What You Need To Know About Pelvic Floor Therapy

Did you know that there's a simple exercise that can elevate your performance in the bedroom to the next level? Well, stay tuned. We're going to find out what this hidden gem is for enhancing your sexual experience not just for women, but for men also. So I'll see you on the inside.

This podcast is for you. The modern man. I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website at sexual healthful men podcast.com for more information and resources from the show. See you on the inside.

Hello there, modern Man. I am here today with Maria Lord. She, she is a doctor in physical therapy. She specializes in pelvic floor therapy along with her husband and they own a company for physical therapy called Nomadic Physical Therapy. And I'm so glad that she's here today joining with me and talking about everything about pelvic floor exercises and Kegel and what it is and why do you need to do it to take your sex life to the next level. Welcome, Maria.

Thank you. I'm excited to be here.

Yes. Great. So first of all, let's talk about pelvic floor exercises or kegel. K E G E L. And let's just start with what it is first and then we'll dive into what does it mean for the sexual health.

So a kegel is basically a contraction of your pelvic floor muscle. So a tightening or a lifting of your pelvic muscles. If you imagine, if you picture where your penis is, it would be like closing and lifting those structures up and in.

Okay, so what does that mean, closing and lifting the penis muscles?

So just like you could activate your bicep by flexing your arm, you can activate those muscles down below as well.

Okay, great. So I've asked Maria to kind of do a little mini session with me later. So we're going to do that so that way our listener can have a sense of what's it like like. So tell me, why do men need to know about Kegel? What does it help them with?

So when it comes to erectile dysfunction, we know that in order to achieve an erection, maintain that erection and then climax, those muscles in the pelvic area have to be able to achieve spasm. So if the muscles aren't strong enough to spasm, your climax isn't going to be as pleasurable, and you're going to have a harder time maintaining that erection.

Thank you for saying that. I like the way how you say that. So when you see your patient, what is the common presentation of the pelvic floor muscles? The common problem?

Typically it's actually opposite of what people think. A lot of people I see come in and they actually have increased tone in their pelvic muscles. So, like they're holding tension down there. And that can be due to a lot of things, from sitting for prolonged periods of time to. To having a high stress life, things like that. And so by teaching you how to contract and relax your pelvic muscles, we're going to increase blood flow and oxygen to those tissues so they can function more efficiently when they need to, like when you're trying to get an erection.

So what you're trying to say is that most of the problem, these guys actually, the muscle down there is more spasm than it is relaxed. And that teaching them how to relax that so that way they can be more efficient in contracting that muscle. Is that correct?

Exactly. I like to use the stuck drawer analogy. If your drawer is stuck, you have to push it back in before it'll come out straight again. So for your muscles down here, they're tense. So by relaxing them, that's going to give you more room to be able to contract them.

Okay, so where are these muscles located at in the male anatomy area?

So we refer to the pelvic floor muscles as like a hammock. So they run from your pubic bone right in front of your body, and they go all the way around back to your tailbone, and then they spread outward towards your hip bones as well.

It's kind of like a hammock. I don't see that. I just see it as a W. So start from the base of the penis and then going down to the ischial tuberosity.

Okay, so you're going to the side, I'm going down and under first.

Right, Right.

But it's that whole region. It would basically be the region that would make contact with a bike's.

So essentially the muscles that are from your pubic bone to your anus, kind of like a triangular region between the muscles, between the scrotum and the anus.

Correct. And it actually goes a little bit further back from the anus all the way to your tailbone.

I have spoken in the past about doing keiko exercises. And essentially those muscles are located from the base of the penis going to the tailbone in between the scrotum, Is that right?

Yes, correct.

Okay, wonderful. And how many muscles are there?

That's a good question.

For me to simplistic wise, I think of as two muscles. The ischiocavenosis and the bulbo spongiosum is the two muscles that mainly talk about.

I believe there's almost like 23. It's interesting you bring this up because females actually have two additional muscles compared to males, but the structure of our muscles is very different. So. So you're talking about the first layer of pelvic floor muscles that make up that urogenital triangle, but there's actually three layers of pelvic floor muscles.

I didn't know that. Can you tell us about that?

Sure. So the first layer of muscles, those are the ones that are important for sexual function as well as sphincteric function to allow things to come out or go in. The second layer is more like support for the internal organs. And the third layer helps to stabilize the bony pelvis. And that's the levator ani muscles. So those are the ones that when you contract, they're going to serve as like a pump to pump blood flow in or out of the area.

Okay. But for as in sexual function, do they need to work on all those three layers of muscle?

So you can't isolate them. It's a package deal. They're all going to contract, they're all going to relax.

Gotcha. I did not know that. So when you're doing relaxation contraction, you're contracting all those group of muscle. And you said for men about 23, and for women it's about 25 muscles.

I would say it's 21 for men and 23 for females.

Oh my goodness. I didn't know there were that many muscle down there to contract. So essentially, men and women, when you're doing sexual activity, they're in that triangle just between your pubic bone, get down to your tailbone. There's 21 for men and 23 for women that are being activated during erection and orgasm and also climaxing. So that is powerful to know. And more powerful to know is that they play an integral part of your sexual response. I sometime undervalue that and often under acknowledge how important those pelvic muscles are to sexual activity. But at least even for me, in just doing pain management over the years. They're also important in low back pain and sacroiliac pain or pain around the SI joint and also with your core for your balance. Even though we don't see it in a private area, it's probably one of the most important muscle to strengthen. Maria said that most of the time, the presentation of the problem is more that the muscles are contracted rather than they're relaxed. Is that right?

For the most part. There are certain cases, like for example, if you just had a prostectomy, where there may be just some weakness within the muscles, but more so than not, it's usually that there's extra tension in the muscles.

And how do people get those extra tension in the muscles?

All sorts of reasons. There's a real high correlation between our psychological health and how our pelvic floor functions. So if you're a person who carries a lot of tension, like up in your shoulders or jaw tension, you catch yourself clicked tension. I would bet that you're holding a little extra tension in your pelvic floor as well.

Interesting. So if a man has ED and he had performance anxiety most of the time, maybe he's holding it too tight down there.

That could be a reason.

So when you see men with ed, is that commonly what you see more. More in more tension rather than weakness?

Yes, it depends. Sometimes it's just tension, sometimes it's because they're having pain. Imagine if you smashed your thumb, thumb with a hammer and that was painful. Kind of. Everything else would tense up in response to that pain. I've also had people who have like, chronic pelvic pain or genital pain, and now as a secondary result of that, they're having ed.

Gotcha. Oh, you mean like pain elsewhere aside from the sexual organ? Let's say they have pain in the back or pain in the neck that can transmit to having the pelvic floor muscles contracted and resulting in ed?

Possibly. I'm thinking more like I've had people with testicular pain, and because they have so much pain, it's impacted their sexual performance as well.

Gotcha. Well, that makes sense. If you're having pain, your brain is distracted and you're not going to be relaxed and you're not going to transmit signals down to your sexual organ. I've always been saying that the brain is the largest sexual organ, and it starts in the brain first before it goes to your sexual organ at this time. So why do you want to strengthen the these pelvic floor muscle? What are the benefit that you get from going to see a therapist that can help you either strengthen or relax these pelvic floor muscles?

So when you see a pelvic floor therapist, you're going to learn how to control these muscles better? Our medical term for that is Your proprioception. A lot of times when people walk in the door, they have no idea where these muscles are located or even how to contract or relax them. So just by learning those skills, skills that's going to help you going forward. So if you are all of a sudden noticing a little extra tension down there, you can address it right away before it comes an issue again. Additionally, the more skilled you are at moving these muscles when they do need to serve sexual function, it's going to be a more pleasurable experience and a more intense climax.

So by being aware of the activities of your pelvic muscles, not only will it help you with erection or performance, it will actually enhance your climax and experience to the next level.

Correct.

So it can be enhanced, but it can also be therapeutic and treated as well too. So how many sessions would your patient need to do to somewhat be able to do it themselves at home?

So it depends how long they have been experiencing their symptoms. So if they've had ED for a few years, it's probably going to take upwards of 16 to 20 weeks until they're at a place where they're happy with how they're performing sexually. If this is something that's happened within a year, a lot of people notice changes within six to eight weeks.

And sessions, it's once a week with that.

A session with a therapist would be once a week, but you would want to do these exercises as often as you can.

Gotcha. So interesting. Well, makes sense. If you have something that's mild, it doesn't take that long to reverse it. But you've had ED for 10 years, it's going to take some time to, to reverse all the neural and muscular pathway that has been dysfunctional. And essentially that's what I'm imagining in my head is that if your muscle has been tight all the years, you're gonna have to rewire the nerve, the muscle again and also connecting with the brain.

Exactly.

To really work on that. That's fascinating. So when you see a patient, what is your evaluation process? If somebody to come to see you, it's like for ed and they said, I want to do pelvic floor therapy to help me with my ed. What would be your EV process?

First we start out by just talking with each other. I'm going to ask you some questions so I can get a better idea of what your specific symptoms present like. And some of those questions might be, how long has this problem been happening? Are you able to achieve an erection? Are you able to maintain that erection and do you have any pain with that experience. We'll move on from there and we'll talk a little bit deeper about climax. Are you able to reach climax? Is it painful to climax? Has any of your functions changed within the last year? What's normal for one person isn't going to be normal for another person. So we need to clarify and make sure that if changes have occurred within that individual, I want to be aware of it. So that's the first segment, and then from there we'll take a closer look at how does their body move. I want to see, like, are there any restrictions in their hip or their back? What's their core strength like? And then if they're comfortable with it, we'll do a pelvic floor assessment and see if they are doing Kegels correctly. Can they coordinate that tightening and that relaxation? Because a lot of people think they're doing Kegels correctly, but they're not because they haven't been educated on how to do them appropriately.

I was one of it. Before we started, I told Maria that I want to do a pelvic floor therapy for a bladder urgency. And I thought I knew how to do it. I find out I was totally messing it up and I had to relearn things again. So a lot of people say, oh, yeah, I know how to do it. Trust me, I thought I knew how to do it. And I tell patient to do kego too. I actually was a patient myself and had somebody actually touch me down there and tell me feedback on what my muscle were doing. I really didn't know. And so my point is, if you think you know keigo, you really don't know keigo until you go, do you see a therapist and have somebody that can actually give you feedback on whether you're actually contracting or relaxing the muscle appropriately and coordinating that with your breathing? You may know of it. Maybe you need one or two sessions. But definitely take the time out to see someone that does this for a living and that knows exactly what that is. So continue with describing your assessment. I just want to input in there my experience and how I feel that going to see the public thought therapist can be very beneficial.

So to continue on. Yeah. Once I have all of that information, I will then kind of summarize to the patient, like, what is going on. A lot of people who walk into my office, they're intimidated. They've been dealing with these issues for a while and haven't gotten an answer yet. And so just by educating them on, like, what their body's doing, and why is a big relief for a lot of people. Just to understand what's going on, we may also at that time, discuss some modifications to, for example, like hydration levels or bowel habit modifications that could make an impact as well. That group of pelvic floor muscles, it helps with urinary function, bowel function, and sexual function. And we can't isolate between any of those systems. So to know some information about how your urinary system or bowel system is working helps us improve your sexual function as well.

No, that makes sense because they're all kind of conglomerate that they're together with the bladder, the sexual organs, and then the bowel function. They're all in the proximity of each other. That makes sense. And all the nerves are all wrapped up and all the nerve actually come from the same plexus. It's not going up and branches up well with the lumbar plexus as well. So that really makes sense. So would it suffice to say that if somebody has bowel problem, they have sexual problem and vice versa?

We typically see it that way. They may not come in thinking that they have, for instance, a bowel issue, but after talking to them for a little bit, I'll often discover, oh, yeah, you have been chronically constipated for the last how many years? Or something like that. It usually is a package deal.

So having said that, what do you feel? Let's say you do your first assessment. What do you feel will be a quick win for somebody to do what they have a session, what they can do? Okay, this is something I need to do right now. The quick win for homework.

The number one thing I teach all of my patients is how to diaphragmatic breathe. And the reason being your diaphragm muscle, which is your main breathing muscle in your rib cage and your pelvic floor work synergistically together. So if you can move your diaphragm well by breathing well, you're going to be able to move your pelvic floor well. And so I'll teach them. Okay, let's breathe down into our lower rib cage. Can we feel our lower rib cage expand as you inhale? And then furthermore, as you inhale, can you feel your pelvic floor open or lengthen like you're trying to lengthen your penis? And once they have that, then we'll reverse it. Okay, can you, on your exhale, can you contract your muscles? Can you pull them up and in? And we'll work on that synergy, because once we Restore that synergy. A lot of symptoms start to improve pretty quickly.

Interesting. You know, as you were talking, I was thinking, oh, my God, what's happened to your breathing pattern? When you're stressed, you breathe more shallow. You breathe more. More shallow breathing. You're not taking in the oxygen as much. The sympathetic nervous system start kicking in, and norepinephrine start releasing, and you're not activating your parasympathetic nervous system. So the breathing, it's so important because that breathing pattern will also affect your pelvic muscles. More so than anything is try to be in the parasympathetic or the relaxation, or try to relax as much as you can, because that will slow down your breathing, first of all. Well, like you said, you want to coordinate that breathing with the relaxation of the muscles. So can you explain a little bit about shortening and lengthening the penis with the breathing?

Yeah. So because we don't get visible feedback on how these muscles are moving throughout the day, it can sometimes be really hard to feel, am I contracting? Am I relaxing? What's going on down there? So visuals can be helpful. So if you imagine on your inhale, like you're trying to lengthen your penis or open up your anus, that would be lengthening the muscle versus when we exhale. I like to have people imagine, like, you're about to walk into a cold lake and your scrotum is about to touch the water. You'd pull everything up and in. So that would be a contraction or a shortening of the muscle.

Oh, wonderful. I love that explanation. So when somebody's listening to that, they can actually kind of do that themselves. So is the ratio of inhale and.

Exhale one to one for something like this? Just focus on getting the synergy correct. It's hard to focus on counting and all of the other things at one time. If you can, on your exhale, make it longer, basically like you're blowing out a birthday candle. That can be helpful as well.

Right. That makes sense. You want to coordinate that. So let's just do like a little mini session with me on walking me and that I'm your patient and that I have ED and I have tight pelvic muscles, and you're walking me through this exercise and something that I can do at home.

Sure. So I would suggest trying this lying on your back first where you're most comfortable. But if you don't have a place to lie down, you can definitely do it sitting. That's totally fine. And I want you to rest your Hands on your lower rib cage. Okay, go ahead and take a nice deep breath in and see if you can feel your lower rib cage expand into your hands. Now, for some people, they may notice more rise in the chest versus lower rib cage expansion. And you may just have to practice that first. So once you can feel that lower rib cage expand on your inhale, then we're going to start thinking about the pelvic floor. Whatever imagery you want to use, whether it's the anus opening or the penis lengthening, you're going to take a nice deep breath in, feel your lungs and your rib cage expand, expand. Feel your pelvic floor lengthen. As you exhale, think about closing and lifting the penis up and in, and rib cage will fall back to center. We try it again. Take a deep breath in and imagine that air pushing all the way down into the pelvic floor, opening and lengthening. And as you exhale, close and lift. And you're going to continue to practice that for about two minutes. It may take a little bit to get the hang of it.

And during this session, are you feeling the muscles and giving your patient feedback?

I can. Feedback is super, super helpful for a lot of people, even if it's just resting a hand down there so they can feel that movement. But I always encourage people in the comfort of their own home to rest their own hand down there as well so they can feel the movement or use a mirror. It's not a large movement, but you should see a little bit of a lift and a little bit of a lengthen as you perform the exercise.

Absolutely. When I assess my patient for ed, I actually do assess the pelvic floor muscles as well. It's like a hammock. You're right. You see in and out, in and out, like that. The recommendation of the mirror is excellent because you will see the muscle kind of contract, relax, contract, relax. So you would do that with the patient for two minutes, and then what's next after that?

Then we're going to try it in a different position. So if you were laying on your back, I'm going to ask you to sit up because it's going to feel different. Because now once you've sat up, there's the gravity pushing down, there's the pressure of your organs pushing and laying on those tissues. So it may feel a little bit different. Some people prefer to do it sitting because they get the feedback from the chair that they're sitting on, so they know if they're doing it correctly or not. But you want to practice this in different positions. And then you can practice it multiple times a day. Like you said, it really helps to relax the nervous system. So if you are waiting in your car for an appointment, take a few rounds of breath, or if you can't fall asleep at night, practice this. It's going to help pump fresh blood and oxygen to those tissues. They're healthier, but it's also going to relax your nervous system and make you feel a little bit more comfortable as well.

That makes sense because when you're inhaling, exhale, and you're focusing on something else, you're distracting your mind from all the stressful things that is on your mind. And you're activating your parasympathetic nervous system, which is your feed and breed. And the parasympathetic nervous system, guys and women, are the system you want to be in if you want to improve your sexual performance or even to be productive. To be productive, you need to activate, be in more the parasympathetic nervous system. The only time you should be in the sympathetic nervous system, if there's a stressful event, that should be temporary. So that will be the session there. So you would change position from lying down to sitting and then maybe standing. Just different gravity input on the muscles.

What I would progress into is, at least in this first session, giving them a program they can use at home to get started on. So, for example, if their main goal is to have sexual intercourse without any issues, we're going to use that breathing technique as, like a preparation for those tissues before sexual activity. You wouldn't just go run a marathon without warming up your muscles. So you wouldn't just jump into a sexual encounter without preparing these tissues. So doing the breathing, but then warming up some of the muscles that attach into the pelvic floor, Your inside thigh muscles actually wrap right up in there. And so I may teach this patient, if they need it, a few stretches or mobilizations for that area. If anyone's familiar with yoga, I'll often give people, like a happy baby stretch that really wakes up the pelvic floor and again increases blood flow and oxygen.

What's a happy baby stretch?

If you're laying on your back and you pull your knees all the way up to your chest and you grab onto your feet. Have you ever seen a happy baby? They do it all the time. They pull their feet right up over their head, but that really helps. Open up the hips, open up the pelvic floor, and then while you're holding that stretch, go ahead and Work on your breathing because that's going to make those muscles nice and mobile so that they're ready for activity.

Right. So when you're doing the breathing, you have to actively consciously relax and contract the pelvic muscle too. It's not just your breathing alone.

Right. And it'll become more natural the more you practice it. But that's why I tell you, practice it in all different positions. Practice it at different times a day so that it just kind of becomes a motor pattern and you won't have to always think about it consciously all the time.

Absolutely. So I love what you said. So maybe for a guy that had ED before sexual intercourse, try to get into the happy baby position, which is lying down. Pull your knee up to your chest and then hold on your hand to your foot. And while you're doing that, do like 10 deep breaths with the relaxation and contraction, the pelvic muscles. What do you think? Almost like a pre trained before the actual activity itself. Is there anything else they could do?

So the adductor stretch, it's basically like a side lunge. I'll show you. And just straightening your leg out to the side to get the inside thigh. That can be super helpful as well. And get your partner to join you because I guarantee you they'll benefit from it as well.

Great. So the side stretch, the happy baby stretch, and the breathing as well with the side stretch. Okay. I love this. This is great. I was like pre sex exercise.

Yeah. Basically the rest just kind of depend on the person. And that's where you're going to benefit from a specialist evaluating you. They're going to look at all of these different components and see which areas really do need more emphasis or treatment.

Absolutely. I like that very much. But at least now, from listening to this episode, they know of at least two things they can do. And I like the way what you said, every time you have sex, it's almost like kind of loon a little bit running. You want to do some stretching. Especially if you have ed, there's a reason why you have ed and these are the exercises that can really help you get out of ed. And as you know, a listener know that I'm anti ED medication because I feel that they need to look at the root cause of why they have ED in the first place. So along with that question, do you feel that the guys that you work with, with ed, the ones that are on that need to take Viagra and then the one that doesn't need to take Viagra, Is there any difference in Their pelvic floor presentation, not structurally, but.

When I talk to the patient, most of them are like, if I take the pill, like, I don't notice any different. Or it kind of helped, it kind of didn't. With these techniques, they usually, like, notice a difference within a few weeks and it sticks.

What you're trying to say is that with the technique, with the guys that take the pill and they benefit more or the one that doesn't take the ED pill, they benefit more.

What I'm saying is with these exercises, once they start to notice a positive change, those changes tend to stick around. Like, they don't feel the need to use additional medications to help them.

Okay. The bottom line is if you do these pelvic floor exercises, you don't need that ED medication. Boom. That's the bottom line. Did you guys hear that? Okay. Because I feel that the ED medication become almost like a crutch. And once they take it, they always feel they need to take it or else they won't get to the performance that they want to be. It really undermine their emotional and their confidence as well and actually probably contribute to more ED because they create more stress, and then that stress will tighten up that pelvic floor muscle. So on that note, I want to lead our listeners to find a resource to find the right physical therapist that can do this. And not all physical therapists can do pelvic floor therapy. I know I used to own a physical therapy facility, and this is a very specialized training along. After they finish their doctorate of physical therapy, they do specialized training, but it's not in your core training. Right. You have to seek certification after you finish your dpt. Is that correct?

That's correct, yeah. To become a pelvic floor specialist, it's all continuing education past graduate school. And typically it requires you to get 2000 or plus hours of experience before you sit for your specialty examination.

So there is a certification called the Herman Wallace certification. I'm big on finding people that have the skills that can help you for what you need and have treated patients. So if you're interested in finding certified pelvic floor floor therapist, go to Herman Wallace.com Herman H E R M A N W-A-L-L-A C E.com and then you go to the tab that says find a practitioner. Click on that and then put in your zip code. Once you put in your zip code, the list of therapists will show up and look for therapists with the word prpc.

Pelvic Rehabilitation Practitioner Certification.

Right.

It's a mouthful, I know.

No, it's kind of a mouthful. Prpc. But the bottom line, I want you to go to hermanwallet.com to look for the practitioner therapist that is certified to do this because it's not something that you can just pick up reading a book and not something that you can just take a weekend course, 2000 hours, a lot of hours. And then you got to pass a minimum standard test. I encourage you, if you have ed, is to seek out a pelvic floor therapist. It certainly can benefit you. Don't think that you think you know how to do Kegel. Believe me, it's more complex than you think. You're talking about 21 muscle down there that need to coordinate with your breathing and you really need to get feedback on whether you're doing it correctly or not because it not only will help you with your sexual activity, it also help with bowel, also help with bladder issues as well as well as probably helping resolve some issues with pain in the low back pelvic region. And we didn't really touch upon this, but pelvic floor therapists can help you for women with pain in that pelvic floor area, which I know is more not too uncommon and can be treated without taking pain medication because I've seen several of my patients that come to see me and they're on big pain medication for dyspareuronuria or pain in the pelvic floor area. So having said that, I just really enjoy our session today. Do you have any last minute advice for our listeners? And then please tell how our listener can find you.

My advice would be is if even thought about seeking help for pelvic floor issues. Go do it. There's no reason to be scared. We are here to help you and nothing's off the table. We'll talk about anything you need to talk about. You can find me@nomadicpt.net that's my husband and I's physical therapy company. You can also find me on Instagram pelvicptmariahel. I post a lot of videos answering client questions, but then just information that is more general in nature that I feel like everyone should really know about their pelvic floor health.

Absolutely. And thank you for being here. And one good thing about this is pelvic floor therapy is covered by insurance. Is that right? I know that you guys do concierge or you don't take insurance, but those that do have insurance, they do cover that.

Yes, some places will accept insurance.

Some place will accept insurance for that. And I don't accept insurance either, but it's something to consider if you want to explore that first. So having said that, thank you for being here, Maria, and thank you and we will see you the next episode.

Thanks for having me.

Are you struggling and frustrating finding a solution for ed? Well, I have just the thing for you. It's called the Modern Man Club led by yours truly Dr. Ann. Together we're redefining male sexuality and embracing a holistic approach to overcoming ED without medication or surgery. I will provide a protective environment for community and proven strategy to overcoming ed. It is a safe place. Expert coaching by me and my team. We provide holistic approach to overcoming ED and an empowering community of men with ED supporting one another and lots and lots of educational resources. Visit mensexualityclub.com at the link here on my right and connect with us and reclaim control over your sexual health. I'll see you there.

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