposition and suspend the vagina back to its original position. 

  • Sacrospinous ligament suspension – also suitable for a patient whose uterus or vaginal prolapsed out of the body. The only method to perform this surgery is through the vaginal opening. As a result, there are no scars outside of the body. During the procedure, a surgeon attaches the vagina to a patient’s sacrospinous ligaments with sutures or stitches. The goal of the procedure is to suspend the vagina back into the sacrospinous ligament.

  • Sacral nerve stimulation – addresses fecal incontinence in cases when other treatments don’t work. The surgeon implants a device called a sacral nerve stimulator. The device stimulates the sacral nerve the same way a pacemaker regulates a heartbeat. The sacral nerve controls bowel movements. Sacral nerve stimulation helps coordinate activity between the nerves and muscles that control bowel movements. As a result, bowel movements become more predictable. 

  • Stoma – also suitable for patients with fecal incontinence. A stoma is a surgically created hole within the intestines so that waste can bypass the rectum and anus. This approach is only recommended when other treatment options are unsuccessful.

  • Uterosacral suspension – the doctor may recommend this surgery for women with prolapsed uterus or bladder outside of the body. It is performed through the vaginal opening. Surgeons may opt for laparoscopy or a robot-assisted approach. Uterosacral suspension involves attaching the vagina to the uterosacral ligaments using stitches or sutures.

Keep in mind that while Kegel exercises are usually good for strengthening the pelvic area, doing them alone is not helpful for the management of pelvic floor dysfunction. That’s why self-care, in combination with doctor-recommended treatment, works best to alleviate chronic pelvic pain and other symptoms.

Outlook

While pelvic floor dysfunction is uncomfortable and may affect your quality of life, the condition is manageable. This treatable condition requires a proactive approach. Don’t wait for the symptoms to go away on their own. Anyone who experiences problems such as painful bowel movements, difficulty passing stool or urinating, pain in the pelvic region, or painful intercourse should see the doctor. Various treatment options are available to help you treat this condition and improve your quality of life.

Conclusion

Pelvic floor dysfunction manifests itself through a wide spectrum of uncomfortable symptoms. Although it feels scary, this condition is treatable. Various non-surgical treatments are available, and a patient can regain quality of life. Just make sure to see the doctor when you notice symptoms and adhere to the treatment in order to avoid potential complications. Wise lifestyle choices can help you improve pelvic health.

Sources

  1. Davis, K., & Kumar, D. (2003). Pelvic floor dysfunction: a conceptual framework for collaborative patient-centred care. Journal of advanced nursing, 43(6), 555–568. https://doi.org/10.1046/j.1365-2648.2003.02754.x
  2. Pelvic floor dysfunction. (2020) StatPearls https://www.ncbi.nlm.nih.gov/books/NBK559246/
  3. Hong, M. K., & Ding, D. C. (2019). Current Treatments for Female Pelvic Floor Dysfunctions. Gynecology and minimally invasive therapy, 8(4), 143–148. https://doi.org/10.4103/GMIT.GMIT_7_19
  4. Treatments for pelvic floor disorders. Johns Hopkins Medicine https://www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/pelvic_health/treatments_we_offer.html
  5. Pelvic floor dysfunction. UC Davis Health Department of Surgery https://health.ucdavis.edu/surgery/specialties/colorectal/conditions-we-treat/pelvic-floor-dysfunction.html

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