5 Signs It May Be Time to See a Pelvic Health Professional: A Guide for Men
When we talk about pelvic health, many people still think of it as a women’s health issue.
But men have a pelvic floor too, and it plays an important role in bladder and bowel control, sexual function and supporting the organs within the pelvis.
Pelvic health problems can affect men at different stages of life. They may occur following prostate treatment or surgery, alongside certain health conditions, with changes in pelvic floor muscle function, or simply become more noticeable as you get older.
Unfortunately, many men put off talking about these symptoms.
Sometimes it’s embarrassing. Sometimes it’s the assumption that it’s just part of getting older. And sometimes it’s because nobody has ever told them that help may be available.
Importantly, not every bladder, bowel, pelvic or sexual symptom is caused by the pelvic floor. Similar symptoms can have many different causes, which is why proper assessment matters.
Here are five signs that it may be time to speak to a pelvic health professional.
-
You’ve Noticed Changes in Your Bladder Control or Urination
Bladder and urinary changes can show up in several different ways.
You may leak urine when you cough, sneeze, exercise, or lift something heavy. You may suddenly need to rush to the bathroom, urinate more frequently than you used to, or wake up several times during the night to go.
Other men notice changes in the way they urinate – such as difficulty getting started, a weaker or interrupted stream, or feeling as though the bladder hasn’t emptied completely.
These symptoms aren’t necessarily caused by the pelvic floor.
The prostate, bladder, urinary tract, certain medications and other health conditions can all contribute to changes in urination. That’s why you should have new or persistent symptoms properly assessed rather than simply accepted as part of ageing.
If you’re organising your day around bathroom stops, avoiding certain activities because you’re worried about leaking, or noticing a significant change in how you urinate, talk to a healthcare professional.
Pain or burning when urinating, blood in the urine, or being unable to urinate requires medical attention.
-
Things Have Changed Since Prostate Treatment or Surgery
For many men, pelvic health suddenly becomes much more relevant following treatment for a prostate condition.
Urinary leakage is a recognised problem following some prostate procedures, particularly radical prostatectomy for prostate cancer.
You may notice leakage when standing up, coughing, exercising or moving around. Some men need pads during their recovery, and the loss of bladder control can affect exercise, work, social activities and confidence.
For many men, bladder control improves with time following surgery. Pelvic floor muscle training may also form part of rehabilitation and can help some men recover continence sooner.
However, recovery is different for every man, and pelvic floor rehabilitation is not a one-size-fits-all treatment.
If bladder control continues to affect your daily life following prostate treatment, don’t automatically assume that this is simply your “new normal”.
Ask what rehabilitation and treatment options may be appropriate for you.
-
You’ve Noticed Changes in Your Erections, Ejaculation or Sexual Function
Your pelvic floor isn’t only involved in bladder and bowel control. It also has a role in male sexual function.
The pelvic floor muscles contribute to aspects of erection and ejaculation, which means pelvic floor function may be one factor worth considering when sexual function changes.
Erectile dysfunction (ED) refers to ongoing difficulty getting or maintaining an erection firm enough for sexual activity.
But ED is not simply a sign of a weak pelvic floor.
Erectile dysfunction can have many possible causes, including cardiovascular disease, diabetes and other metabolic conditions, hormonal factors, medications, neurological conditions, psychological factors and the effects of prostate treatment or surgery.
Men who have undergone prostate cancer treatment may also notice other sexual changes, including changes in ejaculation, orgasm or erections.
These changes can have a significant effect on confidence, relationships and intimacy – but they aren’t something you need to be embarrassed about discussing.
If you’ve noticed a persistent change in your erections, ejaculation or sexual function, an appropriate assessment can help identify what may be contributing and what treatment options are available.
Pelvic health may form one part of that assessment, but depending on your symptoms, medical or other specialist assessment may also be necessary.
Sexual health is health.
-
You’re Experiencing Persistent Pelvic Pain or Discomfort
Pelvic pain in men can be difficult to describe and even more difficult to talk about.
You might experience discomfort in the pelvis, perineum – the area between the scrotum and anus – groin or genital area. Some men experience discomfort when sitting, urinating, opening their bowels, during or after ejaculation, or at other times.
There are many possible causes of male pelvic pain.
Pelvic floor muscle dysfunction can sometimes contribute, but pelvic pain can also be associated with prostate, urinary, bowel, musculoskeletal, neurological and other conditions. Persistent or recurring pain therefore deserves proper assessment rather than self-diagnosis.
Pelvic floor problems don’t always mean the muscles are too weak.
In some people, the pelvic floor muscles may have difficulty relaxing or coordinating properly. This is one reason why simply doing more Kegel exercises isn’t automatically the right answer for every pelvic problem.
The goal isn’t simply to make the pelvic floor stronger. It needs to function appropriately – including being able to contract and relax when needed.
-
You’re Having Difficulty Controlling Your Bowel or Passing Wind
The pelvic floor also plays an important role in bowel control.
Some men experience difficulty controlling wind or stool, occasional bowel leakage, or a feeling that they can’t confidently control their bowel.
These symptoms can be embarrassing, and that embarrassment can make people reluctant to ask for help.
Persistent straining, difficulty emptying your bowel or feeling that you haven’t completely emptied may also be worth discussing with a healthcare professional.
As with bladder symptoms, bowel problems can have many different causes. Pelvic floor dysfunction is only one possibility, so aim to understand what is causing the problem rather than assuming you simply need stronger pelvic floor muscles.
When Should You Ask for Help?
Perhaps the most important question isn’t how severe your symptoms are.
It’s how much you’ve started changing your life because of them.
- Are you avoiding exercise because you’re worried about leaking?
- Planning journeys around bathroom stops?
- Getting up repeatedly during the night?
- Wearing pads every day?
- Avoiding intimacy because your sexual function has changed?
- Living with pelvic discomfort because you don’t know who to talk to about it?
- Worrying about bowel leakage when you’re away from home?
These adjustments can become so normal that you stop noticing how much your symptoms affect you.
You don’t need to wait until they become severe before asking for help.
What Can You Do About Male Pelvic Health Problems?
The first step isn’t automatically doing more pelvic floor exercises.
The first step is understanding what is causing your symptoms.
No single treatment is right for every man. Depending on your symptoms and their cause, management may include medical assessment, pelvic floor physiotherapy, supervised pelvic floor muscle training, bladder or bowel retraining, lifestyle changes, rehabilitation following prostate treatment, medication or other appropriate therapies.
Some symptoms may also require assessment by a GP, urologist or another healthcare professional.
That’s why individual assessment matters.
At my practice, bladder concerns, bowel difficulties, pelvic health and sexual problems can be discussed openly and without embarrassment.
These are health issues.
Whether you’re recovering from prostate treatment, experiencing urinary leakage, struggling with pelvic discomfort, noticing changes in your sexual function or dealing with bowel-control problems, you don’t have to wait until the problem becomes severe before asking for help.
Sometimes the first step is simply saying:
“Something has changed, and I’d like to find out why.”
Men have pelvic floors too – and looking after yours is simply part of looking after your health.
References
National Institute for Health and Care Excellence (NICE). Lower urinary tract symptoms in men: management (CG97).
Guidance on the assessment and management of urinary symptoms in men, including frequency, urgency, nocturia, urinary incontinence and voiding symptoms.
European Association of Urology (EAU). Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms.
Clinical guidance covering male urinary symptoms and the management of urinary incontinence following prostate surgery.
European Association of Urology (EAU). Guidelines on Sexual and Reproductive Health: Management of Erectile Dysfunction.
Clinical guidance on erectile dysfunction, its possible causes, assessment and treatment.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Kegel Exercises/Pelvic Floor Muscle Training.
Patient information on pelvic floor muscle function in men and women and its role in bladder and bowel control.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Treatment for Faecal Incontinence.
Information on the assessment and treatment of bowel-control problems, including the role of pelvic floor muscle exercises in appropriate cases.
Leanne Steyn
Need support? The Society of Sexual Health offers confidential online sexology and relationship therapy. Useful next steps: confidential therapy support.
