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Amanda:  All right. Welcome back to the podcast everyone. I am so excited to have Katelyn Peach back on here today. Katelyn, welcome.  

Katelyn: Thank you for having me again.  

Amanda: Okay, so if you weren’t here last week and weren’t listening last week, we talked about pelvic floor physical therapy for women.

Katelyn is a pelvic floor physical therapist at Wellbeing Physical Therapy in Murray, Utah, which is where I go and see her colleague, Val. So we’ve talked about Val a little bit last week, but I’m going to have Katelyn just introduce herself again, and then we’re going to get into today’s topic of pelvic floor physical therapy for men, because I feel like this is something that is often overlooked, plays a huge role in sexual function and other things as well.

And so I’m excited to talk to Katelyn today. So Katelyn, reintroduce yourself to us.  

Katelyn:  Yes, so my name is Katelyn Peach. I’m a doctor of physical therapy and I specialize in pelvic floor physical therapy. So I treat all genders, all ages for any pelvic health condition. So lots of bowel and bladder stuff, sexual stuff, pregnancy, postpartum, lots of pelvic pain. That’s what I treat. So, I’ve been a physical therapist for five years and I’ve always worked here at Wellbeing and it’s my dream job. I love it. I love it here.

Amanda:  Awesome. So if you didn’t listen to last week’s episode, go back and listen to that one because we went over some specifics about like what pelvic floor physical therapy is and why it’s important and what you need it. And so that gave a good generalization of what it is. But today we’re specifically going to focus on pelvic floor physical therapy for men because we just don’t talk about that as much. I think we talk about it for women a lot. I mean, it’s getting more and more popular, but men have pelvic floors too, and they have pelvic floor issues. So maybe let’s start out, can you explain again, what it is and why it’s important specifically for men’s health?  

Katelyn:  Yes. So pelvic floor physical therapy is like, you know, orthopedic physical therapy.

So we’re getting muscles, joints, tissues moving that need to move. Strengthen, what needs to be strengthened and working on coordination of things. So if you were to get your knee rehabbed, you’d probably, you know, do some muscle mobilization, joint mobilization and strengthening, right? So it’s the same thing but for your pelvic floor.

So, the pelvic floor is a group of muscles that sit at the bottom of your pelvis and have a lot to do with sexual function, bowel and bladder function, and when things go wrong, we can get a lot of pain, pelvic pain. Pelvic floor is also involved with low back and core issues too. It’s all part of the core that stabilizes pelvis. And so all of those things have to work together appropriately to give your pelvis stabilization. 

So specifically for men, I will say, more female patients are likely to say like, oh, my friend got, you know, my friend saw a pelvic floor physical therapist and she told me that I should see one.

Or I think women are more likely to kind of chat amongst themselves of, oh yeah, see a pelvic pt. Or like, oh, I pee my pants. And you know that. I think they’re more likely to say, to kind of share that with each other. Whereas my male patients would rather die than tell their best friend that they’re having testicular pain, right?

So I think they are less likely to know about pelvic floor physical therapy or things that, you know, things they can do to get help. So, yeah, for men, men have pelvic floors, just like women do. We have the exact same muscles. The outer muscles are oriented, obviously just a little bit differently, being around the penis versus around, you know, the opening of the vagina.

And then they have a little bit more structures on the outside of their pelvis versus females have it more on the inside. But there’s, the structures are very similar and need a lot of similar treatment. It just looks a little bit differently.  Yeah. 

Amanda:  Yeah. So those are some key differences between men and women, right? Like inside structures versus outside structures, that kind of stuff. 

Maybe, let’s talk about how common pelvic floor issues for men are and maybe why we, I mean, you said we don’t hear about ’em as much. I think just ’cause men don’t talk about it as much, but, why don’t we hear about pelvic floor issues  for men as much as we do with women?

Katelyn: Yeah. I mean, my theory is toxic masculinity. I think men are, I don’t know, expected to have, you know, like they’re not expected to have pain in sensitive areas. Or like, you know, like you don’t hear men saying like, oh yeah, I pee my pants like a woman does. You know, I think just like culturally, I think, I don’t know, there’s just maybe more shame or we just don’t expect them. Maybe because they don’t have babies. And so it’s like, oh, you don’t have babies, you shouldn’t have problems in your pelvic floor. But I think it’s so common and so underdiagnosed. Something that I see a lot is my male patients that come see me, they have seen six other providers who have all told them like, oh, like I don’t really see anything wrong.

Or they’ve given them antibiotics and that doesn’t help. And so they’re kind of like, uh, I don’t know, like maybe, maybe it’s just in your head, like maybe you actually don’t have a problem. And then by the time they come to see me, they’ve done a bunch of Googling and this is a treatment option and I’m like, yeah, it’s your pelvic floor.

Amanda: Yeah. Makes total sense to me. 

Katelyn: Yes. I’m like, it’s not in your head, like there’s a clear issue in your pelvic floor here that’s  contributing to your problems.

Amanda: Okay. So what are some signs that a man might have some pelvic floor dysfunction?  

Katelyn:  Yes. So number one, any kind of pain.

So pain with erection, pain with ejaculation. Penile pain, testicular pain, tailbone pain, groin pain, hip pain, even low back pain. All of that could be centered in the pelvic floor. Typically, that’s tension issue. So those structures, those muscles are really, really tight and guarded and it’s not getting the necessary relaxation and blood flow. And so we get pain in that area.  

And I will say too, that’s a very vulnerable thing to say, like, oh, I have like pain in my testicle. It’s not easy to just like throw that around. And it’s scary, right? And if you don’t know what it is, that can feel really, really scary.

So, a lot of times that’s, you know, we have tension and then that creates pain and then the nervous system is heightened, so then we get even more guarding, which leads to more pain and then we kind of get in this cycle. 

So for sure pain, any kind of leaking. So, um, urinary or fecal leakage, that’s a red flag. You should probably see a pelvic floor pt.  

For my male patients, it’s more they go to the bathroom or they go pee and then they think they’re done and then they start to fall up their pants and then they have a little bit of dribbling after. That’s typically the type of leakage that I see in my male patients.

And then as far as sexual dysfunction, erectile dysfunction is one that I see commonly. Obviously there’s a lot that can go into that, but for sure it could be contributed by pelvic floor. Either a pelvic floor tension issue or weakness issue. 

Amanda:  So, you’re saying erectile dysfunction, that like, are you saying being able to get an erection, hold an erection, that that’s what you’re referring to?

Katelyn:  Yes. Or pain with an erection. Yep. All of the above. Yep. 

Amanda: Okay. 

Katelyn: And then premature ejaculation, A lot of times that’s a pelvic floor tension issue. Those muscles are really, really, really tight, and so any kind of stimulation, it just, it can’t wait. And then we get the premature ejaculation.

Amanda: How much does anxiety contribute to that?  

Katelyn: So much. Yes. A lot. That’s definitely one that I’ll treat the physical symptoms of that, but then I think there’s also  a mental-psychological piece that I think needs to be addressed. Not to say it’s all in your head. I think, again, our nervous system gets amped up and then it kind of creates another vicious cycle of the issue.

Amanda: Yeah. I’ve seen with clients of mine that have premature ejaculation, a lot of it started out as an anxiety issue and then becomes a tension issue and it just kind of cycles and feeds on each other. And so addressing it both from the physiological standpoint as well as the psychological standpoint is really, really important.

Katelyn: Yes, for sure.  

Amanda: Awesome. Okay. Is there a role in pelvic floor physical therapy that plays into prostate health? 

Katelyn:  Yes. So I have seen a lot of male patients who have had chronic prostatitis. So they’ve had, you know, inflammation in the prostate. Sometimes the antibiotics have worked, sometimes they haven’t. 

Either way they’re still having prostate symptoms. And that is definitely some tension guarding, and potentially some congestion around the prostate that the pelvic floor is kind of holding onto, guarding around, that needs to be addressed. And then if someone has had a prostatectomy, that’s definitely an indication that you should see a pelvic floor physical therapist.

So after getting your prostate removed, you’re probably going to have some sexual dysfunction, some leakage, maybe some pain. So we need to kind of get all of that back to where it needs to be. When the prostate grows, kind of hypertrophies, it creates kind of a stopper for the urethra and so the pelvic floor number one has a little bit more weight on it, so then it kind of gives up and it doesn’t have to engage appropriately for continence.

So then all of that is cleared out and our stopper is now gone and pelvic floor forgot how to work. It’s normal for up to a certain point after a prostatectomy, but for sure we need to rehab those muscles, rehab that area, decreased tension and guarding and then strengthen things back up.

Amanda: I mean, when we think about other areas of the body, like if you had surgery or had something removed, like there’s always rehab that comes with it.

Katelyn: For sure.

Amanda: And yet we don’t hear about rehabbing your pelvic floor after having your prostate removed. They’re just like, okay, this is what you need to expect and see ya. And there’s so much that can be done to help with that. 

Katelyn: Yes. 

Amanda: I’ve had clients, mostly wives, who have come to me worried like their husband had prostate cancer, was having their prostate removed, worried about what their sexual relationship was going to look like afterwards. And pelvic floor physical therapy was never even mentioned in their rehab process.

But I also like to tell them to open up their definitions of sex too. Sex is not just about intercourse. There’s so much more to it. And I know this sounds really funny, but a lot of times the example that I use is like, lesbians have really good sex. And there’s no penetration involved a lot of times. So like there’s just ways to work around it, but there’s ways to work with it too. And rehabbing, this is really, really important. 

Katelyn:  Yes. So expectations might be a little bit, it might look a little different than what it was before. But for sure we should rehab and, you know, maximize function as much as we can.

Amanda:  Absolutely. Okay. What happens during a pelvic floor physical therapy session for men? We talked about it for women last week. So let’s talk about what it might look like for men.  

Katelyn:  So similarly I do kind of an ortho screen. So I look to see how your spine is moving, how your hips are moving in general, how your pelvis is stabilizing, kind of zooming out from the pelvic floor.

And then same thing for men as women I check abdomen, so I see if there’s any abdominal scarring, abdominal tension around organs. And then to do a pelvic floor exam, in some ways that’s a little bit easier because there’s a lot of structures on the outside, right? So I’ll normally start by checking the external pelvic floor muscles externally.

So those are the ones that sit in between sit bones. So I’ll normally start there. I’ll check inner thigh muscles, inner thigh and pelvic floor kind of work together. And so we’ll check the muscles around pelvic floor and then external pelvic floor. And then if it’s indicated, I’ll check mobility of fascia around spermatic cord or on the shaft of the penis.

And so I’ll just feel those tissues, feel how they’re moving, see if that reproduces symptoms or is tender or tight in any way. And this is my style. I normally don’t do an internal exam on a male patient on the first visit. A lot of times that’s a time constraint thing, but a lot of times too, there’s a lot we can do externally first to kind of get things to be able to relax and move and open before we have to go internally.

So, depending on the patient, we’ll either do an internal exam, you know, second, third, fourth, you know, on a subsequent visit or never if that’s what they feel comfortable with. But for an internal exam, we go rectally instead of vaginally. So just one gloved finger lubricated through the rectal opening. And then I’ll go in and palpate each individual muscle of the pelvic floor. And that will give us a great idea of muscle tension, muscle function. If there’s any weakness or coordination issues, and then we can do treatment internally as well if needed.

Amanda:  So I would imagine that this would be a really hard thing for a man to go through. 

Katelyn: Yes, for  sure. Yeah, they’re very, so many of my male patients have said like, I feel so vulnerable right now. Right, like having a stranger like hold my junk in their hands or like having a stranger’s finger up my bum. It feels very vulnerable. So I try and be as sensitive as possible. And like be reassuring. And of course I’m always taking it at their pace. If they’re like, you are not sticking your finger up inside of me, I’m like, great. Okay. We don’t have to do that. We don’t have to do it today. We don’t have to do ever if that’s what you’re comfortable with. I would say most of my male patients, by the time they’re here, are like, do whatever you need to me. Do whatever you need to do to me. I am just done with this. Like, I just want to get better. 

Amanda: Yeah.  I mean, I think as women, even though it can often feel invasive, it’s something that we’ve just been like told our entire lives that this is part of being a woman, like having people up all in your business and stuff like that. But that’s not necessarily the case for men. I think maybe just even addressing the maybe the elephant in the room. Do men often get aroused when you’re doing this?  

Katelyn:  Yeah, that’s a great question. And so many of, yeah, I tell my patients because they will get nervous about it, and I say that is a completely normal physiological response to what we’re doing. 

Amanda: Yeah.

Katelyn:  In fact, if we’re having issues there, that’s a great sign. Right? I’m mobilizing tissues, I want blood flow to the area. And so if you get an erection, I always say I’m not offended and I’m not flattered. That’s just part of what happens.

Amanda:  Yeah. I mean, it doesn’t mean anything. It’s just a physiological response, right? And I think we need to normalize that part of it, that there are things that happen, just as a normal physiological response, that don’t mean anything. And while it may feel vulnerable and embarrassing, this is something that you see all the time you’re used to. It’s actually part of the exam, I would say, just because you need to see how things are functioning. 

Katelyn: Yeah.

Amanda:  And so nothing, even though it’s normal to feel embarrassed, you don’t need to feel embarrassed about it. 

Katelyn: For sure. Yep. 

Amanda: Okay. What are some of the biggest misconceptions that men have about pelvic floor physical therapy?

Katelyn:  Yeah. I would say the biggest one is they don’t have a pelvic floor. But we already talked about that. That it’s like just for women or they don’t have a pelvic floor or they don’t get pelvic floor issues. I think sometimes too, like men are perceived, which a lot of times like men are really strong, right? I’m strong and so it’s fine, right? Like, my core is strong, I have really strong abs, I’m okay. Or I haven’t had a baby, or I haven’t had any, like one time injury that I need physical therapy for. But I think number one strength is not always the only thing that matters, right? Like we’ve talked about. Yeah. A lot of these issues are tension based. 

Amanda: Yep.

Katelyn:  Therefore, a lot of these issues are not necessarily from an injury or from a one-time thing. It’s from chronic anxiety, chronic tension, chronic stress, that these issues have been building up a lot over time. 

Amanda:  Yeah, like do you have, if men have a lot of stress in their life, I would imagine that they’re holding a lot of that stress in their pelvic floor and they don’t even realize it. 

Katelyn: Probably. Yeah.  And I think it’s an easier example of like, oh, when I get stressed, I feel my neck tension and my shoulders tie in. Right?

Amanda: Yeah.

Katelyn: A  lot of people can feel that. That’s easy to touch and feel. 

Amanda: Yeah.

Katelyn:  I think in the same way, a lot of people store stress and tension in their pelvic floors and like in their abdominal muscles without even noticing.

Amanda: Yeah.

Katelyn:  Especially if it’s, and we talked about this last time, like relationship stress or relationship trauma. That is a lot of times stored in the pelvic floor. 

Amanda:  Mm-hmm. And you know, I know men will ask, okay, well, are there exercises that I can do at home to strengthen or relax their pelvic floor? But I would guess that it’s the same answer that we talked about last week, is that they really need to see someone to know if they need to strengthen it or learn to relax it. Because you probably don’t know the difference yourself.

Katelyn:   For sure. Yes. And so I don’t know what one specific person might need without an examination. And the other thing too, if I just tell someone, oh, relax your pelvic floor, they could be like, Am I? I thought I was relaxed. I don’t know how to relax that. So it’s really helpful to get on those pelvic floor muscles and be like, this is the muscle that I need you to breathe into. They’re like, whoa, I’ve never even felt that muscle in my whole life. So that’s another really important piece of making sure that we are relaxing or contracting the correct muscles. 

Amanda:  Yeah. So, you know, we talked a little bit about erectile function, right? And erectile function can be a symptom of both tension and like need to be strengthened, right?

Katelyn: Mm-hmm. 

Amanda: What would you maybe see if it was too tight and what would you see if it needs to be strengthened?  

Katelyn:  Yeah, so I would do kind of similar of what I was talking about before. I would do an examination of checking number one, tension. So if I touch a muscle, does it feel tight? Does it reproduce pain? Does it reproduce any symptoms? Can we relax it completely?  

And then similarly, when I feel a muscle and I ask for contraction, what do I feel there? So do I feel a really good lift and squeeze? Do I feel just like a little flicker of a squeeze? Do I feel like a squeeze and then it lets go one second later. So there’s an endurance piece, or if it’s tight and then they try and squeeze it, it has nowhere to go. So it’s kind of like a tension, weakness problem, which I would say most people have a little bit of both that we have to work through. So a lot of times I’m working through tension first, so getting full range of motion and then we can strengthen now that we have the full mobility that we need. 

Amanda:  Okay. So can men use pelvic floor therapy to enhance orgasm and maybe like prolong that piece of like not having an orgasm for a while before… I know like with premature ejaculation, we define that as like less than like one minute, right? But if they wanted to prolong that even past the minute mark, whatever, would that be something that they could work on in pelvic floor therapy? 

Katelyn:  Potentially, yeah, if there’s some deficits, like we talked about, intention, coordination, strengthening, that could definitely be something we could work on depending on what deficits we’re finding in the examination. 

Amanda: Okay. How does aging impact the pelvic floor?  

Katelyn: Yeah. Just like aging impacts the whole body, right? We get a little less muscle tone, right? So like muscle strength kind of decreases with age. We get potentially more tension, right? If things are, you know, decreasing in strength, sometimes tension increases to try and make up for the decrease in strength. Definitely erectile issues start to get worse and worse with age.

And so I always tell people it’s like if you’re training for marathons, right? Like when you’re in your twenties, you could probably train for a marathon and be just fine. Like not really need a ton of external support versus if you’re training for a marathon in your fifties or sixties or seventies, we might need a little bit more help, right?

Like maybe sturdier shoes, maybe a little bit more trips to the physical therapist, like more stretch, you know? Maybe more nutrition things that we’re working on. So I’m always like, I am here to support you in your goals, whatever that may be. And I’m going to do the best I can to support your body wherever it’s at.

But it may just need a little extra help with age. So that could be, like some pills, some medications, could be some mental health therapy along with physical therapy. But yes, it’s, it’s definitely, we might just need more help as we get older.

Amanda:  Yeah. So, as we end today, thank you so much for being here and thanks for sharing all this. Is there anything else you think we should talk about or we should know about pelvic floor therapy for men? 

Katelyn:  Yeah. One thing that I actually thought of, something that would bring someone to me is, inguinal or umbilical hernias. A hernia is where tissue is being kind of pushed through a hole that it’s not supposed to. So I kind of relate hernias in men to prolapse in women. So when we have increased pressure or tension, that’s kind of pushing stuff into a hole where it doesn’t belong, wwe need to work on pressure management, strengthening tension management to make sure that those tissues are not being, you know, pushed down. So that was just another condition that I thought of and then if someone has had an inguinal or umbilical surgery, you know, a hernia repair surgery, there’s scar tissue now that we need to address to make sure that that’s not causing issues. And then addressing, you know, some behavioral things so that, because if your body was prone to get a hernia before, we don’t want to have another hernia again, right? So making sure that our body is doing things that’s not leading to another hernia. So that’s another common condition that I see. 

But as far as like overall wrap up, I would say if you have any question of whether you should see a pelvic floor PT or not, just call a local pelvic floor physical therapy clinic and ask, say like, Hey, this is what I’m experiencing. Is this something that you treat?  And if they do treat men, they should be able to help you, you know, help get your questions answered, and they should be able to get you help. 

Amanda:  Yeah, I mean, I know I’ve seen men in your office when I’ve been there as well. So, you know, I know it’s something that you definitely see, but if maybe if they don’t live in Murray, Utah or if they don’t want a woman treating them, if they would rather have a male physical therapist, where would you suggest that they go to find that? 

Katelyn:  So pelvicrehab.com is a great website. It’s a directory of Pelvic PTs and so you can just put in your area and all the pelvic PTs will pop up. I would say definitely call and ask to make sure that they do treat men. I could get on a soapbox here. There are some pelvic PTs who just don’t treat men, and I think sometimes that’s just like a training thing, like they just haven’t been trained to treat male patients.

And I think sometimes that’s a them issue that I think they’re either they feel uncomfortable with it or they’re like scared that all men are perverts and like something’s going to happen in this treatment session. I don’t really know. I think all pelvic PTs should treat all genders. That’s just my, that’s my little soapbox rant.

But there are pelvic PTs out there who don’t treat men for whatever reason. So just call the clinic and make sure, like, do you treat male patients? Or looking at someone’s website, it should be pretty clear of who they treat. 

Amanda:  Yeah. Well one thing that I’ve always appreciated about you and Val is just your openness to treating all genders and people and being very accepting, but keeping it, you know, totally appropriate. And you know, I mean, this is medical, like this is not, you know, and like you see bodies all day, every day, just like gynecologists do, just like urologists do, like doctors do. Like you are a doctor of physical therapy, so, you know, this isn’t anything inappropriate or sexual in any nature whatsoever.

Katelyn: No. 

Amanda: It’s just really about the body and treating the body and making it function the best it can. 

Katelyn: Yes, for sure. 

Amanda: Well, Katelyn, thank you so much for being here today. Will you remind people where they can find you? Because I would love to send as many people to you as possible.  

Katelyn:  Yes. I would love to see any and all patients that want to come see me.

So I am in, Murray, Utah at Wellbeing Physical Therapy. We have an Instagram page and a Facebook page that you can see more about us, or you can look on our website.  

Amanda: Awesome. Thanks so much for being here, Katelyn.

Katelyn:  Thank you so much for having me.  

Amanda: Alright, my friends, I hope you found these interviews with Dr. Kaitlyn Peach so helpful and learning more about pelvic floor physical therapy for men and women. Please reach out to her or another pelvic floor physical therapist in your area on pelvicrehab.com if you need any more help in this area. And if you’re wondering if they treat it, it’s better to ask them.

We will see you again next week for another new episode. Bye-bye.