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Most of the time, it is hard to seek treatment from a variety of doctors for men with pelvic floor dysfunction. But, unfortunately, even if they go from one specialist to another the results come back as normal.

In turn, they are naturally looking for information on the internet but the internet searches are mostly for me. That is why it is also difficult to find someone with experience treating men with pelvic health issues, so finding someone who can help is quite challenging.

However, know that you are not alone and some physical therapists can help you. Physical therapists use pelvic floor exercises as part of treatment for pelvic floor dysfunction since they help strengthen the pelvic floor. So you do not have to suffer from your symptoms for the rest of your life!

A Brief Overview of the Pelvic Floor

A pelvic floor is a group of muscles that reside in your pelvis. A man’s pelvic floor muscles support his bladder and bowel. The openings from these organs pass through the pelvic floor. The pelvic floor muscles wrap tightly around these openings to keep them closed.

The pelvic floor muscles can be stretched, weakened, or too tight. If you are unable to relax and coordinate these muscles, this causes pelvic floor dysfunction. A man with pelvic floor dysfunction may have weak or especially tight pelvic floor muscles, making urinating or bowel movements difficult as well as problems having or keeping an erection.

However, do not fret because pelvic floor physical therapy is proven to be beneficial for the treatment of pelvic floor dysfunction in men.

Symptoms and Causes of Pelvic Floor Dysfunction

A weak pelvic floor causes different symptoms. If you are experiencing any of these symptoms, you have a problem with your pelvic floor muscles. Among the conditions that have been linked to weak pelvic floor muscles are:

• Pelvic pain, genital pain, or rectum pain
• bowel discomfort or constipation
• Urinary problems, such as the urge to urinate or painful urination
• low back pain
• characterized by pressure or swelling in the pelvic region
• Erectile dysfunction
• Painful or premature ejaculation
• as well as spasms in the pelvis

Tho it’s scary to have these symptoms, treatment for pelvic floor dysfunction includes strengthening your pelvic floor through pelvic floor dysfunction.

While causes are still unknown, a few of the known factors include:

• Obesity.
• Getting older
• Those people involved in car accidents suffer trauma to their pelvic area
• Excessive pelvic muscle use (going to the bathroom too often, pushing too hard) eventually results in poor muscle coordination.
• Surgical procedures for the pelvis.

The Diagnosis

Pelvis NYC puts your comfort first for the initial consultation before asking about your symptoms or medical history because we know that when you are comfortable, you can disclose everything to us. 

After the initial consultation, you may be required to undergo a physical examination to check for muscle spasms or knots as well as assess your muscle weakness.

In some cases, we may also require you to run some tests for further verification.

The Treatment

Pelvic floor physical therapy uses pelvic floor exercises to address pelvic floor problems. Exercises in this specialized therapy help you manage pain, discomfort, and disturbances to your quality of life.

The goal of pelvic floor physical therapy is to strengthen and relax the pelvic floor muscles to improve core stability, and control over urination, bowel movements, and sexual function. It uses a variety of different techniques to increase pelvic floor muscle control, improve awareness of contraction and relaxation patterns, and decrease symptoms of pelvic floor dysfunction, including pain, disability, and symptoms of incontinence.

Why Choose Us?

A doctor who specializes in pelvic floor dysfunction should be your number one consideration. He should be knowledgeable about techniques that have been proven to be successful in the treatment of pelvic floor dysfunction.

Our expert at Pelvis NYC has been through pelvic floor dysfunction, which is why he understands what you are going through and is dedicated to treating your symptoms. He knows how difficult it is to live without knowing what is going on with your body.

We at Pelvis NYC ensure that you receive expert care, a comprehensive understanding, and a comfortable treatment environment for all patients.

Please visit Pelvis NYC to avail of the FREE 15-minute teleconsultation.

Almost everyone’s back hurts. Particularly those who spend a lot of time sitting on chairs, lifting heavy things on the job, or are overweight. The cause is usually a sedentary lifestyle. Regardless of the cause, physical therapy can help heal your lower back pain fast by pinpointing the problem and designing a stretch and exercise program to ease the pain.

Definition

Low back pain can result from many different injuries, conditions, or diseases. Most often, it is an injury to muscles or tendons in the back.

A person can suffer from mild to severe pain. Sometimes, pain makes it impossible to walk, sleep, work, or perform daily tasks.

In most cases, lower back pain can be treated with rest, pain medication, and physical therapy. During physical therapy sessions, they use hands-on treatment (such as osteopathic manipulation or chiropractic manipulation) to heal your lower back pain fast.

What Causes Lower Back Pain?

Back pain is due to one thing: activity. Pain is either caused by a certain activity or by a general lack of activity. This leaves your back unable to handle the daily demands. Fortunately, you don’t have to worry because these causes can heal fast with physical therapy. These are:

• Sprains and strains – This is the most common cause of acute lower back pain. It can happen when you twist or lift something incorrectly, pick up a heavy object, or overextend your reach and you strain a muscle and tear a tendon, resulting in a sprain.
• Sciatica – A sharp lower back pain that radiates down your legs and butts is caused by compression of the sciatic nerve. Herniated or ruptured discs are common causes of sciatica.
• A herniated or ruptured disc – An accident, fall, or sports injury can cause damage to your spine. The pain begins immediately after the injury. There may also be tingling or numbness in your legs.

Lower Back Pain Exercises You Can Do

Performing Neck and Shoulder Stretches

Basic neck stretches can be done anywhere, such as at home, at work, or even while driving, throughout the day. These include:

• Stretch from the chin to the chest. Bring the chin towards the chest and bend the head forward until you feel a stretch in the back of your neck.
• Lateral Flexion Stretch from Ear to Shoulder. Stretch out the side of the neck as if you were touching your ear to your shoulder. Try to keep the shoulders relaxed and the back in a healthy position.
• Stretch the levator scapula. Place one arm against a wall or door jamb with the elbow slightly above the shoulder, then turn the head in the opposite direction. Stretch the back of the neck by bringing the chin down toward the collarbone. It may be helpful to pull the head gently forward with the other hand to hold the stretch.
• Do a corner stretch. Face the corner of a room and place your forearms on each wall with your elbows at shoulder height. Lean forward until you feel a stretch under your collarbone.

There are some stretches to avoid such as neck circles and quickly bending the neck forward and backward or side to side. Performing these stretches can strain muscles or place additional stress on the cervical spine.

Low back pain stretches

• Stretches for back flexion. Lie on your back and pull your knees to your chest while flexing the head forward until you feel a stretch in the mid and low back.
• The Knee-To-Chest Stretch. Lay on your back with your knees bent and both heels on the floor. Place your hands behind one knee and pull it toward your chest, stretching the gluteus and piriformis muscles in the buttocks.
• The kneeling lunge stretches. Starting on both knees, move one leg forward, keeping your weight evenly distributed across both hips (rather than on one side). Put both hands on the top of the thigh, and gently lean your body forward to feel a stretch in the front of the other leg. Stretching the hip flexors stretches the muscles that attach to the pelvis and can impact posture if too tight.
• The piriformis muscle stretches. Lie on your back with your knees bent and your heels on the ground. Place one leg over the other, resting the ankle on the bent knee, and pull the bottom knee toward the chest until you feel a stretch in the buttock. Alternatively, lying on the floor, cross one leg over the other and pull it forward over the knee, keeping the other leg flat.

These are representative examples of commonly prescribed types of stretches. The majority of stretches can be modified to fit the individual’s level of flexibility and pain and can be made easier by using a wall, door jamb, or chair for added stability. But take note that if you’ve done these steps correctly, it can surely help heal your lower back pain fast.

Physiotherapy for Lower Back Pain

Physical therapy and exercise are considered part of the treatment of most back pain patients, regardless of whether they are undergoing non-surgical or surgical treatment. The reason for this is that patients with lower back pain heal fast with physical therapy.

Physical therapy aims to decrease back pain, increase function, and teach the patient how to prevent further back problems. Because of this, most patients with low back pain get referrals for physical therapy for four weeks as an initial conservative (nonsurgical) treatment option.

Our team at Pelvis.NYC knows that not all back pain is the same. Despite proper stretching and strengthening your core, you may still experience pain for weeks. The good news is that you don’t have to wait until your pain becomes unbearable or chronic. Our experts can quickly pinpoint your pain and design a stretches and exercise program that targets specific muscles to alleviate your pain. You’ll also work with a professional to ensure you perform each lower back stretch correctly.

Don’t wait for a few more days to treat your lower back pain. We can help you now to get back on your feet and back to work faster. For more questions or inquiries, you may visit our website www.pelvis.nyc, and have your FREE 15-minute teleconsultation.

Did you know that a weak pelvic floor can often result in constipation as one of its symptoms? Pelvic floor exercises for chronic constipation strengthen your pelvic floor muscles allowing you to control bowel movements effectively. Here is why.

The most common mistake of people suffering from chronic constipation is identifying the underlying cause of it. They tend to rely on laxatives as a long-term solution, while others believe that diet alone can improve chronic constipation. Though laxatives and changes in diet are an effective part of treating chronic constipation, laxatives must only be used during the treatment phase and diet should be balanced with appropriate exercise. 

One effective form of exercise for chronic constipation is pelvic floor exercises.

Overview

Chronic constipation causes infrequent bowel movements and difficult passage of stools for several weeks or more. Although occasional constipation is fairly common, chronic constipation can interfere with their daily lives. Furthermore, constipation can also cause people to strain excessively when they have bowel movements.

However, ​many are unaware that when you strain yourself too much, it may harm your pelvic floor. To avoid it, doing proper pelvic floor exercises may help strengthen pelvic floor muscles.

Pelvic floor exercises are simple clench-and-release exercises that you can do to make your pelvic floor muscles stronger. The pelvic floor is a series of muscles and tissues that form a hammock-like structure at the bottom of your pelvis. This structure supports your organs.

Making sure that your pelvic floor muscles are strong, you can control your bowels or bladder.

But take note that pelvic floor exercises are only effective if you identify the right muscle. Sometimes, you may need the help of a professional to do it right.

How does chronic constipation affect the pelvic floor?

When people are constipated, they tend to strain themselves by exerting a lot of abdominal force to push the stool down. Little did they know that excessive pressure on the pelvic floor muscles causes them to weaken over time.

Moreover, a weak pelvic floor does not improve constipation. Instead, it worsens these muscles that help open and close the sphincter and assist in healthy defecation.

Then, we are trapped in a cycle of constant constipation weakening our pelvic floor and the weak pelvic floor making our constipation worse. Therefore, where do we go from here?

Finding the Right Professional

As we mentioned, pelvic floor exercises are simple exercises to strengthen your pelvic floor muscles. However, you must identify the right muscle for pelvic floor exercises to be effective. Otherwise, your efforts and time will be wasted.

If you are having a hard time dealing with your constipation, stop, and take a deep breath! We, at PELVIS.NYC knows the difficulties associated with constipation, particularly chronic constipation.

Dr. Adam Gvili PT, DPT, understands that successful treatment for one patient may not be successful for another. This is why we offer different treatment plans depending on the symptoms and condition of the patient.

To learn more about our services and schedule a free 15-minute teleconsultation with Dr. Adam, you may visit www.pelvis.nyc.

Don’t be afraid to ask. We are here to listen and help. We are here to support you every step of the way.

Related blog: Addressing Sudden Urge to Poop in Men

A man may opt for a vasectomy if he does not want to impregnate someone in his lifetime. However, most of them experience lower abdominal pain after vasectomy as a response to their body’s fast healing, resulting in inflammation and secondary pain. But what is it really like after a vasectomy procedure? Is the pain bearable? Is there relief?

Continue reading to find out.

Overview of Post-Vasectomy Pain Syndrome

Post-vasectomy pain syndrome (PVPS) is a continuous or intermittent testicular pain lasting more than three months. About 1–2% of men who undergo a vasectomy experience this discomfort, which leads to some form of medical treatment.

In some cases, the pain may begin within one month following the procedure and continue for years following the surgery. Pain can be ongoing and short-lived and resolved with anti-inflammatory tablets, but can also become chronic. It can be mild to moderate chronic pain and in rare cases, patients may experience debilitating pain. But do not worry because there are treatments used for PVPS.

The experience of lower abdominal pain after a vasectomy is only indicative of your body’s response to the healing process, which includes some inflammation and secondary pain. Typically, it is mild discomfort for 5-10 days and occurs in the scrotum area, but can also affect the groin or lower abdomen.

Symptoms to look for

PVPS symptoms range from mild to severe and are as follows:

• Continual genital pain
• Lower abdominal pain
• Pain when exerting yourself
• Pain from erections or sex
• Experience pain from ejaculation
• Erectile dysfunction

Factors causing PVPS

In terms of the symptoms exhibited and the treatment required, there are a few main causes for testicular pain following vasectomy:

Neurogenic: Some chronic pain is caused by sperm build-up in the vas deferens trapped in fibrous tissue, which then causes intense pain during activities that agitate your scrotum, such as running or cycling

Granuloma: Sometimes sperm leakage occurs during or shortly after a vasectomy, causing a lump and swelling.

Epididymitis: Epididymitis results from an increase in pressure inside the epididymis, which is a tube that transports sperm from the testes to the urethra. Normally, men continue to produce sperm after a vasectomy and the cells are reabsorbed by the body. However, they can develop a buildup of sperm in their vas deferens which can cause the epididymis to burst under pressure.

Testicular Torsion: If left untreated, PVPS can twist the spermatic cord that carries blood to the scrotum and cut off the blood supply.

Diagnosis of PVPS

PVPS is different from acute postoperative pain. Most PVPS patients suffer from persistent orchalgia for greater than three months after surgery. However, some patients experience pain while ejaculating, having intercourse, or erection. 

The diagnosis of PVPS must be an exclusion diagnosis. A three-month follow-up history and physical are recommended after surgery. A scrotal ultrasound using color-flow Doppler is administered to every patient suffering from chronic testicular pain. It is recommended to obtain a routine urinalysis, a urine culture, and a semen culture to determine whether there is an infection.

Treatment for PVPS

Once the root of PVPS is identified, treatment can be as simple as an anti-inflammatories prescription or as drastic as removing the epididymis. Most urologists take a conservative approach and try non-surgical methods first, such as applying hold and cold compresses or wearing a scrotal-support garment. 

An injection of anesthetics or steroids may be necessary if the pain persists. Additionally, removing the granuloma, and the epididymis or reversing the vasectomy could provide pain relief while negating sterilization.

While vasectomy is a safe and routine procedure, the decision to become permanently sterilized is a major life change. Even though there is a very slight chance you could suffer chronic pain after you have a vasectomy, the odds strongly favor you that the heaviest discomfort you experience will come from getting up off the couch to find the remote.

Physical Therapy as a non-surgical treatment for PVPS

Pelvic floor physical therapy can also be beneficial in the treatment of PVPS. People who undergo a vasectomy may experience significant pelvic pain. Due to the abnormal testicular pain, they are experiencing, their pelvic muscles tend to tighten up. A physical therapist can teach them pelvic floor exercises to relax those muscles and take the strain off of other areas such as the scrotum and testicles.

Pelvic floor therapy relieves pelvic pain and discomfort associated with testicular pain by relaxing the scrotum and testicle muscles. By using this therapy, you may be able to increase blood flow and relieve some symptoms.

At PELVIS NYC, we have successful treatments for post-vasectomy pain. By alleviating their symptoms, we enable them to carry on with their daily lives. We listened carefully to identify the source of their pain and formulate the best possible treatment.

If you have more questions, visit www.pelvis.nyc and have your free 15-minute teleconsultation.

Related Blog: Real Story of How We Help Our Patient Recover from Lower Abdominal Pain

Pelvic Floor Physical Therapy as an Adjunctive Treatment for Epididymitis

Antibiotics remain the first line of treatment for Epididymitis. But you may recover faster if the treatment includes pelvic floor physical therapy because it proves to help ease symptoms of epididymitis and boost immunity. Before we continue with how pelvic floor therapists can help relieve your painful symptoms, let us discuss first what causes it and what are the risk factors.

Epididymitis occurs when the epididymis, a long, coiled tube behind each testicle, becomes inflamed. Sexually transmitted infections often cause this condition, but many other types of bacteria can also cause it.

Epididymitis can affect anyone, but it is most common among men ages 14 to 35. Each year, the United States experiences approximately 600,000 cases of epididymitis.

There are two types of epididymitis. The first is acute epididymitis which lasts up to six weeks. Usually, the testes are also inflamed with acute epididymitis. It is also called epididymo-orchitis because it is difficult to distinguish whether the epididymis, the testes, or both are inflamed. This is why epididymo-orchitis is a commonly used term.

Another type of epididymitis is chronic epididymitis, which lasts for more than six weeks. Affected patients may feel discomfort in their crotch, epididymis, or testicles. This may be the result of granulomatous reactions, which can cause cysts or calcifications.

Identify whether it’s epididymitis

Although epididymitis may start with just a few mild symptoms, if left untreated, the symptoms can become more severe.

Epididymitis may cause the following symptoms:

• a gradual or sudden ache in either of your testicles (balls)
• a build-up of fluid (hydrocele) around your testicle
• a feeling of tenderness, warmth, and swelling around the rest of your testicle (scrotum)  

Symptoms may also include difficulty in peeing or a white, yellow, or green discharge from the tip of the penis, depending on the cause.

Epididymitis has several causes

Common causes of epididymitis are two sexually transmitted infections: gonorrhea and chlamydia. However, the causes can sometimes be by E. coli bacteria or the same bacteria that causes tuberculosis in rare cases. Urinary tract infection has also been implicated in the condition, although UTIs are less common in men. These causes are considered non-sexually transmitted.

At-Risk for epididymitis

Epididymitis may be more likely to develop if you:

• are uncircumcised people
• have unprotected sexual activity
• suffer from urinary tract structural problems  
• take heart medications called amiodarone
• are using a catheter
• recently injured the groin  
• recently undergone urinary tract surgery
• have a blocked bladder caused by an enlarged prostate
• suffer from tuberculosis (TB).

Treatment for epididymitis

The treatment of epididymitis involves treating underlying infections and easing symptoms. In treating underlying infections, the most common prescription is antibiotics. Taking it as prescribed will make you feel better in a matter of days. However, no matter how well you feel, take the entire course of antibiotics to ensure the bacteria is treated.

Aside from antibiotics, physical therapy can help ease symptoms. Physical therapists use clinical therapy, workouts, and physical activities in treating epididymitis. It can help boost immunity and enhance faster recovery. Pelvic floor exercises help to relax the pelvic floor and prevent pain, burning, or tightening feelings in the testicular area because of the blood flow blockage.

But know that exercises for epididymitis have limits. Getting guidance from a physical therapist ensures that you are doing the exercises for epididymitis correctly.

If you are looking for a trusted physical therapy clinic, look no further than PELVIS.NYC. We have successfully treated epididymitis and have helped ease all its symptoms. We focus on their health as if it were our own so we provide the best treatment plan. Visit www.pelvis.nyc for a free 15-minute teleconsultation to better assess your problem.

When to seek help?

In the event of epididymitis symptoms, consult your doctor immediately. If your doctor confirms that the infection is from an STD, tell your recent sexual partners so that they can be examined and treated.

Men who have entrapped pudendal nerves (pudendal nerve entrapment) commonly complain about urinary problems such as urgency or frequency. It is reported that men often experience erectile dysfunction despite using traditional erectile dysfunction treatment. In other cases, they also describe it as having a feeling of a lump in their pelvis or groin area, even though there are none.

In light of the different symptoms they experience, how can we determine if the pudendal nerve is entrapped?

Let’s find out now.

Pudendal Nerve Entrapment

Pudendal neuralgia (also known as Alcock’s syndrome or Pudendal Canal Syndrome) is caused when the pudendal nerve is entrapped, compressed, or irritated, resulting in pain in the local region. The characterization is pain, swelling, and numbness in the pelvis or genital area. This happens when there is damage in the major nerve in the lower body or irritation, making it difficult to use the bathroom, have sex, or sit down. Experts believe this condition is rare, but it’s not clear how many people have it.

Symptoms of Pudendal Neuralgia

The primary symptom of pudendal neuralgia is pelvic pain. When there is a compression in the pudendal nerve’s path by other structures, it irritates. Anywhere along the course of the nerve can produce pain, tingling, or other sensations, including the tip of the penis. The reason behind the name pudendal neuralgia is “pudendal nerve pain”.

Also burning, stabbing, or shooting pain may occur, coupled with numbness or tingling sensations when you have pudendal nerve entrapment. Symptoms can be worse by activities involving bending at the hips, such as sitting and squatting.

Talk to your physician if you notice any new symptoms related to erectile dysfunction, urinary illness, or bowel problems. These symptoms may be caused by a medical condition that needs to be addressed by your doctor. When a medical reason cannot be identified, there is a very good chance the nerve is being pressed by muscles or other tissues in the pelvic floor. Physiotherapy for pelvic floor disorders can be extremely helpful in these situations.

Causes of Pudendal Nerve Entrapment

Several factors cause damage to the pudendal nerve. An injury or surgery can cause it and sometimes, exercising too much, such as riding a bike, can contribute to it.

Other causes may include:

• Pressure on the pudendal nerve caused by nearby muscles or tissue
• Spending a lot of time sitting, cycling, horseback riding, or constipating (usually for many years) can sustain repeated minor pelvic injuries.
• Pelvic surgery
• A broken pelvis
• Cancer or non-cancerous growth compressing the nerve

Some causes, however, cannot always be determined.

How to prevent pudendal neuralgia?

Considering lifestyle changes can prevent pudendal neuralgia. These include:

• Managing your bowels and bladder: Don’t strain when emptying your bowels or passing urine, as this stretches the nerve. Physiotherapy can help you establish good bladder and bowel habits that are suitable for you.
• Sitting modification: Avoid pressure on the perineum (the area inside your ‘sit bones’), as this prevents pressure on the nerves. Sitting less can also reduce blood pressure.
• Avoid nerve-irritating physical activities: riding a pushbike and horseback riding are two of the biggest. Other activities to avoid are trampoline jumping, bench pressing, and too many ‘core muscle’ exercises. With osteopathy and physiotherapy, you can identify movements unique to you that may need to be minimized.

Physiotherapy can help relieve Pudendal Neuralgia

Physiotherapists can help you relax and stretch your pelvic floor muscles, which may be over-contracted so that the nerve is less irritated. They can also help you to manage the painful trigger points in your pelvic floor muscles as well as recommend using TENS, if necessary, to relieve your pain. Using this device for self-management is effective – but you may need the assistance of a physiotherapist to place your electrodes properly.

Furthermore, you could benefit from specific external exercises and stretches that will focus on correcting your posture and avoiding activities that may aggravate your pain. Physiotherapists will also encourage you to do general cardio exercises to maintain both mental and physical fitness and strength.

Physical therapy can also help you maintain control over your bladder and bowels if you have pudendal neuralgia. They can help you develop a bowel and bladder management routine.

Physical therapy is one of the best treatments for your pelvic floor problems. If you have the same symptoms for pudendal neuralgia, PELVIS.NYC can help assess your needs. We provide 15-minute teleconsultation for FREE because we care for your health.

Related Blog: Pudendal Neuralgia: PT Is Your Treatment

What is Hard Flaccid Syndrome?

Hard Flaccid is a newly coined term that describes a symptom of pelvic floor dysfunction/CPPS. But before we dive deep into how to get rid of your hard flaccid syndrome, let us understand first what could be the cause and risk factors.

Similarly, patients describe their symptoms to be a nuisance throughout the day and in the bedroom. Men will often describe that their penis doesn’t hang as low as it did in a flaccid state and seems somewhat retracted. Men will describe that their penis can feel cold, takes more physical stimulation to get aroused, feels rubbery during an erect state, the penis doesn’t get as much blood flow/maintain an erection, and a weak stream of urine.

What are the psychological effects of hard flaccid in men?

As for why this happens? We don’t understand the full mechanism behind it. In fact, the majority of medical professionals will deny that this diagnosis even exists and will say “it’s all in your head” and probably prescribe you some sort of PDE5 inhibitor (Viagra/Cialis) to get rid of your “anxiety”. The dangerous part of using the word anxiety is that you may have developed or worsened your anxiety due to this issue as it would any male going through this, but anxiety isn’t causing this issue.

Prior to feeling these symptoms, we men never had to think about our penis. In fact, we only used it for the 2 P’s; Pee and Pleasure. So the fact that now you are constantly thinking of “how much urine is coming out”, “will I be able to maintain and keep a rigid erection” induces anxiety and further takes the SEX out of SEXY. All you are left with is a Y (see what I did there?). This constant feedback loop causes anxiety and further increases sympathetic tone which is the antithesis of getting an erection.

So this blog post is for those that have been searching for some answer, for those who are looking for options, doable options to get rid of a hard flaccid syndrome. This is written for you!

It is equally important to know that these symptoms are real and they are very much treatable. Furthermore, in Pelvis NYC, we do have a working hypothesis that hypertonic/weak pelvic floor muscles may be causing the issue. The majority of men seen with this condition have very tight lower abdominals, their perineum is weak and cannot sustain a contraction longer than 10 seconds.

Who can help in getting rid of hard flaccid syndrome?

First thing is, always get yourself to a primary care physician or urologist to get medically cleared for anything serious. High blood pressure, diabetes, obesity, as well as High cholesterol are one of the few conditions that will start as erectile dysfunction.

Second, get yourself to a pelvic floor physical therapist who can help evaluate and treat you. Remember not all medical professionals are equal, just because you saw one should not mean that you have exhausted your options.

Third, start to take matters into your own hands. Do your best to control the variables in your life that are easily controllable.  Start by evaluating your diet, sleep, stress, and movement. The second you start to see improvements in some areas you will notice improvements within others as well.

What are the pelvic floor exercises I can do now to get me on the path of getting rid of hard flaccid?

1)    Ease the tension around the lower abdominals. Try these:

a.     Cobra stretch ( 2 minutes min with exhalation at the top to let your belly go)

b.     Couch stretch ( 2 minutes- inhale and exhale into the stretch)

c.     Foam/Lacrosse ball – Find a tender area and gently breathe through it This is a nice soft tissue release.

2)    Decrease tension around perineum

a.     Deep Squat stretch – This will help stretch your adductors and your perineum (2 min). If you have a bathtub you can use the buoyancy to help decrease the strain on your knees

b.     Happy Baby – 2 mins

At Pelvis NYC we want you to know that we understand what you are going through. We truly care about your well-being. Now that you know these symptoms are real and that it is treatable….BREATHE!

The next step is to follow some of the recommendations here, see what works for you, and let us know how we can help. Contact us now!

Pelvic floor dysfunction affects more women than men, but MEN ARE AFFECTED TOO. Since most physiotherapists are focused on treating women, a lot of men are silently suffering, left untreated, misdiagnosed, and experiencing depression and anxiety. That is why a need with a Male Physiotherapist is essential.

In this interview between Simon Edward Smith of The Medical Journo on Youtube entitled Interview With Male Pelvic Specialist Dr. Adam Gvili, they have discussed below topics:

00:15​ Can you explain a bit about what you do?

Dr. Adam Gvili: I’m a physiotherapist as you know, in the States, right I’m here in New York City & my specialty is the male pelvic floor. I hope to treat females one day, but I’d like to focus solely on males for now.  I also treat orthopedically and treat a lot of athletes and I really enjoy treating in full spectrum. And the only population I don’t treat is pediatrics. Coz I think there are much better people out there that can focus on pediatrics than men.

So I treat a lot of females for orthopedic issues but I won’t treat them for the pelvic floor. Obviously, I’ll treat men for any issue. 

Simon Edward Smith: “Right and this is based out of New York, you’ve got a clinic there?

Adam: Yeah right in Manhattan.

Simon: How long have you had that for?

Adam: About two years now.

01:40​ Dr. Gvili’s experience with pelvic floor dysfunction 

Adam: I don’t know how much you know about me. I myself went through pelvic floor dysfunction a couple of years back. Maybe ten years ago, at that time there was nobody out there to treat it. Really, in terms of men treating men. Right there were females treating it, but having a conversation like ‘hey you know when you pee at the urinal and you get this weird feeling, oh wait you don’t pee at the urinal right?’. And you can probably relate to this topic.

It’s like a weird dead end that I couldn’t complete a plan of care. But luckily I did meet a woman who is really familiar with male anatomy. I can give her a lot of kudos and I did learn from her. One of the reasons I started on my own, was because I was like there are no males treating males and guys don’t like to talk about their penis that much and that is the truth.

Simon: Yeah so what are your experiences in pelvic pain?

Adam: So luckily I only had some pain like an occasional shooting pain. Sometimes into the rectum maybe two seconds and it goes away. It was just a hypertonic pelvic floor. So as a patient, I had some issues like weird erectile dysfunction, premature ejaculation. Muscles are so tight that it is constantly contracting around my prostate. And it’s almost a borderline persistent general arousal disorder.

And I remember the third physical therapy session got better. It pushes the right buttons so I think that was what it was.

03:18​ Dr. Gvili’s treatment of his pelvic pain 

Simon: What would you do in a physiotherapy session to recover so quickly?

Adam: So we didn’t do much movement base stuff which is kinda I think what is needed to speed up the process but what I did appreciate was this certain individual did a lot of internal and that’s part of my practice as well. I do a lot of internal. I’m gonna kick that taboo on the side. Guys treating guys.

I think even orthopedic clients need that therapy with touch to get that therapeutic effect right. I need to tone down your system. If that is the case, most of my guys have had a hypertonic pelvic floor. I treat mostly an average of 20 to 40, we had the outliers but I used it to tone down the system first before trying to get you engaged or to believe that this is gonna work. Because by the time you’ve gotten to me, you’ve seen so many practitioners that have run you down some rabbit hole. Googling and thinking that you have a terminal disease so I have to calm you down a bit and the way to do that is by internal.

04:31​ The taboo over male-treating-male treatment 

Simon: You said that there was a taboo with men treating men. Do you find that in the US then?

Adam: Totally! And it’s funny! Because when you speak to practitioners in the UK and Australia who are light years ahead of the US. We’re practitioners and we’re here to get people better and that’s our goal. And that has nothing to do with gender. But for some reason when you speak to people coming out of school or people that might be interested in specialties. They hear what you do and ‘oh I can never do that’ those were the usual answers that follow and you do get that a lot.

05:15​ The influence of A Headache In The Pelvis

Simon: You’ve heard of a headache in the pelvis? Well, that’s all internal. Not all of it actually no that’s wrong but some of it is internal isn’t it. And that was crazy in the US. I was quite surprised that it is such a big book within the physiotherapy world. I’m surprised it’s not just common being accepted into the practice.

Adam: It’s such a big one in the physiotherapy practice.

Simon: It’s such a big-known book that I’m surprised that there is a bit of an issue around men treating men.

Adam:  So it’s interesting I do give Dr. Wise a huge kudos because they kind of got this whole movement started. If you really think about it, especially for males. I’ve had a wand and I used it. I’m not the biggest fan of it. But I mean internals out there for some reasons it’s still a taboo right.

Like when I took my first men’s pelvic floor course. I remember it was a two or three-day course either way we spent a good two hours or an hour and a half talking about what you do in a situation where a guy gets an erection. So it was more geared towards women feeling comfortable treating men as opposed to just how do we diagnose and treat men. Even within the female kind of sector, there was a taboo here like oh what do we do right.

06:59​ What name would you give to this condition?

Simon: What name would you give to this coz there’s a lot of debate of groups over what terminology people should use. But you know coming from actually from the field what would you call it?

Adam: Yeah it’s tricky because have you heard of sciatica?

Simon: Yeah that’s the nerve down the thigh.

Adam: Yeah it’s actually at the back of the leg.

Adam: Sciatica or it can be in your spine it could be coming along that pathway. Like pelvic pain, we have an umbrella term, we kinda branch out from there. So I don’t necessarily know if I would rename it because it depends on someone’s symptoms and it depends on it being a multi-fast issue we don’t know what’s going on. I think the biggest disservice we have done so far is diagnosing people with stuff we’re not sure they have.

Simon: Right, such as an inflamed prostate.

Adam: What the h*** does it even mean?

Adam: No seriously I’m a little more animated than your average physical therapist. But what the h*** does that even mean. I have a leading urologist in New York City referring me to clients. Thankfully, I’m very thankful for that. But how can I feel an inflamed prostate? You can’t feel if it’s baggy but can I tell if it’s really inflamed. I’ve touched many prostates. I don’t know if that’s necessarily true. Can I be honest? It could be wrong.  Maybe I’m feeling but I’m telling you what I think. or I mean I have this theory that specifically in the US but I don’t know it is in the UK but we over medicalize here. We definitely over medicalize. We diagnose, the reason why we have to diagnose is so we get paid by the insurance 

I never walk out of a doctor’s office saying we’re not really sure what it is just do this, and this. And we’re always looking for an answer for some reason. How do we know it’s necessarily the pelvic floor and it’s a hip issue? How do we know it’s not a low back issue? So many things can cause the said symptoms. That I think we do some disservice, let’s say it’s for sure like this when we don’t have enough research. Majority of those diagnoses that you’ve heard 

09:42​ The problem with giving it a name 

Simon: Yeah! Cole Monahan mentions that giving a diagnosis can be a bit definitive and not really help the situation. Like you said that there are so many different symptoms coming from different places and it’s hard to classify them.

Adam: Totally! And then I’ve had people who have had a one-night stand and said it happens after that. I never had sex before and they tell me they have these symptoms. So when that happened the first time. That person came to me and said I’m actually a virgin. I’ve never had oral sex either. But I have these symptoms. That was like someone shot me in the head. Because I was like we thought to believe that this could potentially be something that changed your urethral or bladder flora.

Whoa, so I’m always at the question mark and I think that it’s the exciting part about treating the pelvic floor that constantly comes up.

10:44​ Issues around internal treatment and trigger points 

Simon:  So I really want to ask what this internal treatment is? Do you say you’re not a massive fan of the wand? Is that because there are few different types? Is that the easy one, the magic wand?

Adam: It’s kind of like an S-shape. Like a small S shape. I’m not the biggest fan because… to go and search for trigger points, I don’t know how helpful that is. Also unless you’re sort of a Marvel DC Comic character when you have a long arm, or you actually can make it to put it in your butt. You might have a problem kind of relaxing certain muscles because you’re utilizing them in order to contract them to a certain position right.

Well that being said I’ll never tell someone not to do something. In most cases, I won’t say no to do something. So if that makes you feel better, do it.

Simon: So you’re using your finger then?

Adam: Yeah we use gloves.

Simon: You’re using your finger like a wand basically?

Adam: So am I looking for a trigger point or not? I have people that seem that don’t have that much tension in their pelvic floor but they go through all the gamma symptoms and everyone who does, has a high torn pelvic floor. So I’m not necessarily looking for trigger points. But something that says that I’m in the right area right. Especially the first session which is evaluation. I go around and try different things and I’ll tell my clients to text me the next two or three days and then I have a log two-three days and another two-three days until they come in. and we’ll see if that did work and we’ll stick with that a little bit and then when we are at the point where we’re stagnating then maybe we’ll switch to something else.

12:47​ Individual treatment for clients 

Simon: So what are these? Are you telling them to stretch? Or do they do the massage and set the internal massage themselves? What is it? Or just a combination of different methods?

Adam: Yeah, I don’t have cookie-cutter treatment. If it takes someone with a really high tone pelvic floor that kinda sits all day, and doesn’t move much. They would do really well, just kind of going out for a walk starting slow, deep squats. My favorite is deep squatting in your bathtub. I don’t know in the UK if you have traditional bathtubs, not sure if you do. Curve the edges on the side. 

 So you can deep squat with your back with supported heels down that curved the edges will further push you to the hip flexion. So what you’ll get is the opening of that perineum and adductor fascia. That’s my favorite kind of talk of almost everyone on their first visit just to see if we get a change because that is what we are looking for right. An active change.

Simon: It’s funny you say that. Because that is the position that I would do. The wand, that’s the exact position that is really helpful. That deep squat just pulls everything open. You can feel like releasing… come open… so I can certainly associate with that.

Based on the above conversations, we can feel how passionate Dr. Adam Gvili is in treating male pelvic floor disorders and how he works with them closely to improve their symptoms and normalize their pelvic floor.

Do you want to know more about a male physiotherapist and how Dr. Gvili treats his patients? Want to learn more tips and advice from an expert who experienced pelvic floor disorder himself? Watch out for our next blog.

Related Blogs: Physical Therapy for Men: FAQs Answered and Guide to Physical Therapy: What You Need to Know

I was in deep sadness, because of an unhealthy pelvic floor. Past tense because it was all in the past. Have you been searching for ways how to regain your pelvic health?

If YOU or you know ANYONE who has been suffering from pelvic floor dysfunction over the years. Please let them read this. Please share this with them.

Because they need to know what I’ve been through. And how my story can HELP them regain their pelvic health back for GOOD.

Here it is…

My pelvic pain issues made me a pelvic floor physiotherapist.

When I was going through my symptoms of a pelvic floor disorder, I remember feeling very bad for myself. I have experienced all the embarrassing signs of pelvic floor dysfunction.

• Weak pelvic floor
• Urinary incontinence
• Fecal incontinence
• Painful urination or defecation
• Erectile dysfunction
• Pain in the bladder or groin area

I tried to rationalize why someone like me who is a good person, would get such a terrible disease. And I also tried to play out every scenario in my head and think of what I could have done over so that I would not feel the pain and discomfort I was feeling. Weird things like my masculinity kept being called into question, I would second guess myself on routine tasks and I would feel less confident around familiar people. I remember crossing the street and thinking to myself “I bet you, he doesn’t have pelvic pain”. This all drove me mad!

Physicians I consulted with thought I was crazy. Every test they examined me for came back NEGATIVE!

Examinations include:

• Digital rectal exam
• Urinalysis
• Blood tests
• Radiology tests
• Cystoscopy

They all concluded that it must be psychological, and I started to believe them. The issue with men’s pelvic pain is that it’s not tangible; no one can prove that you are feeling pain, neither can you. At some point in your journey, you start to ask yourself is my anxiety causing this? What came first, my anxiety or the pain? Did I even have anxiety prior to this? The truth is, it’s a double-edged sword if you are constantly trying to make sense of something in your head and you are feeling symptoms of that which you cannot make sense of, that is anxiety by mere definition. 

It wasn’t until I finally met a pelvic physical therapist focused on men’s pelvic health, who could finally validate my symptoms. And help me get out of pain and discomfort that I started to see the light at the end of the tunnel.

It took me 6.5 long years to finally get someone to listen to me and let me know that my symptoms are real and actually very much treatable.

I remember breaking down and crying at how happy I was.

This was now the beginning of a great journey and all my efforts up until this point have not been wasted. So many men have been through hell and back and have lost hope.

There are so many reasons as to why you haven’t gotten relief yet. In many cases I see clients that haven’t been pointed in the right direction for care. Sometimes it’s a urologist, gastroenterologist, colorectal specialist or even a PCP that didn’t know how to screen for pelvic pain. Other times it’s another pelvic floor therapist that didn’t know how to properly treat the cause of the symptoms. Whatever it is, know that it takes time to get help for a diagnosis with little to no research. Only now are we starting to see leading practitioners research this issue.

So don’t lose hope, remind yourself that you are doing everything in your power to get better and there is absolutely nothing you can do beyond that. Control the factors in your life that you can control.  Getting rid of pelvic pain is multifactorial, look at the whole picture.

• Check your sleep cycle;
• Water intake
• Stress level
• Activity level
• Check your diet and vices

My only MISSION is to pay it forward.

Be that SOMEONE who listens. That SOMEONE who pays attention to your pain. And we are making it possible by creating a judgment-free community of MEN that support MEN, aiming to be free from pain and live their best life.

Feel free to join our EXCLUSIVE GROUP here CHRONIC PROSTATITIS, PELVIC PAIN & ALL THINGS MEN.

If you need someone to talk to, I am here to listen. I am here to tell you that it will GET BETTER.

I am also providing 15-minutes teleconsultation for FREE.

You can also hear my full story on how I overcome PELVIC FLOOR DISORDER here.

WEAK PELVIC FLOOR is synonymous with a TIGHT PELVIC FLOOR. These words are common terms in the world of pelvic health but are usually misunderstood. To give everyone clarity, a weakened pelvic floor is a state of the pelvic floor muscles where your pelvic organs lack the support it needs to function normally. That may stop you from being able to control urine, feces, or gas. 

Symptoms of a WEAK/TIGHT PELVIC FLOOR MUSCLES

• Leaking urine or flow of urine when coughing or sneezing
• Passing wind/gas when bending or lifting
• Reduced sensation in the sexual organ
• Unable to control bowel movements or passing the stool
• Pain in the tailbone (coccyx pain)
• Sudden urge to pee (urinary urgency)
• Unable to poop (constipation)
• Painful sex (dyspareunia)

WHAT ARE THE COMMON CAUSES OF WEAK PELVIC FLOOR IN MEN?

Men’s pelvic floor can be weakened by:

• Obesity (as defined by the World Health Organization, obesity is the abnormal or excessive fat accumulation that presents a risk to health.)
• Type-A Personality ( People with Type A personalities are often high-achieving “workaholics” )
• Chronic constipation (Constipation that lasts for several months)
• Post-Op Prostate Recovery (People who underwent prostatectomy which is a surgery that removes part or all of the prostate gland)
• Straining to urinate or defecate (An intense exertion to pass the urine or stool)
• Minimal Ejaculation (Ejaculating little to no semen)

WHAT ARE THE COMPLICATIONS OF WEAK PELVIC FLOOR?

Have you tried riding a roller coaster and felt like your internal organs are shuffled? And it felt like there is a strong gravitational force pulling you down there? It may be a little exaggerated, but one of the major complications of a weak pelvic floor is PROLAPSE. Prolapse is the bulging or dropping of your rectum or bladder. It is more common in females but may occur in men as well.

Symptoms of PROLAPSE:

• Pressure in the pelvic region
• A feeling that something is falling out
• Protrusion of the rectum or anus
• Trapped stool or difficult bowel movements
• Urine leakage and difficulty in urinating
• Lower back pain

HOW TO REDUCE SYMPTOMS OF PELVIC FLOOR WEAKNESS?

If your pelvic floor muscles are weak, there are lifestyle changes and pelvic floor muscle training that can reduce the symptoms of pelvic floor weakness. It may include the following:

• Pelvic Floor Physical Therapy –  Pelvic floor exercise (especially integrated with a strong core) can help with the symptoms of a weak or tightened pelvic floor. Your pelvic floor therapist can help strengthen the muscles of your pelvic floor and core. 
• High-fiber diet
• Water intake
• Weight loss
• Exercise/Movement
• Yoga

WHERE TO GET HELP?

Having a weakened pelvic floor is not a medical emergency, but it is EMBARRASSING and UNCOMFORTABLE. Pelvis NYC is on a mission to help men get proper treatment and proper care. If any of the above signs and symptoms are bothering you, please consult your specialist. Or you can book a 15-minute teleconsultation totally FREE OF CHARGE. We are here to listen. We are here to help.

Other Related Blog:

PELVIC PAIN IN MEN: KNOW HOW CAN PELVIC FLOOR THERAPY SET YOU FREE