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 Objectives

• Learn what the prostate is, and it’s location in the

body.
• Learn the symptoms and early warning signals of
prostate trouble.
• Understand the role of the pelvic floor, prostate and
bladder control.
• Learn how to enhance pelvic floor muscle function.
• Incorporate the pelvic floor muscles in your daily
activities.

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 Know the Location of Your Prostate?

• A man’s prostate
produces the seminal
fluid that nourishes and
transports sperm
• About the size and shape
of a walnut
• Positioned below the
bladder and above the
pelvic floor

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 Why does the Prostate matter?

• An estimated 30% of men

under 50 and 50% of men
over 50 will suffer issues
with their prostate, in
particular urinary issues.

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 Common Prostate Disorders

• Benign Prostatic Hyperplasia (BPH) – an enlarged prostate, it can result

in bladder and urethral compression making it difficult to pass urine. It is
benign and does not become cancerous.
• Prostate Cancer – occurs when cells in the prostate keep splitting, making
new abnormal cells. These cells form a mass of tissue, called a growth or
tumor. Tumors can invade and damage other tissue and organs. It is usually
diagnosed by a rheumatologist when looking for the cause of low back pain.
It is usually diagnosed based on a rectal exam and PSA test.
• Prostatitis – is an infection of the prostate. There are four different types.

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 Types of Prostatitis

• Category I: Acute bacterial prostatitis (ABP) which is associated with severe prostatitis
symptoms, systemic infection and acute bacterial urinary tract infection (UTI).
• Category II: Chronic bacterial prostatitis (CBP) which is caused by chronic bacterial
infection of the prostate with or without prostatitis symptoms and usually with recurrent
UTIs caused by the same bacterial strain.
• Category III: Chronic prostatitis/chronic pelvic pain syndrome which is characterized by
chronic pelvic pain symptoms and possibly voiding symptoms in the absence of UTI.
• Category IV: Asymptomatic inflammatory prostatitis (AIP) which is characterized by
prostate inflammation in the absence of genitourinary tract symptoms.

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 Who is at Risk of Prostate Cancer?

• Age: Chance of having it increases after age 50, most after age 65.
• Racial/Ethnic background: African American men have the highest
documented prostate cancer incidence rates in the world. In the US
the death rate is twice that of white men.
• Family History: having a father or brother with prostate cancer
more than doubles the risk of developing it. Much higher if several
relatives, especially if they were diagnosed at a young age.
• Diet: high fat diet may help contribute to prostate cancer.

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 Prostate cancer in the United States
(2017 estimates)

• New cases: 161,360

• Deaths per year: 26,730
• 5-year relative survival rate for
localized stage: >99%
• 5-year relative survival rate for
all stages combined: 99%
• 10 year relative survival rate
for all states combined: 98%

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 What are the symptoms?

• Not being able to pass urine • Difficulty having an erection

• Weak flow of urine • Blood in urine or semen
• Urine flow starts and stops • Frequent pain in the lower back,
hips or upper thighs.
• Need to urinate frequently,
especially at night
• Pain or burning during urination

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 Should you have a Prostate
Cancer Screening?

• In 2012, the U.S. Preventative Task Force recommended against the use of PSA screening
for healthy men of all ages, stating that the harms of screening outweigh the benefits.
• In contrast, physician-led groups, such as the American Society of Clinical Oncology and
the American Urological Association, maintain that PSA screening should be considered in
the context of a man’s life expectancy and other medical conditions.
• Most experts agree that there is no role for PSA screening for men expected to live less
than 10 years.
• Ultimately, decisions about screening should be individualized based on a man’s
level of risk, overall health, and life expectancy, as well as his desire for eventual
treatment if he is diagnosed with prostate cancer.

Talk to your doctor.

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 How does the pelvic floor
fit into this equation?

• The prostate (2) sits

right on top of the pelvic
floor (9), the two have a
close relationship and
will effect each other.

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Symptoms of Prostate
Cancer:
• Not being able to pass urine
• Weak flow of urine
• Urine flow starts and stops
• Need to urinate frequently,
especially at night
• Pain or burning during urination
• Difficulty having an erection
• Blood in urine or semen
• Frequent pain in the lower back,
hips or upper thighs.
How does the pelvic floor
fit into this equation?
Symptoms of pelvic Symptoms of pelvic
floor tension: floor weakness:
• Constipation  Urinary incontinence
• Erectile Dysfunction  Urinary urgency/frequency
• Pelvic pain (pain between the  Stool and gas incontinence
legs or in the abdomen up to
 Sexual dysfunction/Erectile
the bellybutton)
dysfunction
• Inability to empty your bladder
completely  Pelvic girdle pain
• Painful urination and bowel
movements
• Delay of stream/stop &
Starting of stream/weak
stream
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 Anatomy of the Pelvic Region: PFM

Muscle Layers of the Pelvic Floor

• First Layer
• Bulbocavernosus
• Ischiocavernosus
• Superficial Transverse Perineal
• Second Layer (urogenital
diaphragm)
• Sphincteric muscles that compress
the canals
• Includes fascia to support the
urethra

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 Anatomy of the Pelvic Region: PFM

• Third Layer (levator ani)

– Pubococcygeus,
Iliococcygeus, Puborectalis,
Coccygeus

• Pelvic Wall Muscles

– Obturator Internus, piriformis

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 Know Your Inner Core

• The Pelvic Floor Works With Your Inner

Core
– Diaphragm: the dome shaped muscle
Diaphragm
used for breathing
– Transverse Abdominus: the deepest Multifidus
Transversus
layer of the abdominal muscles used for abdominis
stabilization of the spine and pelvis
– Deep Multifidus: the deepest layer of
the back muscles used for stabilization of
the spine and pelvis Muscles of
pelvic floor

Source:
http://fitforreallife.com/2015/02/training-the-core-how-a-physio-looks-at-building-
your-core-stability-plus-3-core-stability-exercises-you-can-do/

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 Why Are These Muscles Important?

• Support for the Abdominal Organs: “Holding Things Up”

• Appreciation for Sexual Intercourse: “Use It Or Lose It”
• Bladder and Bowel Control: “When You Gotta Go”
• Stabilize the Pelvic Girdle: “Your Inner Core”

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 Types of Incontinence

• Urge Incontinence
– “Involuntary leakage
accompanied by or immediately
preceded by urgency”
– Often referred to as an
“overactive bladder”
• Mixed Incontinence (both
stress and urge)

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 What Causes Pelvic Floor Weakness?

• Trauma to the pelvis/abdominal wall

• Lack of pelvic floor/inner core exercise
• Abdominal surgeries
• Bearing down/straining on the pelvic floor in daily life
• Obesity

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 How To Find Your Pelvic Floor

Are Kegels appropriate for men? You bet!

Cues to contract the RIGHT muscles

• Tighten the muscles around the base of your scrotum like you are
stopping the flow of urine
• Pretend like you are holding in as if you are trying to not pass gas
• Try tightening your muscles so you are bringing your pubic bones
and tailbone together or trying to bring your SIT bones together

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 How To Find Your Pelvic Floor

• Get familiar with yourself…

– Use a mirror to see the muscle of your
pelvic floor lift
– Self Evaluation (yup, get up close and
personal)
– Urine Stop Test

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 How To Find Your Pelvic Floor

Common mistakes
• Tightening the buttock muscles
• Tightening the inner thigh muscles
• Holding your breath
Remember, this is a gentle
• Sucking in your belly contraction. If it feels like you
are trying too hard, you
probably are!

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 Myth About Kegels

It’s Not Just About Tightening!

• Your pelvic floor needs to be able to work like any other muscle in
the body. It has to:
– Contract
– Relax
– Elongate
• Muscles need to be able to go through their entire range of motion in
order to be strong!

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 Taking Your Kegel To The Next Level

• When activating your pelvic floor muscles, make sure you can feel yourself tighten,
relax, and elongate. Note: When elongating your pelvic floor, don’t strain.

Pretend that your pelvic floor is an elevator. If your pelvic floor

is at rest at the ground, tighten and lift up to the 2nd or 3rd floor,
then relax back down to the ground. From the ground, see if
you can elongate your muscles down to the basement.

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COORDINATING THE PELVIC
FLOOR WITH YOUR INNER CORE
Now that you know how to find your pelvic floor,
here comes the tricky part…

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 The Amazing Diaphragm

• When you inhale deeply, your diaphragm

pushes down into your abdomen, allowing
your pelvic floor to descend or lower
INHALE = pelvic floor DESCENDS Diaphragm

Multifidus Transversus
abdominis
• When you exhale, your diaphragm and your
pelvic floor elevates to its original position
Muscles of
EXHALE = pelvic floor ELEVATES pelvic floor

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 The Amazing Diaphragm

• It is important that you are aware of your diaphragm. Observe that a

big, relaxed, cleansing belly breath results in belly rising.

• Place one hand on your upper chest and one hand on your belly.
• Breathe in deeply- a big belly breath. If you are doing this
correctly, you should feel the hand on your belly move, not the
hand on your upper chest as much.
• Now do this again and feel what is happening in your pelvic floor.

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 It’s Not Just About Sit-Ups and Crunches
Myth: Sit ups and crunches are all I need to do to get a flat
stomach and work my abs.
• Those exercises are just one-dimensional External
and only work the more superficial abdominal
oblique
abdominals Transverse
• We need to work the entire core, in all abdominis

planes of motion, which means finding the

deeper, inner-most muscles
Rectus
Layer 1: Immediately below the skin - Rectus Internal abdominis
Layer 2: External & Internal Obliques abdominal
oblique
Layer 3: (deepest) Transversus Abdominus
Source:http://fitforreallife.com/2015/02/training-the-core-how-a-physio-looks-at-building-
your-core-stability-plus-3-core-stability-exercises-you-can-do/

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 It’s Not Just About
Sit-Ups and Crunches

Find your Transverse Abdominus muscles by

tensing your lower, inner-most abdominal wall while
continuing to breathe.

• Bring your belly button back to your spine

• Hug your abdominal organs with your lower abdominals
• Like you are trying to get into a pair of slightly tight
jeans

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 It’s Not Just About
Sit-Ups and Crunches

Core Activation: “On All Fours”

• Start in tabletop position (hands and knees) with

the hips and knees at 90 degrees.
• Press hands into the floor and engage the
transverse abdominals.
• Lift arm up towards the walls.
• Hold for 5-10 slow breaths.
• Option to extend the opposite leg behind you with
foot on the ground, or leg in the air.

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 It’s Not Just About
Sit-Ups and Crunches

Core Activation: “Bridges”

• Flatten your spine and press your pelvis up

toward the ceiling, rolling up one vertebra at
a time.
• Keep the pelvis level.
• Hold for 5-10 slow breaths.
• Option to lift one heel or foot, keeping the
pelvis level.

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 It’s Not Just About
Sit-Ups and Crunches

Core Activation: “Clamshells”

• Lay on your side with knees bent. Roll the entire trunk
slightly towards the floor so you feel the abdomen
engage.
• Keep heels together as you lift the top knee. You want
to feel the action in the rear end, not the front of the
hip. (If you are feeling the action in the front of the hip,
try rotating your trunk closer to the ground.)
• Repeat 20 times on right and left sides.

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 Putting It All Together

• If you feel some tension in your low back as you contract

your transverse abdominus or even feel that you lifted
your pelvic floor…you got it!

• This is the ultimate coordination of transverse

abdominus, deep multifidus, diaphragm and pelvic floor

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 Use Your Core
Throughout The Day

• Use your deep inner core with every

day activities such as:
– Lifting
– Going from sit to stand
– During other exercise
– Coughing/Sneezing
• Squeeze before you sneeze - “the knack”

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 Finding Balance

• There are 45 muscles that attach to the pelvis!

• It is important to help optimize the pelvic floor function by
balancing the strengthening with stretching of other
muscles surrounding the pelvis
• Let’s practice stretches for some of the more commonly
tight muscle groups

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 Finding Balance

Piriformis Stretch

• Lay on your back with knees bent.

• Place your right ankle on your left knee.
• Reach for your left thigh and pull it towards your
chest to feel a stretch in the right buttocks.
• Repeat on other side

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 Finding Balance

Hamstring Stretches:
Downward Facing Dog

• Start in Table Top (hands and knees).

• Send the sit bones back to where the wall
meets the ceiling, keeping the back straight.
• While breathing in this posture, visualize the
tailbone reaching toward the ceiling during
inhalation, allowing the pelvic floor muscles to
release.

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 Finding Balance

Hamstring Stretches:
Active Hamstring Stretch

• Stand with feet wider than hip distance apart and knees
bent.
• Clasp hands and place elbows above the knees. Inhale.
• Exhale, begin to straighten knees, keeping the back
straight, and raise the pelvis toward the ceiling.
• Extend the knees to feel the first sensation of stretch in
the calf/posterior thigh.

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 Finding Balance

Hamstring Stretches:
Standing At Step

• Place heel on the step with your toes pointed up

to the ceiling
• Hinge forward at your hips, so you feel the stretch
in the back of your leg.
• Repeat on opposite side.
• Option to use a strap to deepen stretch.

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 Finding Balance

Adductor Stretch

• Sit tall, with the bottoms of your feet together, your

ankles open wide.
• If your knees don’t open to the ground, place pillows
or blocks underneath to help support them.
• For a deeper stretch, hinge forward from your hips.
• This move can also be done in a lying down position
to be more restorative.

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 Finding Balance

Hip Flexor Stretch

• Stand with your feet hip distance apart, left leg in front.
• The left knee is bent, knee aligning over the ankle and
second toe.
• The right knee is straight.
• Press the pelvis forward and tuck your tail under to feel a
stretch in the front of the right hip.
• Repeat on the opposite side.

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 Finding Balance

Deep squat position for pelvic floor relaxation

• Standing with feet hip width apart, squat down to

lower the pelvis below the knees
• If this is too difficult, practice laying on your back,
making a deep squat position by pulling knees
toward chest, and out to the sides.
• Use your hands to hold and support your legs.

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 Finding Balance

Pelvic Floor Decompression:

Legs Up The Wall

• Lie on your back, and slide your bottom as close

as you can to the wall.
• Place your straight legs up the wall.
• If this is difficult, place a pillow under your hips.

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 Are You Aligned?

• Alignment is key in optimizing your pelvic floor and deep inner core function.
• Finding the body’s position of natural ease avoids overworking certain muscles
unnecessarily.

• Keep your rib cage over your pelvis

• Keep your spine and pelvis in a neutral position,
not tucked underneath you (Pink Panther) or
tilting your pelvis forward (Donald Duck)

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QUESTIONS?

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 This presentation was a www.RestoreMotion.com
collaboration between
The National Association for
Continence and
Restore Motion Physical Therapy
of Rockville, Maryland.

• Presentation consultant, Patrick Wenning, MPT, CIMT, CMPTP, of Restore

Motion who has a special interest in Men’s Pelvic Floor Health as well as
interests in Spine, Pelvis, Foot/Ankle, and Performing Arts Rehabilitation.

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 Help Us Help You!!

• The National Association for

Please DONATE to NAFC at
www.nafc.org/donate, so
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Newsletter, “On The Go”.

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 THANK YOU!
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Name
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