Cheryl Martin (Host): Kegel exercises are now a common recommendation for strengthening pelvic floor muscles in women, but pelvic floor muscle health is as important for men as it is for women. Coming up, WakeMed Pelvic Health physical therapist, Kaili Warnock, shares how Kegels can help improve bowel and bladder control and sexual performance for men.

This is WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm Cheryl Martin. Kaili, great to have you on.

Kaili Warnock, PT: Thanks for having me. I'm excited to be here.

Host: Kaili, first, what is pelvic floor physical therapy or PFPT?

Kaili Warnock, PT: It is very similar to traditional physical therapy where we work on muscle strengthening and range of motion and helping you function and do things in the world just like anything else. We just have special training that allows us to go internally inside those pelvic floor muscles and be able to feel and palpate them.

Host: So, what are pelvic floor muscles? And what do they do in regard to male health?

Kaili Warnock, PT: So, pelvic floor muscles are muscles that sit kind of at the bottom of a pelvis. If you think about where a saddle would hit you if you were riding a horse, that's kind of where those muscles are. And in men, they help with bladder function, bowel function, erectile function. And I also like to think of the core as being involved in our pelvic floor muscles, because those muscles work hand in hand together, and so we also look at the core muscles as well.

Host: So, what is normal bowel and bladder function?

Kaili Warnock, PT: This varies between individuals, but pooping three times a day or three times a week can be considered normal. Also, consistency of stool is really important for determining what normal is. Peeing six to eight times a day is also normal. But when we get into talking about what normal is for some people, I like to look at how disruptive it is to their life. If they are peeing so many times a day or pooping so many times a day that it's disruptive, then I like to take a really deep dive into those things and figure out what's going on.

Host: Okay. So when should a man see a pelvic floor physical therapist?

Kaili Warnock, PT: That is a great question. So, anytime there's something going on with bowel and bladder. Are you peeing too much? Are you not peeing enough? Are you pooping way too much? Is your stool liquid? Are you leaking feces? Are you having problems with having a fully erect penis? Are you having penile pain? Are you having testicular pain? Those are all questions I would ask someone about their pelvic floor and determine if they need to come in.

Another thing that sometimes people don't do is prior to a prostatectomy would be a great time to go seek out a pelvic health PT. There's prehab and things that we can do prior to the prostatectomy that can help you function postoperatively. Another time that you could come see a pelvic PT as a man is if you're having a hard time getting your pee out or your poop out. Those are good times as well.

Host: So, Kaili, tell us more about how can pelvic floor physical therapy, or PFPT, how does that help with sexual function?

Kaili Warnock, PT: Sometimes, whether it's stress-related or related to surgery, sometimes the pelvic floor muscles can get upregulated, so they become really tight, or they get really weak whenever we're not utilizing our core and pelvic floor properly. So, strengthening those muscles or relaxing and helping to downtrain those muscles can help with keeping blood in the penis or pumping blood into the penis to help with sexual function.

Host: Any other benefits for men?

Kaili Warnock, PT: Yes. Learning how to utilize the core and the pelvic floor together could be really helpful for men. Men have multiple bends in their urethra, and so they don't have to work as hard to manage their pressure. And sometimes that leads to hernias, so there's a lot of pushing out and doming when lifting weights or exercising. And that can cause hernias or diastasis in their abdomen, which can lead to problems down the road.

Host: So,explain to us, how do you do a pelvic floor contraction? How would men do this?

Kaili Warnock, PT: So, how I like to start is I have people put their feet on the floor and have them sitting on a chair or just a harder surface. And one of my cues is to pull your testicles towards your abdomen. So, nuts to guts, as I like to say to people. Pull everything in and up and see if you can feel any movement on the chair. It's important to see if you can hold it for a little bit of time. And can you squeeze and fully let go? Is that easy motion for you? If that cue doesn't work, sometimes I tell people to try and hold in gas. And then, same thing, can you squeeze and rest and squeeze and rest? Or retract the penis, pull the penis in towards your body and up a little bit? So, different cues for different people. Everything works different. Everybody's body is different.

Host: And how long would one do these contraction exercises?

Kaili Warnock, PT: So, you should be able to hold a contraction while breathing for about 10 seconds, and you should be able to 10 quick squeezes and full let-goes in 10 seconds. So whenever we're doing a pelvic floor assessment, that's a good way to see where you're at as far as your strength and your motor control and your mobility of your pelvic floor, so if you can do those things and you're not having any other issues, then it's a good thing to work towards.

Host: Now, can you ever overdo pelvic floor contractions?

Kaili Warnock, PT: Yes. I see this a lot in men, is their pelvic floor is already so upregulated and tight, and those muscles aren't moving, that if you're doing Kegels on top of something that's already taut and not moving super well, that can cause more testicular pain, more penile pain, more groin pain. So if we're having any dysfunction, it's best to seek out care first and really find out what the dysfunction is.

Host: What does a pelvic floor physical therapy evaluation involve?

Kaili Warnock, PT: A lot of different things, there's a lot of questions, and that's usually where we start, is what's going on, what brings you in today. And then, we will get into your hip mobility, your hip strength, how your core is working. Are you pushing down? Are you able to pull in and up? And then, we also are trained to examine the penis, testicles internally, so we can do an internal rectal assessment, so we can get a better idea of what's going on with the muscles of the pelvic floor. Now, that is not a requirement. It's always discussed beforehand. And it's always based on comfort level too. If that's not something you're up for, we do our best to do and help with what we can externally.

Host: When should a person see results as a result of PFPT?

Kaili Warnock, PT: Everyone is so unique and individual, but you should be seeing some results within a couple of weeks. Maybe everything's not completely resolved, but we should be heading in the right direction. And it might take closer to six to eight weeks to really completely eliminate symptoms, and that's a very general estimate. It's super, super dependent on the person and their symptoms.

Host: Anything else you want to add, Kaili, just about this topic or just other takeaways for men in relationship to their pelvic health?

Kaili Warnock, PT: I just want to encourage everyone to talk to your doctors or your PCP if something doesn't feel right. I know it can feel really isolating to have some of these symptoms, but they're probably more common than you think, and there are so many things that we can do to help you. So, speaking up and telling someone is the first step, and I just would love to encourage everyone to do that. I treat a lot of people, and I can see that there's a lot of shame sometimes about some of these topics, and It is very common and there's so much we can do.

Host: That's great. I'm so glad you're encouraging to push in, push through, despite some uncomfortableness about discussing this and get the help that's needed. Kaili Warnock, thanks for sharing so much of your insights on pelvic health for men.

Kaili Warnock, PT: Of course. I'm so happy to do so.

Host: To learn more about WakeMed Pelvic Health or other physical therapy services, visit wakemed.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for other topics of interest to you. This is WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.