Pelvic Floor Disorders: Overview
The pelvic floor of the male appears to have some impact on sexual function, although its exact role is unclear. One male sexual condition may be helped by pelvic floor therapy, especially men with chronic pelvic pain syndrome. Male pelvic pain syndromes have traditionally been associated with infectious causes or prostate gland inflammation. In many cases, however, evidence of a bacterial etiology is nonexistent, while evidence of prostatic in?ammation is con?icting and nonspeci?c. More plausible causes of prostatitis-like symptoms may include musculoskeletal pain, pelvic ?oor muscular dysfunction, myofascial pain syndromes, or functional somatic syndromes. A study comparing pelvic ?oor muscle EMGs of male patients with chronic pelvic pain to normal subjects reported that men with pelvic pain manifest pelvic ?oor muscle instability compared with normals. The study concluded that pelvic ?oor muscle EMG may be a valuable screening tool to identify patients with chronic pelvic pain syndrome who may bene?t from therapies aimed at correcting pelvic ?oor muscle dysfunction. In fact, pelvic ?oor biofeedback has been studied and found effective in the treatment of men with chronic pelvic pain syndrome. Physical therapy that includes pelvic ?oor biofeedback and manual therapy techniques should be considered as well in the treatment of male chronic pelvic pain.
Physical therapy may also be helpful in some men with premature ejaculation. Ejaculation is controlled by the sympathetic nervous system. The proposed mechanism whereby active pelvic ?oor muscle control may delay its onset may be related to inhibition of the ejaculation re?ex through intentional relaxation of the bulbocavernous and ischiocavernous muscles active during arousal. This may be facilitated by releasing the levator ani muscles through an active relaxation of the pelvic ?oor muscles with avoidance of valsalva. This is a learned technique, which may be mastered using pelvic ?oor biofeedback. Pelvic ?oor exercise has been reported in the treatment of premature ejaculation. La Pera and Nicastro published their ?ndings that 61% of patients with premature ejaculation reported that they were better able to control the ejaculatory re?ex after 15–20 sessions of pelvic ?oor rehabilitation. The rehabilitation protocol included exercise, intra-anal electrostimulation, and biofeedback with an anal pressure probe. The exercise portion of the treatment consisted of basic pelvic ?oor isometric strengthening activities in supine and standing. The mechanism behind actually controlling the ejaculation re?ex through the pelvic ?oor is not clearly understood; however, the exercises do provide self-familiarity and body awareness, which may help improve self-con?dence and sense of control.
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