Guys, Let's Talk About Your Pelvic Floor

If you’re in a certain age range, your feeds or timelines might include ads about pelvic floor dysfunction. Some people might think it's a problem just for women, but our guests for this episode did a wonderful job of educating us about how pelvic floor dysfunction (PFD) affects men. A previous guest who spoke to us about testosterone treatments, Melissa Bowyer is a family nurse practitioner at the Texas Tech Physicians Multispecialty Clinic. Melissa brought Robert Roten, a local physical therapist and TTUHSC alumnus to explain how physical therapy helps treat PFD. They answer questions about pelvic floor dysfunction – what are the causes, how common is it, what are the symptoms, how is it treated and how can we encourage more people to talk about this more?

Transcript

Melissa Whitfield  00:00
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host. Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. If you're in a certain age range, your feeds or timelines might include ads about pelvic floor dysfunction. Before this episode, I thought it was a problem exclusive to women, but our guests are here to explain how it affects men as well. Melissa Bowyer is a family nurse practitioner at the Texas Tech Physicians Multi Specialty Clinic. She brought along Robert Roten, a local physical therapist and TTUHSC alumnus who treats pelvic floor dysfunction. They answer our questions about pelvic floor dysfunction, including, what are the causes? How common is it? What are the symptoms? How is it treated? And how can we encourage more people to talk about this?

Melissa Whitfield  01:09
Robert and Melissa, welcome to our podcast.

Melissa Bowyer, FNP  01:30
Thank you. Thanks for having us

Melissa Whitfield  01:32
So happy to have you on and talk about pelvic floor dysfunction in this episode. So before we get started, if you could each tell us a little bit about yourselves and your expertise and your relationship to the Health Sciences Center or TTP.

Melissa Bowyer, FNP  01:46
Okay, well, I'm Melissa Bowyer. I'm a nurse practitioner and sexual health specialist, sexual health slash men's health at Texas Tech Physicians in urology at our Health and Wellness Department.

Robert Roten, PT  01:59
And I am Robert Roten. I'm a physical therapist. I'm a certified orthopedic manual therapist in both spine and extremity. Have expertise in pelvic floor physical therapy, especially for men, also have a certification in Parkinson's treatment referred to as LSVT big. And I'm also a concussion certified with CCMI. I co own FYZICAL Therapy and Balance centers here in Lubbock. We opened our first clinic over 20 years ago, 6801 Indiana Avenue, and we've opened our second clinic out at 114th and Slide area about a year and a half ago.

Melissa Whitfield  02:41
Well, congratulations!

Robert Roten, PT  02:43
And I'm a proud Texas Tech grad, so it's nice to be back on campus after 30 years.

Melissa Bowyer, FNP  02:51
You don't have to show your age, Robert, he looks super young. You guys can't see us, but wow,

Melissa Whitfield  02:57
So, again. Welcome to our podcast.

Robert Roten, PT  02:59
Thank you.

Melissa Bowyer, FNP  03:00
Thank you.

Melissa Whitfield  03:01
So what is pelvic floor dysfunction and what are the main functions of the pelvic floor?

Melissa Bowyer, FNP  03:08
So I would say before that, before I introduce the expert, as you just heard, all of his expertise and certifications, I see patients referred to urology for myriad things, pelvic floor dysfunction, including urinary urgency, frequency, incontinence, incomplete bladder emptying, pelvic pain, including the penis, scrotum, perineal area, or between the penis and the rectum, things that are thought to be prostatitis, related that people are given antibiotics for over and over again, and so they're referred to us. And my first question always is, you know, when you have sciatic back pain and you have pain that radiates to, you know, your buttocks or down your leg, there's not a buttocks doctor that we send people to right but people forget that there are nerves on the anterior or front of the body that also send signals. And so I was made aware about pelvic floor therapy and pelvic floor dysfunction and all that that entails several years ago, and I've just really kind of dug in to that so much so that I'm the only provider at our urology clinic that sees those issues, especially related to pelvic and scrotal pain. So I was able to meet Mr. Robert Roten, and he's the expert. He's here to tell you all the things that he does. But I just want you to know the things that I send my patients, for my prostate cancer patients that have post prostate removal, urinary incontinence, or, you know, just even minor leaking, to complete leaking, all of my patients that have pelvic pain, literally. Don't you think all of. Them are coming to Robert and seeing, you know, incredible success, patients that had scrotal pain, that were prescribed unnecessary antibiotics without any resolution. I'm now seeing patients get better, completely better, patients that have been suffering year after year, no treatment works. They're dismissed by their physicians a lot of the time. And I'm just so thankful that I was introduced to this idea, and I'm thankful for Robert. He knows everything. I'm gonna give the ball to him and let him tell you everything, but that's kind of what I'm seeing in urology. And just want to make people aware of kind of what's going on there.

Robert Roten, PT  05:43
 Great. Thank you for your your compliments.

Melissa Bowyer, FNP  05:45
You're welcome.

Robert Roten, PT  05:46
Positive words. It's very nice. The way I define pelvic floor dysfunction is just, it's a condition where, really the pelvic floor musculature is unable to activate or contract properly, or it's unable to relax or or even coordinate properly. And you know the functions of the pelvic floor. And when we say pelvic floor, we're looking at really three layers of muscle in the bottom of the pelvic floor that make that up, supporting the bladder, rectum. In women the uterus, and when they don't function correctly, can lead to a whole multitude of symptoms and troubles.

Melissa Whitfield  06:26
What causes pelvic floor dysfunction, other than the things that you were mentioning, and how common is it? And as a woman of a certain age, I honestly thought that this was just a problem that women had.

Melissa Bowyer, FNP  06:38
That's what I was gonna say for people who are listening. The most familiar thing to people is, you know, you have babies, baby after baby. The pelvic floor gets weaker. Now we're jumping on trampolines or coughing, sneezing, leaking, and you know, people think they have to just live with it. We're here to tell you, you don't. Not that this is about women, but the uterus, you know, when people have their uterus removed, the bladder falls down. The pelvic floor is there to support but when we're missing an organ, you know, there's going to be some changes. Similarly with prostates, when a prostate is removed, and for so many other things, the bladder also falls. There's some nerves that are interrupted there, but so they'll have the same symptoms, coughing, sneezing, getting up, moving too quickly. That's what leads to some of our incontinence. But no, it is not just a female issue by any means, and we're definitely lacking in people that specialize in men, because we think it is such a primarily female thing. So do you think you specialize in men specifically, or you're doing both?

Robert Roten, PT 07:50
I definitely see more.

Melissa Bowyer, FNP  07:53
Definitely seeing, yeah, I think every patient I have comes to you. I don't know, maybe that's an overestimate, but I don't, I don't think there's a single person out there that couldn't benefit, not just for urinary issues, but, you know, bowel movements, for example, and and pain. So right? Yeah, there's a constellation of symptoms that that makes you go, ding, ding, ding, I think we have a pelvic floor dysfunction problem.

Melissa Whitfield  08:19
What are some of the common symptoms, and what else does it cause in addition to incontinence, and does it affect sexual health?

Robert Roten, PT  08:27
Well, some of the symptoms have been mentioned, but I would mention difficulty urinating, difficulty having bowel movements, constipation, straining too hard during bowel movements, incomplete evacuation, urgency, urinary urgency, urinary leakage, fecal leakage, which is real hard for anybody to talk about, but I've actually seen a number of these cases. Pain in the pelvic region the genitals, has been mentioned. Pain in the rectal area as well. To mention the ladies pain with intercourse, and definitely on the male side, erectile dysfunction

Melissa Bowyer, FNP  09:07
And ejaculatory dysfunction, I think something that, yes, it is a musculature issue, but what stimulates the muscles to work and contract? It's the nerves, right? So when we have any kind of nerve interruption, be it, you know, something in the brain like Alzheimer's, Parkinson's, multiple sclerosis, traumatic brain injuries, anything. Or, you know, if folks are born with, you know, congenital diseases that result in paraplegia or quadriplegia, we have diabetics that have really poorly, uncontrolled diabetes that results in not only, you know, arterial and venous function, but nerve dysfunction. We're not getting signals from the brain. There's an interruption, you know, the light bulb works, but the electricity is just not there, right? So that, in addition to, you know. The muscles that support that's what I'm seeing. Cause it absolutely, you know, yeah,

Melissa Whitfield  10:07
How do you diagnose it and how do you treat patients?

Melissa Bowyer, FNP  10:11
Yeah, how do you treat patients? That's also something that I don't know. You know, I refer folks to Robert, but, you know, and I see his treatment plans, but he's the one hands on and, you know, giving the exercise and the treatment plans.

Robert Roten, PT  10:27
Well, on the medical side of this, when they come in to see Melissa, she is rolling out a lot of pathology, rolling out infection, doing blood work, your analysis, ordering ultrasounds when necessary. Really weeding out some of the nasty things that could be going along when they make it to me. I am looking at this individual as a whole number one, but I am looking to do a very thorough musculoskeletal exam and a start most of the time with the lumbar spine, making sure there's no lumbar pathology that could be contributing to their problem. We also look at the pelvis as a whole, ruling out SI joint involvement, synthesis, pubis involvement, pathologies and instabilities in that area can lead to pelvic floor pain and dysfunction as well. Also do very thorough hip exam. Labral injuries of the hip can actually cause pelvic floor pain and dysfunction. Lumbar disc herniations can hit the pudendal nerve. That's two three four, that supplies the function of the penis and of the scrotal area as well. Do a thorough exam of their sensation in both lower extremities, deep tendon reflexes. Do full assessment of muscular strength throughout the legs, looking at how certain musculature in our legs are innervated by certain parts of the lumbar spine. Doing sciatic nerve testing, neural tension, testing a slump, testing again, trying to roll out that lumbar pathology or in. And what I'm finding a lot of times is we are seeing musculoskeletal things in the lumbar spine and pelvis that is leading to our pelvic floor pain and pelvic floor dysfunction.

Melissa Whitfield  12:18
So how do you treat it?

Robert Roten, PT  12:21
well? Depends what I find. If it's discogenic, you definitely go after, after decompressing that disc. There's times that's not appropriate. Recently, well, about a year ago, had a young man come in. He actually herniated L5, S1, and he had a big disc fragment setting out in the spinal canal hitting S two three four and so he's a surgical candidate. The same young man also had a labral tear, so he had a lot of groin pain. He's already had the labrum repaired, and he's halfway there to getting through it. So

Melissa Bowyer, FNP  12:56
I'd like to say too, when we are diagnosing, or when I am I'm looking do they have one symptom, or do they have a whole cluster of symptoms, right? Because when patients are referred to me, especially for urinary issues, it's always attributed to the prostate. Always, I don't have a prostate, right? Most women don't, but yet they have symptoms of urgency and frequency and and we generally assume that's related to pregnancy. So if they're having those symptoms, if they have neurologic pain, pain radiating down their back, I always ask patients if they have back pain, and they're like, Huh? And it's, it's so often associated. So if they have erectile dysfunction, diabetic or not. You know, heart disease or not. If they have constipation, if they have this, this, this, this, this, they don't have forceful ejaculations. That just tells me, Hey, we have something else going on here. It's not probably a prostate and they come in having had taken prostate medicines with no effect at all. It's really not difficult, right? You just, you just look and see what has worked. What hasn't worked, what's happening? Is it a whole bunch, or is it just one simple thing? But I do want primary care doctors to know it's not just a prostate. Just because it's a man, just because he's 50, doesn't mean it's just the prostate.

Melissa Whitfield  14:19
Is there a way to prevent PFD and can symptoms come back after treatment?

Robert Roten, PT  14:26
I would say in men, the biggest way to prevent is really pursuing a healthy lifestyle to begin with, keeping a reasonable weight, having some type of cardio and strengthening in general fitness program, if you would. There are exercises specific to the pelvic floor. The most popular is what we all refer to as the Kegel exercise. But there's also a multitude of exercises for our hips. Our hip girdles actually have a rotator cuff, much analogous to our shoulders. And there's a lot of those muscles in our hips that actually blend into the pelvic floor and provide more tone and control into the floor, so controlling weight, good diet, good fitness, and there are some specific exercises out there as well,

Melissa Bowyer, FNP  15:19
And maintaining muscle tone, right? I mean, muscles are supposed to support our skeleton, right? And so we're not exercising, we're gaining weight. Then all of the pressure and weight is on our skeletal system, or we're degenerating, and that's when we see the problems. The other thing too, I know Robert will attest to, we can do exercises pelvic floor specific and get better. But if you don't continue doing the exercises, all the symptoms come back. If you go to the gym and you get all these muscles in your building and then you stop, you're gonna lose the muscle tone. So it is important to to do this lifelong, whether it be maintenance or an everyday thing. But it doesn't just fix it. We don't just get better and and it's, it's done, right? It's not a surgery. We're not lifting the pelvic floor. So it is important, whatever the plan is, that you stick to it lifelong. And if, if you're not really committed to doing that, I mean, don't waste your time. I tell my guys, I like them to go for an assessment to see what's wrong, correct to have you really put some hands on these guys, but it's up to them if they're going to lose weight, if they're going to exercise, if they're going to change their diet or not, and if they're going to be consistent with these exercises.

Robert Roten, PT  16:36
And I do talk with them about all these things, educate as we go, develop home programs, specific home programs to continue as just a part of their fitness and their fitness for their pelvic floor and their their pelvic health.

Melissa Whitfield  16:51
How can we encourage people to talk about this more?

Melissa Bowyer, FNP  16:55
I don't know. I think come to my clinic, I'll make you talk about it. I love talking about it. I love I, you know, go to restaurants and talk to my waiters who appear to be a little bit maybe middle aged, or, you know, anytime I have the opportunity to ask questions to people a I want patients to come in and be transparent and know they don't have to live with things, but we just have to normalize the fact that we didn't make our body. Our bodies were built to do certain things, urination, defecation, yeah, we all do it, sexual health, sexual dysfunction. We all want that. Let's normalize it. Let's make it important. Let's not minimize especially sexual dysfunction. It's okay. It's okay to talk about. It's okay to want up into your oldest age. Who cares? But you gotta ask the questions. Patients don't know what to say. They don't know what to ask about they don't know what's related. So it's up to us. It's incumbent on us to ask the right questions, to help pinpoint the issues and help patients open up. They will. They will. You just gotta ask,

Robert Roten, PT  17:59
Yeah, I agree. I'd say encourage, look them in the eye, be sympathetic, empathetic, really let them know that you hear them and ask the right questions, and do it in an encouraging way, and and share with these guys. There is hope you can get better, and I expect you to get better.

Melissa Bowyer, FNP  18:23
Absolutely. That is so good. This is demoralizing to men. And men, culturally, don't want to talk about it. Again, I hate to say especially sexual dysfunction. They don't want to. But it is demoralizing. These guys come in hopeless. They they've tried something, their primary caregiver, you know, gave them something or a treatment plan, and, you know, they're wearing briefs. Viagra is not working, Cialis isn't working. Nothing's working. They're just sad and their quality of life is so low. And that's what I tell my guys when they come in, especially first visit. I just want you to have hope it can get better. It's not going to get worse, right? If we just embark on a treatment and we're making a plan together, it will get better. Just have hope, and really put yourself in that situation. You know, some doctors are very dismissive. Or providers, not just doctors, very dismissive of pain because they don't have the pain. They're very dismissive of erectile dysfunction because they don't have it, you know? And we just have to say, it doesn't matter if we have it or not. We're here for the patient. We exist for the patient to get better. And you know, what else do we come to work for? Amen, you know?

Melissa Whitfield  19:38
Is there anything else that you'd like to add?

Robert Roten, PT  19:41
To sum up that there, there is hope, and that's one of the biggest words I have written down on my page in front of me, is to encourage men to to reach out, to seek help. And there, there is hope.

Melissa Bowyer, FNP  19:57
Yeah, don't sit alone. Don't suffer inside. Silence. You know, whatever it is that bothers you, that is a personal thing that bothers you. And if you know, if it bothers you, it bothers me, you know. And we can fix it. We can help.

Melissa Whitfield  20:13
Well, thank you so much for coming on our podcast and talking to us about this. Just I learned so much just doing the research and from listening to the two of you. Thank you so much, absolutely.

Melissa Bowyer, FNP  20:22
Thanks for having us.

Robert Roten, PT  20:23
Thank you.

Melissa Whitfield  20:26
Thanks for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams, Krystal Meazell and me, Melissa Whitfield.