Men need to look after their Pelvic floor too

Sep 18th, 2019 / Nicki Chick

Pelvic floor muscles, Kegel exercises, incontinence – all for women, right? WRONG!
By Francesca Ruddick, Specialist Men’s Health Physiotherapist, for The World Run 2020

You may have read some articles on the pelvic floor (they are popping up all over running magazines these days) that did not even mention the male population. In fact, although there are slight (including the obvious ones) anatomical and physiological differences between the pelvis of a man and a woman, everybody has a pelvic floor, and its basic function is the same and just as necessary.

The pelvic floor* is a group of muscles and connective tissues that help to control and support your bladder and bowels, are involved in sexual function, and are a significant part of your “core” muscle group.  They work together with your deep abdominals, diaphragm (big breathing muscle), and multifidus (small muscles in your back) to stabilize your trunk and pelvis and help transmit forces from your trunk to your legs – something very important for runners.  If any one part of this core unit breaks down, you risk injury and decreased performance.   Keeping the pelvic floor muscles functional and dynamic can, therefore, not only help prevent any unwanted bladder or bowel problems such as passing wind, urine, or faeces when you don’t want to, but help ensure you can perform optimally as an athlete.

When you run, your pelvic floor muscles can be thought of as stabilizers and shock absorbers. 

With each repetitive impact, the pelvic floor will gently absorb the impact and support the moving pelvic organs while helping to transfer forces across the pelvis and stabilize the trunk.  Rather than a rigid structure you can think of the pelvic floor like a piston system in a car engine – moving up and down as you run and contracting alongside your hamstrings, glutes and quads.

Maybe you do planks and abdominal exercises, but how can you find and train the pelvic floor muscles?

• Imagine you are walking into very cold water and you are almost at the level of your groin.  Its icy cold and you want to lift your scrotum as far into your body, tightening the muscles at the base of the penis.
• Or, think about stopping wind from the back passage and stopping urine from the front, while gently lifting everything up.  You will be tightening and lifting from the bum to the pubic bone, but keep everything else relaxed and do not hold your breath.

Some men prefer to do this standing in front of a mirror without clothes.  If you are doing it right, you should notice the base of the penis draw in and the scrotum lift up.

Try to hold the lift and squeeze for 10 seconds and repeat 10 times.  Then try to do 10 one second hold and then release, or quick flicks.

Regular pelvic floor muscle exercises are not for everyone**  Many runners and elite athletes actually have a pelvic floor that is too tight or overactive, a program of activation exercises in these cases would likely worsen the issues, so an assessment by a Pelvic Health Specialist is highly recommended.

As a runner, what symptoms may one notice if suffering from an overactive pelvic floor?

Do you ever find you are out for a run and have to stop to use the restroom, only to find there is only a little urine to release? (When you have to go during a 4+ hour marathon, ultramarathon or Ironman race – that is usually pretty normal!).  This could be due to myofascial trigger points (or hyper-tight, overactive areas) in the pelvic floor muscles which may lead to the bladder wanting to empty before it’s full.

But the good news, release of these trigger points by a Pelvic Health Physiotherapist can result in almost full resolution of these symptoms in 83% of both male and females.

Other symptoms of pelvic floor dysfunction may include:

• Feeling like you have not fully emptied your bladder
• Taking a while for the stream to start, or not having a strong stream
• Urgency and increased frequency of urination
• Constipation
• Straining to pass urine
• Leaking urine or faeces, or the inability to control wind
• Certain types of sexual dysfunction

Pelvic pain, or prostatitis, often occurs with a tight or overactive pelvic floor and we see this regularly in men that attend our clinics.  After assessment by a Pelvic Health Physiotherapist, suggestions such as lifestyle changes, treatment by manual therapy and specific exercises to release the tension and ensure the muscles are working functionally and dynamically are often very helpful and can fully resolve the issues in many cases.

If you have a nagging injury that just won’t go away, the pelvic floor may just be the answer.

The pelvic floor is an important part of the “core unit” of stabilizer muscles.  Our body is made up of a lot of these “kinetic” chains of muscles which work together to help us move as well as we do.  As Pelvic Health Physiotherapists, we often find that hip, groin, buttock, or upper leg pain that is not getting better with rehabilitation from a Sports or Musculoskeletal Physiotherapist, can often be resolved after assessing and treating the pelvic floor.  In other words, pelvic floor dysfunction may be the missing link and the pain or injury is due to the body compensating further down or up the chain.

The pelvic floor can experience post-run fatigue and tension.

It is common for runners to experience muscle pain and fatigue during or after runs.  A foam roller after a run, or the use of ice or gentle stretching is commonly used to help with this. What you may not know, is just like your hamstrings and calves, the pelvic floor can experience the same post-run fatigue and tension, but you may not feel it where you would expect. Even if you do not experience ‘pelvic pain’, the pelvic floor will often refer pain to the lower abdomen (like cramping).

Deep pelvic floor muscle pain and tension can result in tension and restriction of movement into the hips, abdomen and lower back.  Alternatively, some hip muscles can refer to the pelvis, such as the muscles on the inside of your thigh called the adductors.  The pelvic floor needs to be dynamic, having both strength, endurance, activation and relaxation – so sometimes gentle pelvic floor stretching post-run can ensure appropriate flexibility of these forgotten muscles, just like you do for your external muscles!

Try these:

• After a run, when you are using a foam roller or Spikey massage ball for recovery, include some attention over the areas of your lower glutes, inner thighs, and upper hamstrings.
• Sit on the ground with your legs in front of you, bend both knees, bring your feet together and open your knees like a butterfly.  Keep your back from hunching. Breathe deeply, imagining your pubic and tail bone getting further away from you, and that hammock of a pelvic floor dropping lower and lower.  This is a nice way to stretch your pelvic floor as well as some of your hip muscles.
• Start kneeling on a mat, lean back onto your heels, and lay your trunk down between your thighs lengthening the tailbone away from your head (In Yoga this is known as Child’s pose but rather than keeping your knees together, separate them wider apart (like a frog).  You can also put a pillow or blanket between the bum and your feet if that is more comfortable. Arms can be reaching in front or relaxed down beside you.   Take 5 deep breaths into your belly as you lengthen your body imagining dropping of your pelvic floor and lengthening of the tail bone away from the pubic bone.

None of these exercises should cause any pain and just like any non-individualised advice, these pelvic floor stretches may not be enough, or may not be the most appropriate thing for you.

If you are experiencing any of the symptoms or signs mentioned, we would urge you to seek an assessment from a Pelvic Health Physiotherapist****: to guide you through exercises which will optimally activate your core, build stability throughout your pelvis and trunk, and guide you back to running safely.

It is important that you exercise in the right way for YOU!

*The pelvic floor is a group of muscles and connective tissues that stretch like a hammock, or fruit bowl, between your pubic bone and tailbone and from either side of your pelvis.

** The NICE guidelines state that an assessment done by a Pelvic Health Specialist is highly recommended before starting a pelvic floor exercise program.  This is because a lot of the people, especially in the runners and elite athletes, actually have a pelvic floor that is too tight or overactive, and a program of activation exercises in these cases would likely worsen the issues.

***  Research suggests that release of these trigger points by a Pelvic Health Physiotherapist can result in almost full resolution of these symptoms in 83% of both male and females. (Weiss JM. Pelvic Floor Myofascial Trigger Points: The Journal of Urology. 2001:2226-2231. doi:10.1097/00005392-200112000-00045).

**** Research all points towards a pelvic floor assessment by a trained professional as one of the only ways to assess this and ensure the exercises you are doing are the ones that will help you reach your maximum potential.