Could this be the answer to training pelvic floor muscles in men following prostatectomy to restore continence?!

A study by Stafford et al. (2017) looked at the relationship between the activation patterns of specific pelvic floor muscles and incontinence in men following prostatectomy (surgical removal of the prostate gland).

It was found that "poor function of the bulbocavernosus* and puborectalis* muscles could be compensated by good striated urethral sphincter* function, but the bulbocavernosus and puborectalis muscles had less potential to compensate for poor striated urethral sphincter function." (* these names are of specific muscles within the male pelvic floor)

This study does not show that intervention targeted at improving striated urethral sphincter muscle function would necessarily change activation patterns and therefore continence. It purely shows that different activation patterns exist between continent and incontinent men.

The only way to assess the particular components of the male pelvic floor is the use of transperineal ultrasound. This is the use of ultrasound placing the transducer head over a man's perineum (the area between his genitals and anus) to get a view of the pelvic floor muscles up towards the bladder. Transperineal ultrasound allows for the multiple muscles within the pelvic floor to be visualised simultaneously in real-time (Stafford et al. 2012). For further info about transperineal ultrasound https://goo.gl/uxBvrx

There have even been studies which have shown that different verbal cues can influence the activation patterns within the pelvic floor (Stafford et al. 2015).

So for incontinent men following prostatectomy, transperineal ultrasound allows for assessment of the individual muscle actions within the pelvic floor and potentially for assisting with training these muscles (watch this space for more scientific evidence in the future).

For more info about our physiotherapy services for men with incontinence and for pre- and post-prostatectomy management, visit http://www.nsmhp.com.au/

Reference links ⬇️

Stafford et al. 2017 https://www.ncbi.nlm.nih.gov/pubmed/28745804

Stafford et al. 2015 https://www.ncbi.nlm.nih.gov/pubmed/25727781

Stafford et al. 2012 https://www.ncbi.nlm.nih.gov/pubmed/22902016

What's the link between baldness & erectile function?

What’s the link between baldness & erectile dysfunction?

Well nothing directly, although there is a link between a common hair re-growth treatment and sexual function in men!

Propecia (finasteride), a medication which can be prescribed to men to aid hair regrowth, has known undesirable side effects including erectile dysfunction, impotence and loss of sex drive.

If you are someone who is a little follicly challenged (like me), these side effects are something you ought to consider prior to taking Propecia.

Whilst it was believed for some-time that these side-effects were reversible upon cessation of Propecia use, a 2011 study revealed that side effects including reduced libido, erectile dysfunction, reduced arousal and issues with orgasm were frequently long-lasting and even potentially permanent.

Irwig, M. & Kolukula, S. (2011). Persistent sexual side effects of finasteride for male pattern hair loss. The Journal of Sexual Medicine; 8(6):1747-53

Have you taken your baseline measurements?

For many men experiencing incontinence symptoms, health professionals assisting with your care will often be interested in some specific details to determine the extent of your symptoms and also to track changes over time. These can be extremely useful to those experiencing incontinence symptoms, as changes don’t always occur rapidly and small changes over time can be difficult to recognise without using specific outcome measures to accurately assess changes.

“REMEMBER – once you have urinary incontinence symptoms, it is too late to get baseline measurements!”

What are baseline measurements?

Baseline measurements are a recording of where you are at now (or what is normal for you now), such that you have something to compare to should your situation change. Individuals can vary quite a bit with certain measures and as such it is always good to have some baseline measurements of your own to compare back to. This isn’t always possible for every situation, however if you are about to undergo a procedure like a radical prostatectomy (where post-operative incontinence is quite common) then you should try to record a couple of baseline measurements before having the procedure for reference should you experience incontinence symptoms.

What baseline measurements should I take?

Two (2) of the simplest baseline measurements to record are:
– Urinary voiding frequency; and
– Urinary voiding volume.

Your urologist, doctor or men’s health physiotherapist may also be interested in some other measurements, depending on your circumstances. You should ask them if there are any other relevant baseline measurements to record.

Urinary voiding frequency

This refers to how often in a day you urinate. Sounds simple. You might say well this varies day-to-day depending on a number of factors and you are quite right. In saying this though, most men will roughly void a similar number of times each day. There is quite a bit of variation between men as to how often you urinate, so it is good to know how often you go.

The best way to record this is for a few days, simply record how often you urinate such that you get to know what your urinary voiding frequency is. You may need to carry around a piece of paper or record this on your phone/computer throughout the day, as it is easy to lose count. If you want to go the extra mile, it can be good to know how often you go throughout the night compared to throughout the day.

Urinary voiding volume

This refers to how much urine you pass each time you go to the toilet. Again, this will vary a bit each time you void and can vary enormously between men. Consequently, it is good to get a range of what is normal for you.

Measuring this isn’t completely straight forward. You will need to urinate into a measuring jug to determine how much you pass and then record this amount. You can then tip this into the toilet. Understandably, you are unlikely to be able to do this when you are out and about. The best way to do this is to set-up a measuring jug at home beside the toilet and over the course of a few days when you are at home record your voiding volumes. This way you will hopefully get a range of what normal voiding volumes are for you.

What do I do with these baseline measurements?

Make sure that you record these baseline measurements somewhere that you will be able to locate should you need them. If you have been consulting a men’s health physiotherapist prior to surgery, then let them know. You may not need to refer to them at all, should you not have any post-operative incontinence symptoms. However, quite a few men will experience incontinence symptoms post-operatively and knowing what is normal for them is quite relevant if you end up in this position.

Having prostate surgery? When to start pelvic floor exercises.

If you have been diagnosed with prostate cancer and are having surgery to remove the prostate gland (i.e. prostatectomy), you will likely have many things on your mind. Whilst there may seem to be more pressing things to deal with than pelvic floor exercises, the reality is that the earlier you can start this the better in terms of the situation you may find yourself after surgery in relation to urinary incontinence. It can be difficult to acknowledge the importance of this before surgery whilst you are still continent and there benefits of addressing this now aren’t obvious.

“The best time to start doing pelvic floor exercises is now, for those having prostatectomy“

The reality is that the majority of men having prostatectomy will experience some degree of urinary incontinence and erectile dysfunction following surgery. Whilst the majority will regain this function in due course, it appears that those who are able to start doing pelvic floor exercises prior to surgery have fewer issues following surgery.

Most men aren’t particularly well attuned to their body, so when it comes to pelvic floor muscles most don’t even know where they are let alone how to contract them or use them. It is far easier to learn how to use these when everything down there is working fine. Doing this makes it far easier for men to know what they are supposed to do after surgery and what it should feel like.

If you imagine what things may be like after prostate surgery, you will likely be a bit sore in your pelvic region, you will have wounds that are healing and you may generally be feeling a bit off or fatigued. None of these things make it particularly easy to learn how to contract your pelvic floor muscles. In fact, it makes things particularly difficult. So, if you already know how to contract your pelvic floor and what it should feel like to do so, you will be much better placed to just get on with doing your pelvic floor exercises.

The best way to learn how to do pelvic floor exercises is to consult with an experienced men’s health physiotherapist who is able to assess you using real-time ultrasound to see whether your muscles are actually able to contract well or not. This is much easier to do when your pelvic region isn’t tender (as we need to apply the ultrasound head on your lower abdomen or between your legs) and when you are actually continent. It can still be done, just not as easily.

Additionally, the sooner you are able to get started, the more you are able to practise and refine your pelvic floor contraction such that it becomes second nature. It also gives your body a chance to condition your pelvic floor muscles – in the same way that your muscles get stronger by doing exercises in the gym.

In outlining the above, hopefully you can see that starting your pelvic floor exercises as soon as possible once you know you are going to have prostate surgery the better. This may not seem all that important prior to surgery to start pelvic floor exercises as you will more than likely or have any issues with your continence, however those that do typically have less issues after surgery.

Note: if you have had surgery and weren’t in a position to start pelvic floor exercises prior to surgery, this does not mean that you have missed your opportunity. Learning how to contract your pelvic floor and starting a program of pelvic floor exercises is still very important. In this situation, it is imperative that you consult with an experienced men’s health physiotherapist who can guide you through pelvic floor contractions and assess whether you are doing it right (it can be difficult to know whether you are doing it correctly without tools to assess this properly).

“Pull your head in!” & other verbal cues

When a men’s health physiotherapist tells you to “pull your head in”, all may not be as it seems!

Many men have absolutely no idea of how to go about contracting their pelvic floor muscles unless they are trained to do so. In teaching men how to contract their pelvis floor muscles, the use of verbal cues can assist greatly. Not all men will respond to each of the cues and it has been shown that certain verbal cues will lead to contractions of certain individual pelvic floor muscles1.

Common cues used in teaching men how to contract their pelvic floor muscles include:

• “Nuts to guts” 
• “Pull your head in”
• “Shorten your penis”
• “Imagine you are trying to stop the flow of urine”
• “Tighten around your anus”
• “Imagine you are trying to hold on to a fart”

Feel free to give these cues a go yourself and you may find that different cues feel like you are using slightly different muscles.

Just remember though, if you are experiencing issues of incontinence or erectile dysfunction that it is best to actually know that you are actually contracting your pelvic floor muscles correctly. This can be done by consulting with a men’s health physiotherapist (preferably using real-time ultrasound). Some pelvic floor contractions using certain cues can result in increased pressure on your bladder and result in increased incontinence, so it is imperative that you know what type of pelvic floor contractions are best for your circumstance.

1. Stafford, R. E. et al. (2015). Pattern of activation of pelvic floor muscles in men differs with verbal instructions. Neurourology and Urodynamics, 35 (4): 457-63.

There is only one "R" in PROSTATE!

It would seem a common misunderstanding within the male population the pronunciation and spelling of PROSTATE. I have no idea why, but it seems that the majority refer to their PROSTATE as their PROSTRATE! Why the extra “R”?  I have no idea! Whilst to me this has become a bit comical at times; it also concerns me. Whilst this might seem trivial; it suggests to me that men simply don’t understand their bodies and their anatomy. It may be an indication that there is a bigger problem at play and that there is a lack of education provided to men about their own anatomy. Then again, I might also be over thinking it and men find it easier to say PROSTRATE than PROSTATE.

So to set the record straight…..

The walnut-sized gland down near your nether regions that might be making peeing difficult and in those unfortunate men may have cancer in is called your PROSTATE.

There is actually a word in the English language, PROSTRATE. The word PROSTRATE has absolutely nothing to do with any part of the male anatomy. The definition of PROSTRATE, according to www.dictionary.com is as follows:

1. lying flat or at full length, as on the ground.
2. lying face down on the ground, as in token of humility, submission, oradoration.
3. overthrown, overcome, or helpless.
4. physically weak or exhausted
5. submissive.
6. utterly dejected or depressed; disconsolate.
7. Botany. (of a plant or stem) lying flat on the ground.

For all you men out there who have been referring to your PROSTATE as your PROSTRATE, I hope you can see that this trivial extra “R” in a word has a distinctly different meaning in the English language. I would like to see men being proud of their bodies and as part of this I believe having an understanding of your distinctly male anatomy is important. So, let’s put this matter to bed and refer to that walnut-sized gland in your pelvis by its proper name – PROSTATE!

To view on the Northern Sydney Men's Health Physiotherapy website, click here.

Do supermarkets reflect societal attitudes towards men’s health issues?

I was strolling through my local Coles supermarket recently and as I made my way down the personal hygiene aisle I noticed something I hadn’t noticed before. It left me rather surprised, bemused and with a number of questions. No, it wasn’t that I noticed that they stocked men’s incontinence pads (if you weren’t aware, they do!). No, it wasn’t that these pads were right in amongst women’s incontinence and sanitary pads. It was the signage right above these products – FEMININE CARE (along with the stereotypical pink colours representing all things female).

I am aware enough to know that not every product in a major supermarket can be cleared signed and that the major supermarkets likely sell vastly more feminine care products than male sanitary pads (hence in the interest of the supermarket to ensure that female pads are easily found by consumers). It also doesn’t bother me that male products are being stocked under the signage of female products – some men may see this as a positive as the products are discreetly positioned in the supermarket. Others may take offence though.

My first thoughts upon noticing this placement of male incontinence pads under the signage of FEMININE CARE, was that this clearly reflects the awareness and attitudes of the broader society towards men’s health issues like incontinence in that:

• Both men and women experience incontinence issues;
• Men don’t talk about their issues or seek the help they need;
• Services for specific men’s health issues are less readily available, less frequently spoken about, less frequently referred for and under utilised by men who need them.

Now, I don’t know this for sure, but I suspect that the average man walking through the supermarket may not know that male incontinence pads even exist. Or even if they did, they may not realise that they are stocked in major supermarkets in Australia. I would then hazard a guess that a larger proportion of men would be aware that women’s incontinence is an issue affecting many women and that women’s incontinence pads are stocked in major supermarkets.

Just a thought – wouldn’t it be nice if male health product like incontinence pads weren’t seemingly tucked away in the bottom corner under signage for FEMININE CARE products. Perhaps a greater number of men and women may become aware that male incontinence is a real issue affecting a large number of men in Australia. In turn, this could help change the perception of men’s health in Australia, helping more men to access appropriate health services and to know where they can even find products like male incontinence pads.

On another point – I don’t know what the men purchasing these products think when they see male incontinence pads under the signage for FEMININE CARE. Perhaps they like that they are discreetly positioned without the fanfare, perhaps they do think it is sexist, perhaps they see the humorous side to it and have a bit of a chuckle.

My only concern is potentially for the men with incontinence issues, who may not realise that male incontinence products even exist or that they are so easily accessible in major supermarkets.

In time, I hope that societal attitudes towards men’s health issues change for the better (I do think that this is slowly happening) and that perhaps in years to come my experience strolling the supermarket aisles might be a different experience.

To view on the Northern Sydney Men's Health website, click here.