Male Pelvic Floor - resource

[venom888]

Exhaling through the mouth feels weird. Is that what y'all who've had success and focus on your breathing do?

[Pegasus]

My last post was the views of Dr Tara Sullivan . Many guys onsite put emphasis on breathing many do not.

[WillGetBetter]

Great information. It’s good to see there are some resources out there to help men with ED and PreE. But, considering the % of men who have one or both, I’d hope that more general family doctors had this knowledge.

[Pegasus]

One day over the golden rainbow .

Look years ago the docs said ed and pre e was all a head issue .

[Pegasus]

Quote
Kegels are no good for a hypertonic or “tight” pelvic floor.
For decades doctors, PTs, trainers, therapists, you name it, have been hammering away at women—and men too—that if they want to strengthen their pelvic floors, they must do their kegels.
Getting folks to stop doing kegels is a bit of an uphill battle because it’s advice that’s seeped into the mainstream consciousness. On an episode of “Sex in the City” Samantha jokes about doing her kegels; Oprah Winfrey had experts on her show dispensing the advice to her zillions of viewers, and if you google “kegels” you’ll come up with about 1.3 million hits.
So you can imagine my delight when I came across an article that went against the party line, and actually delved into the potential harm kegels can do to the pelvic floor. An issue that PTs who treat the pelvic floor are all too familiar with.
The article is titled “Stop Doing Kegels: Real Pelvic Floor Advice for Women (and Men)” is written by Nicole Crawford and published on BreakingMuscle.com.
Ms. Crawford’s article is a Q&A with Katy Bowman—a master’s level Biomechanist whose focus is the mechanical causes of disease. In the past, Ms. Bowman has made waves advising folks against doing kegels.
Ms. Bowman says that at the heart of the problem with doing kegels to strengthen the pelvic floor is a theory in biomechanics called: “Overgeneralized Theory of Strength.” When you do a kegel, she explains, you are doing a muscular contraction, and if you already have a tight pelvic floor, contracting these muscles will only make it tighter, making your pelvic floor problems worse.
Here I agree with Ms. Bowman 100%. If you have a tight pelvic floor, or even a pelvic floor with active trigger points, you should not do kegels. Doing kegels under these circumstances will compound your pelvic floor problems.
Ms. Bowman goes on to say that kegels are never appropriate. In her prior writing on the topic, she’s held that doing kegels can actually cause weakness. As an alternative to kegels for pelvic floor strengthening, Ms. Bowman recommends deep squats. Her reasoning is that deep squats strengthen the glutes, which in turn “pull the sacrum back, stretching the pelvic floor from a hammock to a trampoline” and thus providing for a stronger or more stable pelvic floor.
Here is where I am forced to disagree with Ms. Bowman both on her assertion that kegels are never appropriate and her advice that deep squats are a better way to combat a situation where the pelvic floor is weak.
If you’re not someone who has dealt with the symptoms of a tight pelvic floor, you might wonder why a tight muscle is a bad thing. Often folks equate tight muscle with “toned” muscle. In fact, here’s a comment from a reader on this very point:
“Why is a tight pelvic floor a bad thing? Isn’t it the same as a toned pelvic floor? And a toned muscle is not a bad thing. I understand that if you over-do it, your pelvic floor muscles can become too tight, but isn’t that the same as with any other muscle fatigue in the body when you over do it? The muscle rests and relaxes a bit then it’s fine.
A toned muscle is not a bad thing, the reader is correct. Unfortunately, however, if you “over do it” with your pelvic floor muscles, they do not just rest and relax. Your pelvic floor muscles are the only group of muscles in the body that never get to rest, ever. If they completely relaxed we would be incontinent. So, they are working all the time to maintain continence, to support our pelvic organs, and to contribute to our posture and stability.
Therefore, these muscles are “working out” all the time, and don’t follow the same rules as the other muscle groups in our body. If you do get carried away with kegels and over-strengthen your pelvic floor muscles, they can become too tight, which in turn can cause dysfunction and symptoms, such as pain, urinary urgency and frequency, among others.
When this happens, it often takes the expertise of a pelvic floor PT to return the pelvic floor muscles to a normal tone to eliminate the symptoms.
So, the pelvic floor muscles do not need extra strengthening from doing kegels, unless something has happened that has overstretched them or injured them in some way that has made them truly weak (not weak AND TIGHT, more on that in a bit). Your pelvic floor muscles can become overstretched and weak after childbirth, around menopause, and after some gynecological surgeries. And this overstretching and weakening can lead to organ prolapse.
So kegels are appropriate when the pelvic floor is truly weak and/or overstretched. I prescribe them all the time for this patient demographic. And there are many experts in the field of pelvic floor rehabilitation that will strongly agree that doing kegels are appropriate when pelvic floor muscles are overstretched and/or weak. And in fact, there are many articles in medical journals that support this.
It’s important to note though that many postpartum women can actually have tight pelvic floor muscles so any woman who thinks she needs to do kegels after pregnancy should absolutely get an evaluation by a trained PT to make sure that is indeed what she needs to do. Because if you start a pelvic floor strengthening program when you actually have a tight pelvic floor, you will create problems, I promise you. So, unless you’ve been evaluated by a pelvic PT, and told you have a weak, not tight, pelvic floor, do not continue to do kegels.
So tight muscles = kegels bad. Weak and/or overstretched muscles = kegels okay. Oh, if only we could end things here. But as anyone who has researched the pelvic floor knows, there is no black and white when it comes to this part of our anatomy–only lots of shades of gray, and more than 50, I can tell you that much!
Here’s the clincher: it is possible for a weak pelvic floor to also be tight and/or to contain active trigger points. In this situation, it is NOT okay to do kegels.
So what does someone who has both a tight and a weak pelvic floor do, especially if he or she has a prolapse or other symptoms caused by the weakness. Well, the appropriate course of action in this situation would be to first work to clear up the tightness and trigger points with PT and whatever other treatments are appropriate. And then once the pelvic floor muscles are at a healthy tone–no longer too tight, and all active trigger points gone–do kegel exercises recommended by a trained PT to strengthen your pelvic floor without fear of causing further problems.
So, to summarize: kegels are not appropriate for folks with a tight pelvic floor or active trigger points or folks with a weak AND TIGHT pelvic floor. But, it’s okay to do kegels to strengthen a weak pelvic floor.
I hope this updated post has cleared up all confusion. But, if you still have questions or concerns, please don’t hesitate to send them my way.
All my best,
Liz


Comments

[Anthony_gerio]

So, they are working all the time to maintain continence, to support our pelvic organs, and to contribute to our posture and stability.

I am telling this for a while now out of my experience. Excellent peace of Article Pegasus.
When you become aware of your pelvic floor, you even see that if you rise one of your hand, to keep the body balance PF starts to work. And it get trained in many activities.

Moreover, (again out of experience and personal belief only), This muscle get trained and grow based on movements not contractions. People who train at gym understands this, if you contract your chest pecs as mucg as you want, it has a very limited or no impact on its growth. While through the presses or flies, it expands and then pressured from the sides of the muscle. I very believe that the same applies to these muscles as well.

it is possible for a weak pelvic floor to also be tight and/or to contain active trigger points

Again mentioned this a lot, these muscles seem to be localized, meaning strethcing of a part may not have much impact on relaxation of other parts, so you have to be sure to include all the sections of PF in your program and while holding a light RK during the day, it's better to be sure to keep the RK on the whole of the front PF.

[Pegasus]

This from David Wise phd.
Quote
In my view the whole issue we are dealing with about treatment for pelvic pain is simply this–how to allow the body to heal itself? I think contemporary medicine tends to forget that it is almost always the case that ‘the body heals itself and the doctor collects the fee.’ In the National Library of Medicine today, I found there were 3743 research articles listed on prostatitis. An infinitesimal 7 articles even contained the word healing. My view about treatment for pelvic pain is that we want to optimize the circumstances for the body to heal itself, we want to get out of the way of the healing of the tissues, muscles and structures inside the pelvic floor. Healing is what we want. In my own case, when I began thinking this way, my condition began to resolve.
The Wise-Anderson Protocol is about healing. It is about creating a hospitable environment for the restoration of normal happy tissue inside the pelvic floor. The relaxation protocol allows the nervous system to quiet down so that the irritated tissues can heal and can stop being squeezed into an irritated state… a squeezing that in most people who have pelvic pain has become habitual and chronic. The relaxation protocol aims to change the habit of tightening the pelvic muscles under stress. The physiotherapy we do stretches and lengthens the pelvic tissue and deactivates trigger points to make room for a healthy life in the pelvic floor.
The idea of RSD as it is understood today, at least as I read it, implies a condition where healing is remote. I balk at theories that imply healing isn’t possible because of my personal experience and others who have gotten better with this problem. Healing is possible. The patients I have seen who have done the worst – especially those who have suffered from unwise medical interventions, have given the entire responsibility for curing their condition to someone or something outside them. They come to the doctor and say “fix me doc”. Any treatment for the kind of pelvic pain we treat needs to be the servant of the body’s healing mechanisms. This requires the intimate and whole hearted participation of the patient.
Physiotherapy alone, while an essential component, is usually inadequate to resolve symptoms because it alone cannot make this healing occur. I understand this experientially. It is tempting for someone to think that physiotherapy, this outside procedure, will fix them. In my experience this person will be disappointed as I was. I had over 50 physiotherapy treatments and at the end of them all, I was still symptomatic and in pain. It was only after I saw that my problem came from my chronic tension, anxiety and habitually squeezing my pelvis – and particularly when I began the relaxation protocol in earnest, often up to 2 hours a day for over two years and doing moment-to-moment pelvic relaxation throughout the day, that my symptoms began to resolve. The pelvic pain of those we help is not simply a mechanistic problem that can be fixed from the outside with a physical therapist’s finger. The habit of tightening the pelvic floor is usually decades old and has been practiced thousands of times. It is part of a coping repertoire. Tightening their pelvic floor under stress is the default mode and keeps the tissue of the pelvic floor irritated and shortened.