Men’s Pelvic Health

The truth about pelvic function in men over 50.

by Dr. Keith Poorbaugh, PT

Nothing is for nothing

Most of us had no intention of making it this far. We were raised in an era when men were expected to be something. Whether it was a family provider or community protector, we learned to accept that life carries some risk. Of course, the nature of most men is to push the boundaries with little thought about the consequences. As a physical therapist treating men with pelvic problems, I have the opportunity to hear the story of men chasing dreams, taking
risks and pushing themselves to the edge. It’s a privilege to listen to individual struggles in hopes of understanding how this person in front of me ended up with pelvic problems which interfere with their daily life and relationships. The reality is that most pelvic problems in men over the age of 50 have a common thread. Everything matters and it’s all connected.

Everything a man achieves in life takes something from him. Intuitively I think most men are aware of this hard truth, but we fail to consider how it may affect us personally. I can remember watching one of the great running backs of all-time, Earl Campbell defeat the odds during his football career.

Recently I watched a segment showing how he struggles with simple movements due to severe arthritis in nearly every joint. It’s an extreme validation of this cold- hard truth, but the reality is nothing is for nothing. If you play hard or work under extreme stress for extended periods there will be a penalty.

Nothing stays the same

As we age, our tissue changes dramatically. Most men are too busy with life, family and work to realize that their tissue is on the clock. Mature men accept that life is full of struggle, and we welcome it to a certain degree. Yet, our bodies are changing simply due to genetics, age and lifestyle. As we transition from struggling to make our mark to simply trying to figure out how to make the most of our lives, we start to hit a few of the common pitfalls of aging. Let’s face it, no one, except the old guys at the donut shop, ever told us that one day life will catch up to you.

Every high school anatomy class should teach the reality that life begins at conception and ends at 35. We all know how life is formed in the womb, cells divide, and tissue develops to form ten interdependent human systems. All these systems are developing throughout our youth allowing us immense ability to build strength, speed and power. Once these systems are mature they transition from development to a constant state of breakdown and repair. The ability to repair is drastically reduced after 35. Once we hit 50, the repair cycle of tissue is entirely based on what you have stored up in the tissue health bank. Over 50, is where the rubber meets road.

Your tissue health bank must be refueled every day, especially if you are over 50. The beauty of the human systems is that tissue will respond to change. If you make changes regardless of your age, then you improve the ability of tissues to recover from daily stress and repair the break-down caused by years of disuse or overuse. Building your tissue health bank requires you to implement sound lifestyle habits better known as a wellness strategy. Extensive research has validated the 4 pillars of wellness to safeguard your health. Let’s check your wellness S.A.F.E.

• Sleep – Get 6-7hrs of sleep each night. Sleep is the body’s mechanic.
• Activity – Perform 160 minutes of aerobic activity each week. Build some sweat equity.
• Feeling – Be positive with your thoughts and emotions or get help to resolve stressors.
• Eating – Eat a balanced diet and seek moderation or elimination of unhealthy habits.

The movement system is unique since it is the largest and most vascularized system in the human body. This means it has the most potential to respond to a wellness strategy. It includes over 300 pairs of muscles which support and move over 200 joints with dense layers of fascia. When you look at the movement system from a engineering standpoint with all the cartilage, capsules and discs, it’s obvious this system is designed for a purpose. It is a 3D load bearing, mobile platform which allows us to exert power and force while sustaining and dissipating the same. When this system starts to break-down, it is a major warning sign to the nervous system which must act. Since the nervous system can’t create strength out of thin air, it resorts to stiffness which allows it to retain some stability with movement, but it also overloads the joints.

If you do nothing, you will allow the movement system to further degenerate and weaken. You must force it to change in a way that improves balance, but you can only do this if you are well.

Holding it together

Most men will struggle with pelvic problems for months to years before seeking help. Unfortunately, there is some internal stigma associated with admitting you have problems which cause pelvic pain, urinary leakage, bowel issues or difficulty maintaining an erection. There is little reason for anxiety or shame, it’s hard to find exact numbers but the estimates are that 16% to 50% of men over 50 struggle with pelvic dysfunction. If you are struggling with any pelvic problems, it is important to get a complete medical evaluation from a qualified medical provider to rule out problems in any of the other human systems. Remember your body is changing, a thorough medical evaluation could rule out problems due to trauma, infection, pathology or surgery (TIPS).

Once it’s clear that TIPS is not the culprit, you should consider the impact the movement system has on pelvic function. Medicine is geared towards identifying and treating disease, but so many men are simply dealing with a dysfunction which is difficult to identify with standard medical testing. All too often, I hear stories of clients considering a course of medication or invasive procedures to treat a pelvic condition of unknown origin. The reality is that it’s only unknown because traditional standards of care rarely consider the impact of all human systems being interdependent. It’s possible you may need to consider this fact: the site of the problem is rarely the site of the dysfunction.

For instant, consider how easily a hip or back dysfunction could lead to a pelvic problem. The pelvis is the first horizontal structure situated between a mobile spine and load bearing lower extremity. Essentially it is a rigid horizontal ring set between a mobile spinal column and shock absorbing vertical limb reliant upon the balanced function of a chain of muscles during all movements. Basically, our movement system demands balanced tension to perform at optimal levels. The entire floor of the pelvis is made up of muscles, fascia and ligaments. Tension of the pelvic floor can be altered due to the presence of weakness, instability, or stiffness (WIS) at any segment which influences or acts upon the pelvis. The pelvis is the center of the entire movement system. It is the easel upon which our body paints movement. Everything starts with stability and strength in the pelvis and all forces exerted and absorbed end up influencing the pelvis. Since the terminal points of the digestive and urinary system pass through the pelvic floor it’s very likely an imbalance of tension could impair the function of those systems. In my experience, there is little reason to treat the pelvic floor problem directly until the nearby functional imbalances in the spine and lower extremity have been addressed to restore a balance of tension. The movement system works as a chain with a sequence of interconnected joints, muscles and fascia to support the entire body. Essentially the movement system is holding everything together, but it must do it with balanced mobility, strength and stability. This is why any course of treatment for pelvic problems must first address WIS elsewhere in the chain.

Balance your pelvis

If I haven’t loss your attention, then you should be able to appreciate a few concepts relevant to resolving pelvic dysfunctions.

• Tissue is on the clock. You can’t avoid the consequences of lifestyle, age, and genetics but you can establish a SAFE Wellness strategy to restore the ability of tissues to heal.
• Most problems in the movement system begin as a dysfunction or imbalance. If TIPS has been ruled out, it’s unlikely for the site of the problem to be at the site of the dysfunction. In other words, just because you have a pelvic problem doesn’t mean the issue is in the pelvis.
• The presence of WIS anywhere in the movement system can alter tension of the pelvic floor thereby impairing the function of the tissues and organs contained thereof.

How do you know if an imbalance of tension in your back, hip or elsewhere is causing your pelvic floor problem? It’s a question that you can only answer by challenging your movement skills. Do some simple movement tests and be honest with yourself. Is the movement smooth and balanced? Could you do better? If you have a weak hip, can you get stronger? If you have a stiff back, can you restore flexibility? If you have an unstable knee, can you regain stability?

I am putting myself out on a limb here, but I believe it’s a worthwhile risk to help most men struggling with pelvic problems. In my opinion, every man over 50 should be able to achieve the following movement skills:

• Balance on 1 leg for 30 seconds without looking like an acrobat on a highwire.
• Squat and touch the floor with both palms flat on the floor and heels down.
• Jump up to a step with both feet landing quietly and safely.
• Get off the floor to a standing position from either sitting or lying with some grace.

Of course, if you have some physical ailments or limitations, then you will have to come up with your own movement tests to determine if there is an imbalance of tension. Regardless of how you determine the presence of WIS in the movement system, it’s important to establish a routine for addressing the dysfunction in a consistent and progressive manner. Tissue changes slowly, so you must be determined to stay the course and gradually challenge yourself to improve mobility, strength and stability. I have attached a video to this article to give you an example of some exercises to address WIS in common areas of dysfunction which impact the pelvis. Please realize your exercises may be different due to physical limitations or the fact that your imbalance exists in some other area of the movement system. Just be confident that persistence in movement training will help you gain balance in the movement system which will benefit overall pelvic function. Happy training.