Pelvic Floor Dysfunction – Who Gets it?

We have all felt “Why me?” at some point in our lives. When it comes to Chronic Pelvic Pain Syndrome (CPPS), this is a very common phrase we hear. The short answer is, “Because you are human.”  Basically, if you have a pelvis, things can go wrong with it. But there are a few common elements I have noticed in my work with men who have CPPS; these may be somewhat subjective, so adjust your expectations accordingly. 

Pelvic floor dysfunction is a chronic problem that tends to come and go depending on stress levels and physical activity. Think of it as a threshold where events pileup on top of each other until it triggers severe tightness or spasms. The body can tolerate a certain amount of anxiety/stress, it can compensate for tight muscles, but if either stress or body mechanics go beyond a certain point, the body responds by tightening these muscles – and problems begin.

There are some interesting profiles about the typical man that has chronic pelvic pain syndrome. Most men begin having symptoms between the ages of 18 and 40. Most of these men tend to be in fairly good shape, some of them are in amazing shape and go to the gym multiple times a week. These men especially seem confused that they are told they have muscles that are weak. The fact is virtually none of us exercise our pelvic floor muscles. In my observation, I would say that the majority of men can be described as active and having high energy. 

The most common similarity is that very frequently, men with pelvic floor dysfunction tend to carry their stress in their stomach. For example, I carry my stress in my neck and shoulders. My neck is always stiff; my shoulders are always tight. Men who tend to have pelvic floor disorder, may involuntarily tighten their stomach when they are stressed, or anxious, or nervous. You may also feel your anus contract when you are nervous. If you are the kind of person who gets a stomachache when you are anxious, this would be you.  

On a side note:  One quick self-check told to me by a man with CPPS was that if he was feeling nervous and he went to go to the bathroom, he would notice his penis was often retracted or smaller. Some men call this “hard flaccid” and there is a whole website devoted to this phenomenon. Men go to their doctors complaining they have “Hard flaccid” and the doctors have no idea what they are talking about. If you do a quick Google search of this term, you will find many medical articles puzzling about what exactly “hard flaccid” is. We have a long way to go in educating the medical community!

And in most cases, there is a triggering event. This means that some trauma occurred. This can be a fall on the ice, a car accident, a sports injury, a traumatic emotional event such as death of a loved one or loss of a job, a small surgical procedure, or even sitting on a bench or a bicycle seat for too long. In other words, almost anything can trigger pelvic floor issues. These triggering events may have happened decades ago, but the problem never crossed into an acute situation for various reasons. 

I often think there are three aspects that determine whether a man develops pelvic floor dysfunction. First there is a genetic propensity for it. Second, there is a lifestyle which may be stressful or anxious, and third, there is a triggering event that activates the muscles to go into spasm. I have found it seems as if all three need to be present for the pelvic floor to become problematic.

So, who can develop CPPS?  You can!  If you have a propensity to carry stress in your abdomen or pelvis, if you are experiencing stress or anxiety, and if there is a triggering event, it can happen to you!

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