What About the Men?

Men's Health,

Many pelvic health PTs have more education and training to treat female patients, but what about male patients? What’s our responsibility to help this patient population?

If you were to ask physical therapists (PTs) treating pelvic floor conditions about their patient populations, I suspect many would answer that they treat female patients, and only a few would answer that they feel comfortable treating male patients.  After all, many refer to pelvic floor physical therapy as “women’s health PT.” Why is this so? Well, I can think of a few reasons, most of which relate back to our education and training, as well as cultural norms. However, I feel we are doing our profession an injustice if we, as pelvic health care experts, only choose to treat one sex.

When I first became a PT, never did I see my career going into pelvic health, and certainly never would I have guessed I would be treating men after prostate surgery or with chronic pelvic pain.  I have always loved treating orthopedic and sports injury conditions. However, after my older daughter was born, I developed an interest in, which turned into a passion for, helping those with pelvic floor dysfunction.  I, like many in this specialty, saw that the need is great for skilled pelvic health therapists. I also noted rather early on in my career that there are a lot of men with incontinence and pelvic pain and few providers who feel comfortable treating them.  As my education and experience in this field grew, I saw the need to branch out of my comfort zone and feel empowered to treat male pelvic health patients. Previously, there was no provider who felt comfortable treating these patients in my region. I work in a rural area and it’s not feasible for patients to have to drive 1-2 hours to larger communities for weekly therapy appointments, so their compliance and recovery suffers.

The numbers are staggering.  One in nine men will be diagnosed with prostate cancer in their lifetime (https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html).  Furthermore, 59% of men are incontinent six weeks after prostatectomy and this statistic is likely on the low side.  These numbers demonstrate the need for men to be able to access pelvic floor therapy services.  There is also significant evidence that men can benefit from skilled pelvic floor therapy services for the treatment of both incontinence and pain.  So what’s the hold up?

The first hurdle is that, while it can be difficult for women to bring up topics related to incontinence, pain with sex, or pelvic pain, it can be just as difficult for men to bring up these concerns with their providers.  Additionally, even if a man is referred for pelvic health PT and are able to find a provider, they may contact a clinic only to find that a provider does not treat men. Much of our post-graduate educational coursework is focused on typical female anatomy and treatment for female pelvic health concerns.

I would encourage any pelvic health provider who wants more education on treating male pelvic floor conditions to seek out additional coursework to gain confidence and education in treating this population, because the reality is, you can change people’s lives.  There are many more similarities in treating men and women than there are differences. We know there is a need for this kind of service, and from a business standpoint, being able to offer pelvic floor physical therapy will likely bring in patients you aren’t currently reaching.  To be able to treat men in your clinic is a very positive experience and these patients, like so many of our patients, are often grateful for our services. Of course, if this is not an area you choose to specialize in, at least familiarize yourself with your area and find a provider who is, so you can appropriately refer patients to the help they need.  We as a profession are always trying to learn to be inclusive of all patients, and this can be one way that we strive to do so.

Rachel Polito, DPT, OCS, ATC

Rachel is a physical therapist practicing at Physical Therapy Solutions in Dyersville, Iowa. She is passionate about helping men, women, and children with pelvic floor dysfunction restore their quality of life. She practices pelvic health PT as well as treating orthopedic and sports injury conditions. She is a Board Certified Orthopedic Clinical Specialist, and enjoys taking her knowledge of orthopedics and applying it to pelvic floor muscle dysfunction.