What is Male Pelvic Floor Therapy?
Male Pelvic Floor Therapy refers to a number of therapeutic assessment and treatment techniques intended to decrease pain and increase your control of your pelvic floor muscles. Achieving and maintaining pelvic floor health is essential to lifelong sexual enjoyment by minimizing or preventing injury and increasing arousal and sexual intensity. Pelvic floor therapy can be used in the prevention of pelvic floor issues (such as urinary incontinence) or the rehabilitation of existing issues and post-surgical recovery. Many members of our community who bottom or want to bottom don’t know how to achieve success. We are experts in prevention and rehabilitation of the pelvic floor and will help you achieve your bottoming goals.
What is the Pelvic Floor?
The Pelvic Floor consists of the muscles, nerves, connective tissues, tendons, and ligaments that lay like a hammock between your tailbone and your pubic bone. This hammock supports you penis, bladder, rectum, and anus. It is important to keep these muscles strong, flexible, controlled, responsive, and alive, especially because these muscles are crucial for sexual function.
What Is Male Pelvic Floor Dysfunction?
Male Pelvic Floor Dysfunction refers to the inability to control the muscles of the pelvic floor. To simplify things, there are two main issues that cause most of the issues with the pelvic floor: the muscles are either too weak or the muscles are too tight.
What are the symptoms of Pelvic Floor Dysfunction?
The symptoms of Pelvic Floor Dysfunction vary and can include, but may not be limited to:
- Pain or spasming in the anus, deeper into the pelvis, penis, and/or scrotum
- Difficulty urinating, including urge and stress incontinence, mixed incontinence, hesitancy, and frequency of urination
- Anxiety about sex before, during, or after the act, causing a dissatisfactory experience
- Pain with receptive anal sex
- Inability to experience receptive anal sex
- Fecal constipation or incontinence
- Sharp, stabbing cramps, such as pelvic pain
- Weak ejaculation contraction
What are the causes of male pelvic floor dysfunction?
Weak (or “loose”) pelvic floor muscles can be caused by:
- Too much sex
- Engaging in fisting and/or double penetration
- Playing with large toys
- Bladder or bowel surgery
- Radical prostatectomy (surgical prostate removal)
- Being overweight
- Heavy lifting
- Coughing that is ongoing, like smokers cough or chronic bronchitis
- Being physically unfit
Weak muscles are responsible for leakage of urine and fecal matter and can cause a person to become socially isolated.
Tight muscles are caused by a number of factors:
- Learned behavior or habits over time
- Inability to relax
- Anticipation of pain during sex
- Misunderstandings and overcorrection of core stability training
- Extended edging sessions
Tightness can make bottoming difficult and painful, which can lead to bleeding and/or physical damage to the anus. It can also cause the inability to completely empty your bowel and/or bladder, as well as create intermittent or constant pain due to muscle tension.
Is Pelvic Floor Rehabilitation right for me?
If you are a gay male and think you have issues related to being too tight or too loose in or around your ass, causing pain, any problems with sex, aesthetic issues, bowel or bladder issues, constipation, or leakage, you will benefit from Pelvic Floor assessment and treatment.
What are the benefits of pelvic floor rehabilitation?
Pelvic Floor Therapy is designed to give you control of your pelvic muscles and thereby give you control over your life by preventing injuries from happening or reoccurring in the future.
What are the procedures used for pelvic floor evaluation?
Evaluating a pelvic floor involves looking at a person holistically and completely. The comprehensive assessment is vital so we know how to help you in the best way possible and includes:
- Postural assessment
- Muscle strength and length testing
- Internal and external palpation for tenderness and restrictions
- Surface Electromyography testing to assess the electrical activity in your pelvic region
- Real-Time Ultrasound Imaging of your pelvic floor position and excursion during contraction, relaxation, and symmetry
- Anal Manometry: a test of anal pressures and responses
What to Expect During Male Pelvic Floor Therapy
There a number of techniques designed to help with pelvic floor disorders. The main aim of treatment, no matter what the issues are, is to relax the muscles to an acceptable baseline level. After achieving an appropriate baseline of muscle activity and resting tone, the goal is to create control through the range of muscle activation. So, to put it another way, pelvic floor muscle action controlled by you, from relaxation to contraction and back again.
Treatment Techniques can include:
- Education about your condition, treatment, and home program (including Kegel exercises)
- Postural realignment and re-education
- Manual therapy to tighten external and internal pelvic muscles
- External muscle strengthening and lengthening as needed
- EMG Biofeedback
- Ultrasound imaging Biofeedback
- Manometric Biofeedback
- Manual therapy to mobilize restricted skin and pelvic floor structures, including the anus
- Manual scar mobilization to ease anal stricture
- Home program of anal dilatation activities and control through range exercises
How long does a course of pelvic floor rehabilitation usually take to work?
It takes between 6 to 8 weeks to see a physiological change in a muscle or skin after therapy has started. However, is it not uncommon to see changes in coordination and muscle control well before this time due to a reinforcement of the existing neural pathways.
Is there any special preparation I need to do before having a pelvic floor evaluation or treatment?
The answer depends on how well you know your bowels and at what time of the day your appointment is. Most likely, if you have had your normal bowel movement for the day before arriving for assessment or treatment, you should be fine. If you want a little more reassurance, please use a Fleet Enema, being mindful to follow the directions provided on the box, two hours before your appointment.
Dr. Evan Goldstein, D.O.
Dr. Evan Goldstein is the founder and President of Bespoke Surgical, a surgical practice for modern males based in New York and Los Angeles. He received his medical doctorate from the University of Medicine and Dentistry School of Osteopathic Medicine in 2002. Receiving the highest osteopathic education was pivotal in shaping his holistic whole-life approach towards his practice of private surgical care.