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You’ve already read all about WHY pelvic health is also important for men, now let’s dive into a case study!

Case Study – Male Pelvic Health

CT is a 43 year old male seeking help because he is having problems with leaking urine whenever he does physical activity. He has also been experiencing consistent sharp/burning pains around his rectal area. In the beginning he was leaking only a few drops of urine and feeling slight discomfort in his pelvic floor… but after a few months CT is leaking his full bladder and his pain has greatly increased. He is afraid to participate in golf, fishing, and jogging because this is when he leaks the most urine.

During the pelvic assessment it is found that CT has a weak pelvic floor (2/5 strength), and a lot of tension/tightness of his pelvic floor muscles. He is educated that he needs to strengthen his pelvic muscles in order to close his urethra (tube which pee comes out), so that he does not leak before he is able to get to the bathroom, or when participating in golf, fishing, and jogging. CT also requires training in relaxation exercises, and stretches for his pelvic floor, which will decrease the tightness and therefore stop the pain that he has been experiencing.

After the assessment CT is sent home with a breathing exercise, several pelvic floor stretches, and a muscle strengthening exercise.

At the next session CT reports having decreased episodes of leaking and reduced pain in his pelvic area. During a follow up evaluation CT now has 3/5 pelvic strength and a decrease in muscle tension. The therapist manually releases his pelvic muscles and he is once again sent home with progressed pelvic floor strengthening exercises and stretches.

After a few more weeks and 2 or 3 more sessions CT is no longer leaking and feels no more pain and discomfort in his pelvic floor. He is educated to keep up with his exercise program occasionally to maintain strength and proper length of his pelvic floor.

 

Not all pelvic health issues will present the exact same, and as such there is no one-size fits all program that will work for everyone. Need help with your pelvic health complaint? Don’t hesitate to contact us or book an appointment. Not sure if your issues can be helped by a physiotherapist? Give us a call, or send a message, we are happy to help you sort through it.

Book a pelvic health assessment with Scott

Book an orthopedic assessment with Scott

Scott Golding is a Pelvic Health Physiotherapist that has a special interest in male pelvic health and rehabilitation. He is passionate about advocating and supporting men in their pelvic health journey. He has completed the U of S Level 1 and Pelvic Health Solutions courses for pelvic health Level 2, and 3 in addition to orthopedic and integration of pain science courses. He has been working with both women and men for pelvic health and orthopedic issues since graduating in 2016.

 

He is driven to provide excellent care in a safe and comfortable environment for his patients. Scott believes that pelvic floor health needs to be a fundamental aspect of a healthy life, as many individuals struggle in silence. 

 

“My future goals include becoming a strong support and resource for men as it relates to pelvic, and general health. I want to help decrease and remove the stigma associated with male pelvic health and provide exceptional resources for men who need or are seeking help.”

Pelvic floor dysfunction is not just a problem for women… after all, everyone has a pelvic floor!

A study by MacLennan et al, reported that 4.4% of men have self reported problems with urinary incontinence (inability to control urine) (1). If you take the population of Saskatoon, which in July of 2018 was reported at 278,500 and divide that in half you have approximately 139, 250 males (2). 4.4% of the Saskatoon population will give us 6, 127 men that have problems with leaking or controlling their bladder. Keep in mind that urinary incontinence is only one of many potential issues with the pelvic floor.

The crux of the issue is that pelvic floor health can be a big problem for both women and men.

  There has always been a stigma around men seeking help for any issue, let alone their leaking bladder, erectile dysfunction, and pelvic pain. Men need to understand that they do not need to live with these stressful and often embarrassing problems.

Pelvic Health Therapists are specifically trained to help men and women with a vast majority of their pelvic floor dysfunctions. The pelvic floor is a bowl of muscle that surrounds the external openings, in men that is the urethra (the tube you pee out of) and the rectum.

The muscles are the same as any others in the human body and therefore they are treated similarly.  In a good number of cases urinary incontinence is related to the lack of strength, coordination, and increased tension/tightness of the pelvic floor muscles that close the urethra. Then when the bladder is full, or someone has the urge to pee they cannot stop themselves. By simply teaching someone to relax, strengthen and coordinate their pelvic muscles, urinary incontinence problems can often be resolved.

If the pelvic muscles are too tense it may cause pain in the perineum, abdomen, low back or inner thigh. Relaxation exercises and manual therapy skills can be applied to achieve relief. Strengthening pelvic floor muscles and addressing other contributing factors can often lead to the resolution of erectile dysfunction and healthier sex lives (4). Men need to understand that the tools and resources are out there to help them with their pelvic floor dysfunction, part of which may be pelvic health physiotherapy assessment and treatments.

In short, I am asking that men take it upon themselves to seek out help for their pelvic floor dysfunction and in return understand that they will be treated with privacy, respect, and compassion. Waiting and suffering in silence doesn’t need to be the case; we are here to help you, help yourself. I have had the privilege of treating many men and women struggling with dysfunction, and the experience has been rewarding for myself and the people who have trusted me to help them.

Book a pelvic health assessment with Scott

Book an orthopedic assessment with Scott

Scott Golding is a Pelvic Health Physiotherapist that has a special interest in male pelvic health and rehabilitation. He is passionate about advocating and supporting men in their pelvic health journey. He has completed the U of S Level 1 and Pelvic Health Solutions courses for pelvic health Level 2, and 3 in addition to orthopedic and integration of pain science courses. He has been working with both women and men for pelvic health and orthopedic issues since graduating in 2016.

 

He is driven to provide excellent care in a safe and comfortable environment for his patients. Scott believes that pelvic floor health needs to be a fundamental aspect of a healthy life, as many individuals struggle in silence. 

 

“My future goals include becoming a strong support and resource for men as it relates to pelvic, and general health. I want to help decrease and remove the stigma associated with male pelvic health and provide exceptional resources for men who need or are seeking help.”
  1. https://www.ncbi.nlm.nih.gov/pubmed/11192101
  2. http://worldpopulationreview.com/world-cities/saskatoon-population/
  3. https://www.google.ca/search?q=happiness&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjdo52egMPiAhVPHDQIHTU0BBkQ_AUIDigB&biw=1218&bih=573#imgrc=A0NGFCYX4gqASM:
  4. https://bjgp.org/content/bjgp/54/508/819.full.pdf

As with many issues, often we aren’t sure if what we are experiencing is normal and expected, if it will just go away, or if we need to have it looked at. For many women who are pregnant and postpartum, this is made even more difficult as we are often told that symptoms we are experiencing are normal because “you’ve had kids” and that “this is just how it is now” which can delay effective treatment of these issues! Here you can see a case study on Prolapse, which outlines some of the issues that someone may experience.

The presenting symptoms:

A 31 year old woman attends the clinic mentioning a history of intermittent pelvic floor heaviness “feeling like things are falling down” and discomfort. She has noticed that the heaviness has been worse since starting back with weight lifting at her gym 1 month ago. She has two children ages 2 years and 4 months old.  She had continued to go to the gym throughout her pregnancy (symptom free), but notes she had reduced her weights somewhat during her third trimester.

She hadn’t returned to the gym until now, as her life has been quite busy since the delivery of her second child! No pelvic floor pain, urinary or fecal incontinence is reported.  She had felt like now was a good time in her life to return to the gym and is quite devastated at this setback. Going to the gym and working out had been an

important part of her life-mentally, socially and physically and she is worried she won’t be able to do any activity at all anymore.

She went to see her family physician as was concerned about her symptoms and was referred to pelvic floor physiotherapy for prolapse. She reports no symptoms first thing in the morning, but these progressively worsen as the day goes on.  Some days are better than others with her symptoms.  Lifting weights at her gym and lifting her children aggravate her symptoms.  She notes she did just get over a bad cold and had been coughing/sneezing quite a lot during the past month. She also identifies that she has always had issues with constipation.  Both of her deliveries were vaginal with no instrumentation (forceps or vacuum) or complications. She is currently breastfeeding.

Assessment and Treatment

The client was assessed with an internal pelvic examination by a pelvic floor physical therapist. A Grade 1 cystocele was found. (A cystocele means the prolapse was from the bladder descending into the wall of the vagina and a Grade 1 prolapse means the organ descent was halfway to the vaginal opening). The pelvic floor muscles were weak with a Gr. 2 strength (a weak squeeze and no lift of the pelvic floor muscles) and tight.

The client and the therapist worked together to increase her pelvic floor strength and coordination, as well as to optimize her intraabdominal pressure management systems. Toileting positions and discussion around constipation management were discussed and the client was able to implement these at home. Optimizing postures during breastfeeding and throughout the day were discussed to reduce strain on the pelvic floor and discussed on how to successfully get them implemented at home.  Education on anatomy of the pelvic floor and the pelvic organs/their supports as well as POP was provided which will help the client to take control and understand the why behind the recommendations.

Activity modifications were implemented but keeping her active was part of the plan and exercises were progressed as appropriate.  The client returned to her gynecologist for a pessary fitting to use intermittently during heavier weight lifting at the gym. She was seen in follow up 2 weeks after the initial assessment and then 1x/month for 6 months. She was able to return to her weight lifting and was symptom free with all tasks and activities at the conclusion of therapy, although her Grade 1 prolapse remained.

Have you been struggling with prolapse symptoms? Not sure if your symptoms could be part of prolapse, please feel free to contact us and we will help chat you through what you are experiencing as best we can.

Don’t delay start your road to recovery today!

Maja Stroh is a physiotherapist that has a particular interest in pelvic health and perinatal care. She graduated from the U of S MPT program in 2009 and has been working with pelvic health populations since 2013. Maja’s interest in helping her clients and spending quality time with her family has brought her to Warman Physio where she will be providing services in the Saskatoon and Warman locations.

March was Endometriosis Awareness month, and we have provided some information related to endo for everyone on our social media (Facebook and Instagram). If you are wondering what endometriosis looks like for someone living with it, you can check out the story we posted earlier in the month. As promised here are some of the things that Pelvic Floor Physiotherapy can do for you…

Pain Science

Physiotherapists that work with pelvic pain conditions, such as endometriosis, have additional training specific to the actual science behind pain. Having this knowledge to give to our clients allows us to de-mystify pain, help us understand pain perception, and why the symptoms are occurring. Globally with pain science, one of the most important things to understand are there are no pain signals to the brain. The brain receives information from the body, and depending on what all those signals are saying, will determine if something is painful or not. Have you ever stubbed your toe when you are having a great day? It hurts SO MUCH. But, if you stub your toe while you are in the middle of an argument with someone, it doesn’t hurt the same; that’s pain science!

Everyone has heard a story of someone being in an accident of some kind and being able to get to a hospital (or civilization) before feeling pain.

How does this apply to endo? Endometriosis is the presence of uterine-like tissue outside of the uterus, within the pelvic bowl and abdomen (generally). Endometrial tissue contracts during menses to shed the lining of the uterine wall. If this tissue is outside of the uterus… it still contracts on the tissue it is adhered to.

Which brings us to….

Assist muscle tension

If you have a muscle that is contracting and creating more tension over time, and you aren’t stretching it, eventually it becomes tighter. Have you tried stretching tight muscles? How about making them contract more?

Here is where we talk about what happens in a painful body – when we have abdominal and pelvic pain, we try and protect the area. This protection leads us to adopt a fetal position. Tightness develops in the abdominals, hip flexors, pelvic floor, and diaphragm, which plays into the pain cycle. Pelvic floor physiotherapists will work with each woman to obtain appropriate length, strength, and coordination of the muscles in the abdomen and pelvic bowl.

Tight muscles are often painful muscles.

Provide self-assistance tools

We are here to help you, help yourself. Giving you tools to reduce pain for between episodes, things to try during painful episodes, and ultimately manage your pain.

Some things that could be helpful include: stretching your hip flexors, deep breathing, yoga, meditation, using a wheat bag, and releasing muscles using an acupressure ball (or tennis ball).

 

Endometriosis can’t be cured by physiotherapy, but the symptoms can be managed. Contact us today to see how we can help you, or use the Book Now section to schedule your assessment today, and take control.

*Note: Kendra Usunier is our Pelvic Floor Physiotherapist that is able to take new clients at this time. Only clients that have seen Haylie Lashta previously are to schedule in with her at this time. We appreciate each person and their unique journey to find us, contact us directly should you have any questions.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.

For Endometriosis Awareness Month, we wanted to give our readers a true story to hear from. The individual that wrote this story has not been seen at the clinic, and is in no way affiliated with Warman Physiotherapy & Wellness. She, like many others, wants to raise awareness, give some of her symptoms, and hopefully, help people understand that pain is NOT normal. Onto her story….

My journey with endometriosis began many, many years ago. I just didn’t know it. As a teenager I was riddled with crippling periods involving an extremely heavy flow, and excruciatingly painful cramps that I remember eating handfuls of Midol to help get through the day. I was told “welcome to being a woman, this is normal”. Hindsight is 20:20. It was the furthest thing from normal. Thankfully, I was put on birth control, which seemed to make my periods manageable. My actual diagnosis of endometriosis was not until Oct of 2017. 6 Months prior to this I started developing excruciating stabbing pains in my right lower abdomen. A walk in doctor triaged me to the emergency room thinking my appendix had ruptured. Blood work showed no signs of infection, IV pain meds were given and an x-ray image did not show anything concerning. I was sent home with pain meds and told that I needed to poop. Exactly one month later (a month between my period) I ended up in excruciating pains where once again I ended up in the emergency room. This ER doctor again thought for sure it was my appendix but this time ordered an ultrasound. The ultrasound showed a 4cm hemorrhagic cyst on my right ovary. I was sent home with pain meds, and another ultrasound requisition. I was told to go see my family doctor in 6 weeks. I was told that a hemorrhagic cyst is nothing to worry about that it can happen with ovulation. My anatomy background and my knowledge of how a body works from also being a vet tech gave me a feeling that something more was wrong. The pain experienced during this time nearly made me pass out. Breathing hurt so I would hold my breath. I knew something wasn’t right. A 2nd ultrasound 30 hrs later showed that my cyst had grown by a couple of centimeters but that the radiologist wasn’t concerned as it’s just a hemorrhagic cyst and they can happen during ovulation. I wasn’t ovulating, I was at the end of my period. Something wasn’t right.

 

I have a really amazing gynecologist. Let me say that again. I have an amazing gynecologist. When I went into pre-eclampsia with my daughter, this gynecologist delivered my daughter and I met the most compassionate doctor who actually listened. I knew I had to get in to see her and that as long as I could get in to see her everything would be ok. But of course because I hadn’t seen her in over a year I would need a new referral. Off to another walk in dr. Unfortunately, my gynecologist didn’t have an available appointment for months. My stomach ached, and my guts ached, I would bloat up as if I was 8 months pregnant. There was a time at work where I came to work wearing jeans and by the end of the day I left in scrubs because my button wouldn’t do up. I begged the receptionist to send my gynecologist a message, begging her to understand that every month I will end up in the ER from passing out pain due to this “no big deal cyst on my ovary.” My compassionate gynecologist heard my message and within days, I was booked an appointment with her. She ordered more tests, another series of ultrasounds. Cysts usually burst and go away or at least shrink; mine wasn’t. I was still having daily pelvic pain, daily gut aches. I was put on a birth control to hopefully stop my cycle and stop the stabbing/ passing out pain that came at the end of my period. My gynecologist mentioned that she thought I had a disease called endometriosis. I had honestly never heard of it before. I went home that night and did what most people do– I took to google. Symptoms of this disease was pelvic pain, which I did have prior to these episodes but chalked it up to the many bladder infections that I’ve suffered from. Extremely painful periods was another symptom, which again I had when I was not on birth control. Surely, this disease couldn’t have started at the age of 16. I kept reading, “many women with endometriosis suffer from infertility.” 2 years prior, I had a beautiful baby girl so I couldn’t much relate to that. Back pain can also be a sign of endometriosis. Sure, my back hurt, but I had also been diagnosed with scoliosis of my spine years earlier so my back pain was from that. “The feeling of your insides being pulled down”. My gynecologist asked me during one of my appointments how I was feeling. I told her “it’s like I’ve eaten Chinese food for all 3 meals a day. Like my guts are just so heavy they are all hanging below my belly button.”

I wasn’t convinced. I kept thinking that this disease would have shown up on my previous CT scan, my previous abdominal ultrasounds I’ve had for a tumor I have in my liver. Surely, it would have shown up when I had a previous laparoscopic surgery to remove my gall bladder.

I went in for surgery in October to have this cyst removed. Upon waking up from surgery, I was told I had endometriosis bad. Really, really, bad. I was told that it was so bad another surgeon had to be called in to help. I heard the words “you are the worst case of endometriosis I have ever seen”. My surgeon(s) spent hours cutting out the endometriosis that they could. They removed the cyst on my ovary that was larger than my uterus. They spent hours and hours cutting off endometriosis off major blood vessels, my uterus, this cyst. I was told when they opened me up they found a pool of blood in my abdomen. That is the thing with endometriosis, when you have your period and shed your endometrial tissue from the inside of your uterus, your endometriosis that has grown outside of your uterus also bleeds.

The bad news didn’t end there. If someone is going to have endometriosis it usually stays in your pelvic area. Attaching to and growing on your uterus, ovaries, bladder, colon, pelvic floor. In rare cases, endometriosis grows outside of the pelvis. I happen to be one of the rare ones. Many, many endometriosis lesions were found along my ribs and my diaphragm. My gynecologist had no idea that I had this disease this bad, and neither did I. After all the first ER doctor told me that pooping would solve all of my pain.

I read online that someone compared endometriosis to cancer. That it can spread like cancer does, the only difference is that there is no cure for endometriosis. There were days I was in denial that the diagnosis seemed like a bad dream. The one thing that brought that dream back to reality is that I still suffered pain. You see this disease has two options, cut it out and try to suppress it with medication. I am doing both. And yet it seems with myself and many others even with excision surgery and suppressive medication, there is still pain.

I look back at my journey of my diagnosis and I thank God each day that I did not accept “it’s nothing to worry about” for an answer. Thank God I insisted on seeing my gynecologist sooner vs months later. I am thankful every day for the medical background I have in my personal career that gave me the knowledge that “something isn’t right.”

 

 

My journey with endo isn’t over, I don’t think it will ever be over. I will be on hormone suppressing pills for the rest of my life. I will have more surgeries in the future, some life threatening ones where they shut down your lungs one side at a time. I’ve been sent for MRI and CT scans to see if they can find endo in my lungs. Yes, this endo can invade your lungs. I’ve often told people that endo is a silent disease. From the many support groups that I have joined; I’ve learnt that it’s not uncommon to go years without a proper diagnosis. Endo isn’t always detectable on MRI, CT, Ultrasounds, or X-rays. A laparoscopic surgery performed by an endo specialist is the proper way to diagnose endometriosis. I’ve even heard of some peoples endo only being found under a histological biopsy.

 

I truly believe there needs to be more endometriosis awareness seeing as how 1 in 10 women suffer from this disease. Heck, I was that 10% and I didn’t even know it. I am very open with others about my endometriosis hoping that maybe I can raise awareness and make someone realize that pain doesn’t have to be “being a woman.”

 

Wonder how Physiotherapy can help you with endometriosis? We will be completing our follow-up on what physiotherapy is capable of assisting with for those that have endometriosis before the end of the month. If you want to start now, schedule in with Kendra HERE.