Today I am celebrating the gift of subtler forms of pelvic floor recovery after prostate cancer, including the aptly named “Reverse Kegels.” Toronto’s only male pelvic floor specialist physiotherapist has opened me up to new dimensions of pelvic floor health, more than four and a half years after my radical prostatectomy surgery.

At the core, he pointed out that relaxation of the muscles of the pelvic floor is as important as it is to get sufficient strength in those muscles. Many of his patients, he says, come to him with chronic pain arising from an overly-tense pelvic floor, sometimes exacerbated by lack of exercise or being overweight. And he is confident that both strength and relaxation of the pelvic floor contribute to general health as well as erectile function.

I already know these two things:

So I listened to his words and trust his examination, diagnosis and treatment. And I am motivated to loosen up the part of my body that Daniel Devere refers to as a kind of stress collector bowl. Please note that this article concerns more advanced pelvic floor health; the basics of pelvic floor health for men are covered here.

“Reverse Kegels” – importance of relaxing pelvic floor

After a remarkably gentle, careful, thorough examination, Devere reported that my pelvic floor muscle strength is good. Strength and agility in these muscles is essential for urine control and to support erections. However, he found these muscles remained unhealthily tense even when I was at my most relaxed. This is a problem because blood flow, muscle agility and emotional health all depend on easy shifts between tension and relaxation in these muscles.

If you are wondering how he can pick up details about muscles buried between our hips and behind our genitals – yes, the only way into a male pelvic floor area is through the rectum. Get over yourself – there is nothing wrong with having a finger up the bum for your health! The procedure is simple and safe. The physiotherapist is kind and gentle and respectful, and for me it was completely painless. More importantly the delicate palpation of the pelvic floor muscles helps to release painful muscle spasms you were not even aware of. I can already feel the difference after two treatments.

Extra ten minutes stretching per day at home unlocks new possibilities

Devere didn’t just treat me in his rooms – he empowered me to help myself. In our first session he asked about my exercise, yoga and stretching routine, and noted that I wasn’t doing much to stretch or relax my pelvic floor. Then he detailed easy and excellent exercises for me. After ten minutes a day for a week, I can already feel the difference. One of the daily additions to my routine is “reverse Kegels.” I learned how to tighten the pelvic floor, and then whoosh: a conscious drop and release. It really helps those crucial muscles relax. Breathing deeply and consciously letting the pelvic floor drop, drop, drop.

I’m shocked how much tension I was holding in my pelvic area. I feel quite shaken up as I release it. I also believe the shift is contributing to a slow improvement in my erectile health. As Devere says, “this is not a quick fix.” But that doesn’t make it any less important.

At least some of the tightness likely comes from the huge clenching efforts we make after prostatectomy to seal up urine control. Now I am acknowledging there is a lot of tension I can release without soiling my underwear. How would I have learned this without the care and treatment of an expert pelvic floor physiotherapist?

Time for more male pelvic floor physiotherapists

At present, there are 1485 pelvic floor physiotherapists in Ontario. Only 4 are male. Yet, according to Daniel Devere, one in 4 women and one in 5 men have pelvic floor health issues. This points to a massive disparity between the need for attention to men’s pelvic floor health, and the availability of specialists to help us.

It’s true that some female pelvic floor physiotherapists are willing to treat men, and some men are OK with being treated in such intimate parts of their bodies by female health care professionals. Indeed when I lived in Johannesburg I got great care from a female pelvic floor physiotherapist.

Nonetheless it is time for men to speak up and ask for the care we need!

Top 5 pelvic health problems in men

According to Daniel Devere, these are the most common issues where pelvic floor physiotherapy is indicated for men:

1. Prostatitis. Inflammation of the prostate gland, which can cause pelvic pain, painful urination, and sexual dysfunction. It may be acute or chronic.
2. Benign Prostatic Hyperplasia (BPH). A non-cancerous enlargement of the prostate that can lead to difficulty urinating or frequent urination, especially at night.
3. Chronic Pelvic Pain Syndrome (CPPS). Persistent pelvic pain in men that may be associated with urinary symptoms, sexual dysfunction, or discomfort in the pelvic muscles.
4. Urinary Incontinence. Men can experience urinary leakage, particularly after prostate surgery or due to weakened pelvic floor muscles.
5. Erectile Dysfunction (ED): Difficulty achieving or maintaining an erection, often related to pelvic floor muscle issues, nerve damage, or prostate health problems.

Many journeys, many challenges – we need all the help we can get

Not every man treated for prostate cancer has the luxury of the fine tuning described above. Many struggle with basic urine control. Others have to dedicate all their energy to fighting the resurgence of cancer after treatment. But I believe almost all of us can benefit from skilled and experience physiotherapy. Yet few doctors treating us for prostate cancer refer their patients to physiotherapists.

It is shocking to me that only one in 500 specialist pelvic floor physiotherapists in Ontario are men. There are very few in the world. I think it is time that men asked for and found more help from the profession. If we don’t ask, nothing will change.

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