Men are embracing pelvic floor therapy — and not just for better sex
Sometimes it's a response to too much stress or anxiety but there are other causes too.
Strength training, stretching, breath work, and no more than 10 minutes on the toilet all help.
If you're a woman, you probably already know what a kegel exercise is, and have been told to work on strengthening your pelvic floor.
But an increasing number of men are discovering they have the opposite problem: a pelvic floor that is hyper tense and over-flexed nearly all the time.
All of us, regardless of gender, are sitting on a hammock of muscles that control how well we can urinate, perform a bowel movement, and have sex. This is the pelvic floor.
When operating properly, it sits largely unnoticed, helping thanklessly to facilitate these bodily functions throughout the course of each day. But, if the pelvic floor muscles become too tight or too loose, chaos can ensue.
That's what happened to Adam Gvili when he was in his early 20s.
"I went like 20 times a day," Gvili, now a physical therapist treating pelvic floor issues, told Business Insider, referring to his frequent urge to pee — one of the most common symptoms of hypertonic pelvic floor.
According to the US National Institutes of Health's Pelvic Floor Disorders Network, up to one in five women will have surgery for a pelvic floor disorder at some point in her lifetime, and even more women — about 32% — will have some sort of diagnosed pelvic floor disorder. The number of men with chronic pelvic pain is estimated to be about half that, around 16%.
Pelvic floor experts told BI these men are often suffering in the shadows. Almost no one is talking about the male pelvic floor, due to a mix of shame, a lack of awareness, and the fact that getting a diagnosis typically involves a long process of elimination with specialists.
Many patients quietly find PTs like Gvili on Reddit or through frantic Google searching, he said. Others might hear him on a podcast, or are referred from a urologist.
"Because they have this urge and frequency to go, it's like, 'Do I have to go? Should I go? Wait, I'm not sure. I already went like 20 minutes ago. Does that mean I really have to go?' And that's just for urination," Gvili said. "So imagine how much in your head you can get."
Beyond needing to pee often, common tell-tale signs of a pelvic floor in panic mode include:
Shooting pain in the rectum
Erectile dysfunction (ED)
Premature ejaculation
Constipation
Groin pain
Testicular pain
"It's not like the muscle pops up and says, 'Hey, I'm the problem,'" physical therapist Karen Brandon, president of the International Pelvic Pain Society, told BI.
"What is more common is that men will experience symptoms of urgency and difficulty urinating and some random strange pains in their penis or their scrotum."
There are myriad reasons that a pelvic floor can become tight and overengaged. Sometimes, it's stress.
"For some people, they tense their pelvic floor when that [stress] happens" Gvili, the founder of Pelvis NYC, said. Tensing and tightening those muscles can also be a response to anxiety, or sexual trauma.
Not all of the cases he sees are linked to stress, though. He says there are a fair number of "type B guys here that are way chill and have this" for other reasons. Older men can develop a hypertonic pelvic floor after a prostatectomy, for example.
"It could be, for a lot of men, masturbating too many times, it could be after squatting or deadlifting, I mean, there's many reasons."
Male pelvic floor issues can also be spurred by an infection or injury to the area, even a "really bad bowel movement," Brandon said.
"What happens is your pelvic floor muscle then starts to guard and get protective."
Ultimately, Gvili said, there's not a ton that men can do to prevent the pelvic floor from going into overdrive. Of course, maintaining a good exercise routine, staying flexible, breathing through stress, and time for relaxation, those all help.
His work endeavors to help people pay less attention to their pelvic floor, and let "your body's natural mechanism" operate automatically again.
"My goal is to decrease your awareness to a certain area of the body," Gvili said. "It's not as simple as 'just do some kegels.'"
Instead, it's the engagement and then release of the pelvic floor throughout the day that will help keep it healthy.
Brandon imagines the pelvic floor like a set of saloon doors that can swing both ways: lifting and pulling in, much like you would for a kegel, but also doing the opposite, by dropping and releasing, telescoping the anus to push towards the floor, almost like you're about to pass gas.
One of the best things Gvili recommends for maintaining a healthy pelvic floor is strength training.
"Lift heavy," he said. "Squats, dead lifts."
But you have to be careful. Brandon stresses that maintaining "good form" for your strength training is essential, to ensure you're not "biasing a certain muscle and overusing the one that's connected to the pelvic floor."
Men with really tight hips who never take time to stretch after they work out are prime candidates for a hypertonic pelvic floor.
"Don't be shy or afraid of being flexible," she said. "The majority of the male issues I see are that."
Poses like frog can help release the pelvic floor, when done correctly. The goal is to be able to both contract and relax this silent set of muscles, in proper balance.
"For a lot of men that are tight, we help them use those muscles, but also tone down their nervous system to know that there's no reason to tighten them up," Gvili said.
Gvili and Brandon both had the same parting piece of advice for maintaining a healthy pelvic floor: Don't spend too much time on the toilet.
Invest in a squatty potty if you are often constipated, it will help relax the muscles so your bowels can flow without pushing.
"I get the whole scrolling on the phone thing," Gvili said.
If you need some alone time in the bathroom, that's fine, just don't spend too long with your cheeks spread across the bowl. If you're constipated, try leaning forward or backwards without pushing, breathing deeply, and if you're ultimately unsuccessful, get off and try again later.
"I tell people five to 10 minutes, no longer," he said.
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For a healthier take on this breakfast, Cassetty suggests swapping in a hard boiled egg, nut butter, Greek yogurt or cottage cheese to boost protein from whole food sources. India: Dosa, idli sambar, paratha and poha The classic Indian breakfast can vary, depending on which region you're from. But popular dishes include dosa (a type of crepe made from fermented rice), idli sambar (steamed rice cakes with a vegetable-based lentil stew), paratha (flatbread stuffed with potato or vegetable) and poha (rice cooked with spices and nuts). 'Fermented rice cakes like idli are light and easy on digestion,' Keatley says. 'Lentils add protein, fiber and iron. The spice and vegetable stew brings phytonutrients and digestive benefits. It's an excellent balance.' France and Italy: Continental breakfast In France, it's known as 'petit déjeuner,' while Italians call it 'colazione.' Both essentially mean a continental breakfast of coffee and some kind of pastry or roll. While delicious — who doesn't love a good pastry? — this meal is tough for dietitians to get behind. Keatley refers to this meal as 'elegant, but metabolically unhelpful.' He adds, 'It's mostly refined carbs and caffeine, with little protein or fiber to stabilize blood sugar.' The coffee may be helpful for overall health, though. 'It's surprisingly rich in antioxidants, and studies link regular coffee consumption to a range of impressive health benefits, from improved cognitive function to reduced risk of chronic diseases,' Cassetty says. But the lack of protein is concerning to registered dietitian Sonya Angelone. 'This breakfast is also low in fiber, low in produce and high in sugar,' she tells Yahoo. So why is it a breakfast staple for some? 'The reason why it may work for the French and Italians is that their portions are so much smaller than what we eat in the U.S.,' Upton says. Still, that doesn't mean this meal should be off the menu: Keatley says it's fine to have on occasion. Sweden: Bread, a boiled egg, yogurt and coffee A classic Swedish breakfast usually features bread with butter or cheese, an egg, yogurt and coffee. Some Swedes may have muesli or porridge instead of bread, says Angelone. Keatley calls this meal 'compact but balanced.' The egg and yogurt deliver protein and fat, while the bread provides whole grain carbs, he says. Angelone also praises the probiotics in the yogurt. 'Those are good for the gut,' she says. The only thing to make this already great breakfast even better? Add some produce. 'A few slices of cucumber or tomato on the side would round this out nicely,' Keatley says. England: Full breakfast A full English breakfast usually features bacon, sausage, eggs, baked beans, tomatoes, toast and mushrooms. Some people also enjoy black pudding, which is a combination of pork or beef blood, animal fat and a grain like oatmeal or barley. The tomatoes are one of the best parts of this breakfast, according to dietitians. 'The tomato is doing the heavy lifting, nutritionally,' says Keatley. While the eggs, bacon and sausage provide plenty of protein, the breakfast is high in saturated fat. 'Bacon and sausage are processed meats, which we want to eat less frequently,' Cassetty says. 'You can keep the vibe of the meal by swapping in sautéed mushrooms or low-sugar baked beans and choosing whole-grain toast. Doing this would be a balanced, filling and nutritious start to the day.' Tanzania: Mandazi, eggs and fruit Mandazi, which is a type of fried bread similar to donuts, is popular for breakfast in Tanzania. It's usually served with coffee or tea, along with eggs and fruit. 'Eggs and fruit are a solid combo because they provide protein, vitamins and fiber,' Cassetty says. The nutritional quality of the mandazi depends a lot on the type of flour used, according to Keatley. 'If it's refined wheat, that adds carbs with little other nutrients,' he says. 'Adding a small portion of vegetables or seeds could increase nutrient density and satiety.' Angelone recommends balancing the carbs you eat with some protein for more stable blood sugar. South Korea: Rice, seaweed soup, and banchan The classic South Korean breakfast features a mix of dishes: rice, seaweed soup and banchan, small side dishes such as kimchi (fermented vegetables) that are usually served with rice. Keatley says there are several good nutrients in this breakfast. 'Seaweed offers minerals including iodine, and kimchi supports gut health and adds bold flavor,' he says. Though Gans points out that there's not a lot of protein or fiber in this meal. 'It may leave someone hungry too soon after eating,' she says. To remedy that, Keatley suggests adding a protein like egg or tofu. 'That would make this more complete for sustained energy,' he says. Solve the daily Crossword
