Tips for controlling that "gotta go" feeling

If you’re tired of taking frequent and inconvenient calls from Mother Nature, you might try flexing a little muscle.

That muscle is actually a group of muscles called the “pelvic floor,” and contrary to what most people think, “men have a pelvic floor, just like women,” according to Belia McNabb, PT, DPT, a physical therapist at PeaceHealth in Longview, Washington.

Ok, well not just like since there are some anatomical differences. But for both men and women, strengthening the pelvic floor can help you control some important things in life.

First, the basics. What is the pelvic floor?

The pelvic floor is a group of muscles that run from the pubic bone to the coccyx (tailbone) and ischial tuberosities (sit bones). These muscles are vitally important to bladder, bowel and sexual function.

Weakness or lack of coordination in the pelvic floor can contribute to the following health conditions:

Stress urinary incontinence

Stress urinary incontinence is leaking urine when you cough, sneeze, laugh or do other things that put sudden or intense pressure on your abdomen. Men are less likely to suffer from stress urinary incontinence than women, but it happens in about three to 10 percent of men.

Incontinence usually happens when there has been damage to pelvic floor structure due to trauma, prostate surgery or neurological injury to the spinal cord.

There are reflexes that are part of the pelvic floor.  Your pelvic floor should reflexively contract whenever you cough, laugh or sneeze.  Sometimes this reflex goes away or slows down. For women, that could be after the delivery of a baby. For men, it could be after abdominal or pelvic surgery.  If your reflexes are sluggish because of this AND you also have weakness in your pelvic floor, that’s increases your chance of leakage.

Overactive bladder

Overactive bladder is the bossy bladder that often gives you that overwhelming “gotta go” feeling. According to the National Association for Continence, one in six adults suffers from overactive bladder. 

Men suffer from overactive bladder more frequently than any other form of incontinence. Some men experience not only overactive bladder, but also urinary frequency, urgency and nocturia—the urge to go in the middle of the night.  Frequent urgency is essentially the same thing as an overactive bladder. When the bladder is contracting frequently, you feel like you have to go before your bladder is actually full.

Overactive bladder can be caused by a number of things, including infection. According to McNabb, infection is the first thing you’ll want to have checked.

Once your doctor rules out infection, then you can learn other things you can do to show your bladder who’s boss.

If overactive bladder seems to be the problem, try keeping a bladder log for a few days. You might see a pattern and the information can help your doctor understand what might be going on and how to fix it.

Bowel incontinence

Bowel (or fecal) incontinence makes it difficult to stop or control how and when you pass gas or stool. A “number two” leakage can be caused by things, such as:

• Poor toileting habits, waiting too long to go
• Gastrointestinal problems or conditions that cause chronic diarrhea or constipation (irritable bowel syndrome or Crohns)
• Damage to muscles or nerves due to constant straining
• Pelvic floor weakness or discoordination
• Depending on the underlying cause, you may be able to gain better control of your bowel by strengthening your pelvic floor. In addition, you’ll want to follow a healthy diet that agrees with your digestive system.

Changing some of your habits or triggers can also help.

One habit to change would be to avoid going to the bathroom “just in case." Going too frequently will train your bladder to be sensitive to any small amount of urine.

And pay attention to triggers that send you running to the bathroom. These are things like the sound of running water or the 'key in the door' (having to go as soon as you get home).  Try retraining your triggers to help prevent leakage.

Impaired sexual function

Like the conditions above, there might be various reasons for trouble with sexual function. However, having a healthy pelvic floor can improve issues such as erectile dysfunction, which men commonly experience following prostate surgery

Give new meaning to “floor exercises”

Learning to exercise your pelvic floor can be tricky. “A lot of people have difficulty performing these exercises correctly, even with written instructions,” she says.

The important thing is what a stronger pelvic floor will do for you. “With time and practice you can master it and enjoy a more ‘in control’ feeling,” McNabb notes.

Once you start exercising your pelvic floor, you’ll want to keep up the habit. How often and how long you do this will depend on your current strength, power and endurance.

Aim to be able to contract your pelvic floor without holding your breath for about 10 seconds, 20 times a few times a day at first. Once you’ve mastered that, you can drop back to doing the exercises just a few times a week to maintain strength.

Physical therapy can help

You don’t have to go it alone. Incontinence and erectile dysfunction might be common as men get older, but they don’t have to be a normal part of aging.

“There are things you can do to prevent or treat these so if you are suffering from any of the conditions above, ask your doctor to discuss treatment options, including physical therapy” says McNabb.

Ask for a therapist who is trained to treat pelvic floor conditions so that you can receive the best possible treatment, she notes.

If your doctor recommends physical therapy, your therapist will get a thorough history on what is going on.  Physical therapists can help test the ability to contract or relax the muscle group, measure the strength of the muscles, check for sensation and coordination.

Therapists can also help you understand changes to your diet and other habits can give you more ways to manage your symptoms.

“Some recommended changes might be small, but sometimes the smallest changes make all the difference,” shares McNabb.

Consider the relative size of the pelvic floor compared to the many important things it can help you control, like overly frequent calls from Mother Nature.

REFERENCES
Nitti VW. The Prevalence of Urinary Incontinence. Reviews in Urology. 2001;3(Suppl 1):S2-S6.
Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991 Aug; 165(2):322-7.