Men’s health is 30 years behind women’s health, but both men and women’s pelvic health are now well and truly on the physical therapy agenda. So said Jo Milios from the University of Western Australia's School of Sport Science, chairing a session declaring men’s health a new frontier for physical therapy.
Among speakers at the session, Paul Hodges from the Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, Australia, provided an overview of new understanding about continence in men after prostatectomy. It is now clear, he said, that incontinence is very different for men than women, and there is little evidence that pelvic floor muscle training is effective in men after surgery.
“Function in men involves complex interactions between multiple mechanisms,” he said. “Key questions are still to be answered in the rehabilitation of pelvic floor muscle dysfunction.”
Ruth Jones from the United Kingdom also highlighted the need for more research and greater understanding, in the field of male pelvic pain. Chronic pelvic pain syndromes affect around 8% of men, and there are more outpatient visits for prostatitis than prostate cancer. Yet there has been only one trial of physiotherapy interventions for this condition. The study found that 57% of men responded to myofascial physical therapy, and 21% of men responded to global therapeutic massage.
The pelvic floor, she said, was “one potential component to the mystery of unexplained pelvic pain”.
Gerard Greene from the UK asked: “Where are all the men’s health physios?” It was often a challenge for male patients to find someone to treat them, and subjects like penile pain and erectile dysfunction were still taboo. Equally, there were many barriers to physical therapists specialising in the field: there was a lack of training, mentoring and funding and it involved lone working.
There are also still significant knowledge gaps in women’s pelvic health, an earlier state of the art presentation found.
Kari Bø, Rector of the Norwegian School of Sports Sciences, presented a study about diastasis recti abdominis (DRA) – an impairment of connective tissue causing the rectus abdominis muscles to separate through the midline of the linea alba. Despite claims that this was being treated successfully by physical therapists, there was no theory or data behind it, said Kari Bø. Studies supporting abdominal training were few and of poor quality.
Her study of a postpartum training programme, with an emphasis on pelvic floor muscle training, found that it did not reduce diastasis in first-time mothers.
“There is an urgent need for further high quality RCTs investigating the effect of different abdominal and pelvic floor muscle exercises on diastasis,” she said.
Another study presented at the session, by Cristine Ferreira from Brazil, also revealed a lack of evidence that pelvic floor muscle strengthening after surgery produced an improvement in quality of life or sexual function.
Concluding on the session, co-chair Annelies Pool-Goudzwaard said it was remarkable that the studies presented were indicating the pelvic floor muscle training was producing no or a small effect. This did not mean there was no benefit: “But it makes me wonder what we can learn from listening to these studies,” she said. “This is a layer of research in this area, but we need more research to ensure we are building on solid ground.”
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