A doctor and patient converse across from each other.

How to Ask Your Doctor About Pelvic Floor Physical Therapy

Many pelvic floor physical therapists are women, and our initial basic training is almost exclusively geared toward women’s bodies. Some female physical therapists prefer not to treat men. This isn’t because they believe men are lecherous or they fear being hit upon. It is because treating men for pelvic problems (cancer or not) requires a lot of talk about quality of erections, sexual ability, and a man’s emotional response to his relationship when it comes to sex. These conversations don’t always come readily to us.

Obstacles to getting care

The lack of practitioners who treat men is an obstacle to getting care after prostate cancer treatment. The more remote the area in which you live, the more challenging this may be.

Another limitation to receiving pelvic floor physical therapy is that not all urologists have heard of it or are on board with it. I spend a great deal of time talking to urologists about how effective pelvic floor PT can be for their patients.

With these doctors, it is important that I discuss urinary leakage, quality of erections, and how penetrative sex can continue to be part of a man’s life after prostate cancer. You can imagine how difficult it can be to break down these barriers with doctors who have little time and need to scurry off to their next patient.

How to find a pelvic floor physical therapist

If your doctor hasn’t brought up this topic, you can start a conversation by saying, “I have heard of pelvic floor physical therapy and that it can help with my condition. Would you please write me a prescription so that I can seek out this treatment?”

Most urologists won’t say no to such a direct request from a patient. And if they do, you can always ask your primary care physician to write that same prescription. It doesn’t matter who writes it. All that matters is that you get the care you need.

Finding a pelvic floor physical therapist who treats men in your area may feel like a major roadblock, but it IS possible. There is a website of providers who are trained in this type of PT, and you can enter your ZIP code and see if there are any practitioners near you. This website also clearly states who treats men and who doesn’t.

My experience treating urinary leakage

I distinctly recall meeting the first patient I treated who had survived prostate cancer. He was tall, lanky, very fit, and was using about 4 urinary pads per day to control leakage. He’d had a nerve-sparing radical prostatectomy over 20 years ago. The scar that I saw extended in a straight line from his belly button to right above his pubic bone. This was before the days of robotic surgeries; it was also beforethe medical community knew how much pelvic floor physical therapy could help men following a diagnosis of prostate cancer.

I was quite nervous treating this patient. I had studied and taken many classes on how to treat men with this diagnosis, but it wasn’t until I touched that ropey scar on his abdomen that it really sunk in. Yes, I had entered the world of a type of cancer that impacts male sexuality. While this man reported he had a good libido and an active sex life (he was in his 80s), I also knew how much his urinary leakage was impacting his sense of masculinity.

I found myself getting more and more comfortable during each visit. This patient described when he leaked (while serving a tennis ball), what made him leak more (wine with dinner), and what other exercises he was doing in the gym. We worked together on strategies to lessen his incontinence during his tennis game, and he decided to limit alcohol to only twice weekly and lost weight as a result. This culminated in the need for 1 less pad over the span of a day.

Getting help

I was delighted that he responded so well and that I had been able to feign expertise in a situation where I had so little. Since then, I have treated hundreds of men for this same problem, and guys with this diagnosis are my favorite to treat.

In summary, ask any doctor who you believe would be willing to write you a prescription for pelvic floor physical therapy. Look for someone who treats men near you. If that practitioner is too far away or you cannot seek direct treatment, please comment below, and I will help in any way I can.

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