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The Wellness Hood Podcast: Men's Health Physiotherapy

Hi there, my name is Danielle Barratt, and I am the founder of PhysioMatters Singapore. We were established in 1997, and back then the first Women’s and Men’s health physiotherapy clinic in Singapore.

I first began my journey in this area back in Perth Western Australia some 30 years ago! OMG I am getting old! Even prior to becoming a Physiotherapist, I always want to work in healthcare for both women and men’s health. Be it in a physical hands-on capacity or in an educational or counselling area. I had the privilege of working as a work experience student with 2 established women’s and men’s health care clinics in Perth, as an undergraduate and fell in love with the area.

Prior to physiotherapy I graduated with a BA in Business and Administration and then worked for 3 years in the corporate sector in management and public relations. I soon decided this area wasn’t for me! I wanted more job satisfaction and I wanted to work in health, making positive changes to people’s lives.

Now years later, I am so glad I did my business degree and approached physiotherapy after this, as both the combination has really given me a solid education base to work in private practise. Of course, marketing and today’s world of IT and technology is growing at a rapid pace, and we need to keep up but the fundamentals of owning and running your own clinic, people management and marketing hasn’t change too much.

After a few years and feeling more confident in multiple areas of physiotherapy (primarily women’s and men’s health, cardiology, musculoskeletal, chronic pain management, and Neurology) I decided to embark on my world travels –and off I went and worked in Canada, UK and the eventually back in Singapore.

Where I married my husband and began the journey of starting our family.

After years of assisted fertility (IVF, IUI) exploring surrogacy and more - we were blessed to adopt our son and within weeks I was pregnant with our daughter. Wow what a journey! I learnt so much along the way emotionally, spiritually, and physically as a clinician. There is no doubt this journey has paved the way forward for me working in women’s and men’s health. I was able to undergo the changes with hormones and aging and still do as well and understand my husband’s journey with this too. And men do have a journey just like us women.

So, let’s talk about all things Men’s health --

Discuss the range of conditions you and your team specialisations in at Physio Matters, emphasising the diversity of issues related to men's health.

Men go through hormonal changes, often related to changes in testosterone.

These changes may trigger health concerns related to:

Prostate changes (this is the gland that is about the size of a ping pong ball and is located just below the bladder and in front of the rectum) – important in reproduction as it supplies part of the seminal fluid (semen) which mixes with sperm from the testes.

Bladder and bowel changes (leakage, frequency of urination)

Erectile dysfunction (premature ejaculation and or inability to obtain or sustain an erection)

Pelvic pain related syndromes, and more.

Many of these conditions mentioned relate or encompass Pelvic floor muscles and how they function or more importantly malfunction!

Some common techniques and approaches we use to treat male pelvic floor dysfunction / issues are:

i. Pelvic floor muscle exercises (Kegel exercises): These exercises involve contracting and relaxing the muscles of the pelvic floor to improve strength, endurance, and coordination. As physiotherapist we educate on how to do Kegel exercises correctly and develop an individualized exercise program based on the specific needs of the individual. A program may involve strengthen the pelvic floor muscles, and or relaxation of the pelvic floor muscles if they have high tension (high tone) and more.

ii. Biofeedback: Biofeedback techniques can help males gain awareness and control of their pelvic floor muscles by providing real-time feedback on muscle activity. This can be done using specialized equipment or devices that monitor muscle contractions and relaxation.

At PhysioMatters we use the gold star equipment such as Real Time Ultrasound Imagery (RTUI) which can assess and provide feedback in real live time of how your muscles work. RTUI is a great way to view your body for the inside out and is pain free (note - Males Pain free!!) a great non-invasive educational and feedback tool - as its used via the skin in the abdominal, pelvic, and perineal areas (between the anus and testes for males).

iii. Electrical stimulation: Electrical stimulation, also known as neuromuscular electrical stimulation (NMES) or transcutaneous electrical nerve stimulation (TENS), involves the use of electrical currents to stimulate the pelvic floor muscles. This can help strengthen weak muscles and improve muscle coordination. And is pain free too. In fact, used to relieve pain.

iv. Manual therapy: Hands-on techniques such as soft tissue massage, myofascial release, and joint mobilizations may be used to address muscle tightness, trigger points, and restrictions in the pelvic and anal region. Most men with pelvic floor tension find releasing the pelvic floor muscles brings such relief of pain that they have had for years!

v. Shock Wave Therapy – more recently been shown to be effective in reducing high tone / tension in the Pelvic floor and pelvis for males and as a result reducing prostate associated pain. The shockwave is applied between the scrotum and anus area and with micro impulses of varying intensity breaks down adhesions, as well as creates a natural inflammatory reaction form which your body recognises and repairs. All male clients I have treated have found shockwave therapy very effective in reducing pain and their symptoms.

vi. Bladder retraining: This involves teaching individuals’ techniques to improve bladder control, such as scheduling regular voiding times and gradually increasing the intervals between bathroom visits. Did you know that normal bladder voids (emptying of the bladder is 5-7 times a day approximately 3-4 hours. Bowel voids 1 x a day up to 3 x a day is within normal range. Most people don’t think of how often they use their bladder or bowel until they can’t stop either or can’t go! Thats, where we step in as physios and establish a normal range and techniques to achieve this for our clients.

vii. Functional exercises: Physiotherapists may incorporate functional exercises into the treatment plan to improve pelvic floor muscle function during activities of daily living, such as lifting, bending, and carrying.

A client maybe an athlete with a specific sport and passion for a certain sport. We can outline a return to sports program that’s pain free, leakage free and achievable for every male client. In doing so this reduces depression, anxiety and gives a person as sense of self-worth and achievement of normalcy again. NO person male or female wants to wear a pad in their daily lives let alone sports and they should have too. And if this is the option let us point you in the direction of wearable fashionable absorbent pads – not Old Age Nappies!

viii. Behavioural strategies: Involve education and guidance on lifestyle modifications, bladder and bowel training techniques, and dietary changes to manage urinary and faecal incontinence and pain. Physiotherapists can provide information on factors that may contribute to pelvic floor dysfunction, such as poor posture, constipation, obesity, and chronic coughing. They may also offer advice on how to modify these factors to improve pelvic floor health.

Overall, pelvic floor physiotherapy for males aims to address the underlying causes of pelvic floor dysfunction and incontinence while empowering individuals to actively participate in their own care.

Treatment plans are tailored to everyone’s needs and may involve a combination of techniques to achieve optimal outcomes. It's important for individuals experiencing pelvic floor issues to seek assessment and treatment from a qualified physiotherapist with expertise in this area.

Explore you and your team's qualifications and expertise in Men's Health Physiotherapy.

To become a physiotherapist, you must undertake studies in a course usually of 3-4 years of duration and then be recognised and registered by the Allied Health medial board in the country you are working. In Singapore there are very strict guidelines for qualification and registration and many universities and countries qualifications are not recognised here. As a result, the Women’s and men’s health qualified and registered physiotherapist in this area is small. Of this group of clinicians in Singapore - there are only 2 of us that treat men’s health.

I have undergone post graduate training and have over 28 years’ experience in this area. I think age alone qualifies me as the most senior clinician in Singapore practising Men’s health physiotherapy ☹.

Our team at PhysioMatters consists of both locally and overseas trained clinicians and all have post graduate training and are developing skills in this area under my mentorship.

More are welcome if you’re listening out there.

It’s such a growing fabulous area to work in. More and more men of all different generations are more vocal, open to discussing any concerns and seeking treatment. Being proactive rather than waiting for their conditions to worsen.

With the openness of gender diversity nowadays clients are seeking physiotherapy, as they transition through body change, hormonal changes. It is exciting times as a clinicians learn and grow with society changes.

You don’t need a referral to seek physiotherapy treatment here in Singapore, however if you would like to claim on your insurance policy, some insurance providers do require a GP referral to physiotherapy. If you’re not intending to claim then please call our clinic, email or sms us and we will follow up with you, and if you would like to chat to myself or a to a member before coming your most welcome too as well.

Let’s investigate the specifics of male clients seeking Men's Health Physiotherapy, considering factors such as age, cultural differences, and common conditions.

We have male clients ranging in age from 8 years old upwards. The oldest male client I have treated was 95 years old and was not going to succumb to wearing a nappy / diaper in his old age! Good for him!

Often parents will contact us to book physiotherapy for their child or teenager. Physiotherapy for bed wetting concerns, urinary frequency (going to toilet too often) nocturia (waking at night to wee), constipation and pelvic pains.

Males in the age bracket of 21-55 years may experience the above as well but often they’re seeking treatment for erectile dysfunction such as premature ejaculation, inability to sustain an erection which may be related to pelvic floor pain or dysfunction related to bladder or bowels. Or simply unresolved pelvic pain.

We do see clients who have had a spinal injury - be it prolapsed disc in their spine or had an impact head or spinal injury and now experience bladder or bowel pain or leakage or changes to frequency.

I recently have treated a male client who was swimming and hit his head on a unknow object ion the water. As a result, he had temporary spinal shock which affected his bladder and bowel function. After 3 months of x 2 a week physiotherapy and a daily home program his bladder and bowel functioning as almost normalised allowing him to returned to full time work. And is incredibly grateful to physiotherapy.

More often our male clients aged 55 and over may have undergone surgery, chemotherapy or radiation that has cause bladder, bowel, or erectile changes. Pelvic pain may also be high on their list of concerns too. In some case changes their prostate, maybe the main driving factor causing some of these body changes however most cases there is multifactorial causes that we as clinicians need to address.

Explore common misconceptions or myths surrounding men's health issues that you frequently encounter in your practice.

Traditionally women by nature always have been more open to seeking treatment for any gynaecological or women’s related condition. Women, I feel are often more proactive in seeking help for any health concerns, Men in the past (relating to my husband) have never been proactive but rather reactive, once they have a serious diagnosis. When body functions stop working and often when it’s a medical management issues with several specialist doctors involved.

Thank goodness men are now taking more care of their own health. They are talking about their health concerns to friends, partners, accessing the internet to seek therapy options. Doctors are now referring males in for physiotherapy treatment too – as I feel a few years ago in Singapore Doctors didn’t know of the benefits of Physiotherapy for men’s Health.

I think Covid was a huge changing point for Men’s Health Issues. We saw more mental health support for males available, more males were and still are seeking support (counselling, seeing their GP) and companies have invested in health support programs for their staff. As a result, health concerns are being picked up (I hope sooner rather than later) and men are receiving treatment.

The internet has obviously made access to resources, information, anonymous chat groups easily available. And word spreads. I am so happy males of all cultural backgrounds are seeking Physiotherapy for their conditions now.

I regularly treat more Asian males now between 45-75 years of age for bladder, bowel and pain conditions related to prostate conditions and other pelvic pain syndromes.

Prior to Covid I would say I saw more Western Males – perhaps culturally seeking physiotherapy for this area was more known in their home countries and acceptable. I am so pleased doctors are more supportive, referring clients sooner and more me are big proactive discussing Physiotherapy’s options with their medical teams and then coming in sooner. There certainty appears more of an Allied Health Medical team approach now for men’s health.

The biggest Myth and fear Males have seeking Physiotherapy is - I would like all males to hear and their partners if your listening on their behalf is - that Physiotherapy does NOT need to involve further anal investigation or treatments involving anal probes or anal pain management. We have so many other modalities available to us such as - Real Time Ultrasound Imagery, Shockwave, Electrical biofeedback feedback tools, electrical stimulation and more that do not involve even exposing your genital area!

Often males by the time they see physiotherapy are exhausted, possibly traumatised by medical procedures and do not want another therapist anywhere near their genital, area. I don’t blame them!!

I recall when I gave birth to my daughter years ago, having undertaken IVF and other gynaecological or medical interventions, having seen so many doctors over the years and I know I just did not want another health professional to probe or treat me anywhere near my female areas!

Future treatment may involve the pelvic or genital area and maybe jointly be discussed and considered later in the physiotherapy treatment plan however we don’t need to expose your genital area at all.

Finally, I would like to say that males, more so than females from my personal experience with my husband and or clients are terrified of PAIN or any further pain caused by physiotherapy.

Most physiotherapy treatments and modalities relieve pain and are aimed at resolving your pain – that don’t hurt! You’re already suffering with physical and or emotional pain - so let physiotherapy and your team relieve this!

Discuss what an initial consultation involves for a male seeking physiotherapy in the areas mentioned or maybe specify some examples as you cover many areas.

So, we have already established that a physiotherapy consultation can be initiated by you or may require for insurance purposes only a referral for your GP.

The consultation typically involves a 10 -15-minute chat to establish a detailed subjective history, outlining your reasons for seeking treatment, and identifying any goals for the sessions. This time also allows for an opportunity to discuss any past or impending surgeries or any other health concerns.

Your physiotherapist will then follow on with a comprehensive physical objective assessment and treatment.

If you are seeking advice and treatment for bladder, bowel, pelvic girdle pain and or any other pelvic floor muscle dysfunction, your physiotherapist will conduct a routine pelvic floor muscle assessment. This will typically involve a model of the pelvis and the use of Real-Time Ultrasound Imagery (RTUS) to show you, your pelvic floor muscle function on screen and provide objective measures from which to base further assessment and treatments.

Subject to your objective findings and diagnosis, an internal assessment may be suggested. Internal assessments may involve an anal assessment. Any internal assessment will only ever be conducted with your full understanding of the procedure and with your verbal and written consent.

Sessions routinely are 45 minutes in duration unless an extended consultation is requested (when multiple treatment areas are involved) and are weekly and or longer apart, depending on your treatment needs. Alternatively, in ACUTE pain situations, 1-5 x sessions may be needed a week until your pain settles. Yes, in some more chronic presentations more sessions maybe required.

You are treated as an individual, with your own progressive treatment plan. All information is confidential, unless shared with your permission. As often a team approach with other allied health professionals, maybe the best approach for you.

Initially males more often than female clients feel a little self-conscious but as you build a rapport and trust with your physio this soon fades away. Most men are so relieved to be heard and given hope that successful treatment is possible.

Your most welcome to bring your partner / spouse to the sessions should you feel more comfortable. Often males do come to the first sessions with their partner or spouse as both parties would like to know more about their condition and the best way forward. Then after a few sessions perhaps both feel more confident and comfortable with the therapist, so the male client comes in alone. All are welcome to support your best treatment.

Sometimes having a partner at the session you then have the opportunity to hear more about the clients condition and how they are doing, not doing in other aspects of their life – as often males are a little less open to sharing their personal life or areas they are struggling with due to their pain - be it in their relationship (sexually) or with a sport or working / daily life so I welcome partners to join the session if they would like too, as the more information shared the better we as physios can help our clients.

Discuss the psychosocial aspects of men's health, addressing how these conditions may impact a person's mental and emotional wellbeing. Discuss strategies for holistic care.

Naturally any medical condition affecting our daily bodily functions affects our lives both physically, mentally, emotionally, and therefore socially.

I am going to generalise here, but I find more often males may isolate themselves from social events, sports and with draw from their partners both emotionally and physically, as they feel unable to cope with their pain, and or they are embarrassed about their condition and overwhelmed.

Most of us take our bodily functions for granted and push ourselves until we can’t anymore. Often as physios we will see clients who have had their pain or condition for years. It’s now chronic. They have seen many doctors and have no idea physiotherapy was or is an option for them. It’s not uncommon for some of my male clients to have a few tears, simply as they are relieved that’s their options for pain management for them. Especially when no medial drug options have worked.

Chronic pain or any chronic medical condition male or female can make us feel isolated, alone, depressed (some time we don’t even know that we are depressed), anxious and more emotions that we have ever experienced. Traditionally I feel males often don’t recognise or acknowledge these emotions as quickly as women. as men are often so stoic and have a social persona to maintain.

Often just attending physiotherapy and knowing that over 1/5 males will have issues with their pelvic floor muscles that may affect their bladder bowel or pelvis in some way - is comfort enough to know they are not alone!

There is help here for you.

I see my role as a physiotherapist to treat my clients’ symptoms but also a sense of responsibility to provide them with an all-round holistic approach to their treatment. I will always cross-refer to doctors specialising in sexual dysfunction, bladder or bowel specialist, counsellors, perhaps even nontraditional medical models may work for some clients such Ayuvedic medicine or acupuncture. It’s a team approach to wellness for us all ad not one approach fits all.

A good physiotherapist is open minded and looks at a client as a whole person and needs to address this a, acknowledge we all have skills in different areas, put our egos aside, and aim for the best treatment approach and plan for the client.

Share anonymised case studies or real-life examples of male clients you have treated, highlighting the challenges and successful outcomes.

I have treated young children from ages of 8-15 years who have bed wetting issues, and or severe constipation and need help resolve these issues. Often anxiety is high with the child / teen and naturally with their concerned parents. These and other emotions in turn may affect the bladder or bowel further so we need to look at the causes of anxiety, stress, the times, or occasions that these conditions occur and why.

I recall one young child (boy) 9 years who had a locum fill in teacher at school for a week while his regular teacher was away on leave - this teacher would not allow the kids to use the bathroom outside of break and lunch times. So, despite this child bursting to go to the toilet for a wee, he wasn’t allowed to go. One day this young boy couldn’t hold and wet his pants in school. The kids laughed and this was the start of several bladder changes for him.

We worked on the emotional side this issue created with a very good child counsellor; art therapy was a great resource for this child to express his emotions. As a physiotherapist I provided pictures of the body parts (child appropriate) and education, using real time imagery which the child found fascinating to see his body parts working, lots of tips and tricks to hold his bladder and when not too.

Naturally the school was involved and provided education on the damaging effects of such behaviour on children’s blader ad bowel health. I do acknowledge some kids try to pay the system to get out of schoolwork (I have 2 children of my own and have seen the games children can play at school too) however a teacher needs to be able recognise the simple and clear signs of when a child is struggling to hold their bladder and needs to wee.

There are clear body positions and body language signs that we ca use and to recognised positions and supports we do without realising such as crossing or legs in sitting or standing, putting pressure on the perineal area, leaning forwards and or perhaps a sway action. Childhood reflexes we use even as adults and don’t realise. The teacher and school were very supportive and changed their ways.

This occurs more often than we realise – how a simple action of an authority figure can have a detrimental adverse effect of a child’s emotional and physical bodily behaviours.

I have treated many males in managerial and high-level executive roles with bladder, bowel and or pelvic pain conditions. Post surgery and or chemotherapy / radiation of the prostate cancer or blockage. A gentleman I recall had all the above and most of all was struggling to ride his bike as he was a cyclist. Cycling was his passion, and this was the only way he felt her could manage his stress and function.

We resolved his bladder, bowel, and prostate related concerns and the last to resolve was his pelvic pain every time he rode his bike. Supportive padded underwear for cyclist, changing his position and ergonomics while riding, changed the bike seat to wider and better fitting for his pelvis, by watching his body pattern of movement on a stationary bike, I would adjust the pressure that he was putting through his pelvis and bike seat and more. All be it took us 6 months of physiotherapy, but he is pain free, and cycling daily 60-100km. A very happy man.

By resolving our clients pain activities we take for granted such as eating out at a restaurant, sitting for extended periods of time at a movie, eating certain foods we all love and enjoy (chilli, spicey foods often that cause pain or bladder or bowel issues for some clients), riding a bike, horse riding, and return to full time work, are able to travel again. Brings back quality and function back into our client’s lives! Seeing these results brings immense joy and rewards for me as a men’s health physiotherapy. I do love my job! I would do this job some 30 years if I didn’t!

Discuss the importance of home exercises and selfcare routines for male clients dealing with pelvic health issues. Provide practical tips and exercises they can incorporate into their daily lives.

Pelvic pain presents in so any ways but primary we would often regard the pelvic floor muscles to be part of the cause of pain. Often its due to increased tension and or a weak high tone/ tension pelvic floor muscle.

So, to reduce the risk of pelvic floor related pain or dysfunction, firstly, I would suggest a home stretching program. This may involve stretches you can find on the internet or naturally your physiotherapist will provide such as:

Happy Baby

• Figure of 4 stretch

• Cat and Cow stretch

• Knee rolls and knee hugs

• Hamstring or gluteal stretches as these muscles may jointly be affecting a client.

I find by nature man don’t often stretch and are sitting at work or behind the computer for hours at a time or day, so just stretching daily or a minimum of 4 x a week can make a difference. Stretches should be held 30- 45 seconds and repeated at least 3 to 4 x times. No pain just a lengthening feel for the muscles should be experienced.

Good fluid intake is important for good bladder and bowel function, as well as cellular health – we suggest 2-3 litres of water a day avoiding large amounts of caffeine (tea coffee milo) and alcohol as these stimulants that affect the bladder health and function. Sodas such as coke or even mineral may irritate the bladder or bowel for many of us too.

The bowel responds to 5 key factors: fluid, foods, exercise, emotions (stress) and time zones!

Bowels needs water plus fibre and regular exercise to initiate bowel stimulate bowel action so please exercise daily 30-60 minutes if you can, it doesn’t need to be high impact a walk or swim is great. Simply walking up the stairs a work rather than taking the lift or walking a little further for a bus or MRT stop before and after work is still good exercise. A skipping rope at home and skipping for 15 minutes is a great cardiovascular exercise if your can skip. Y point is you don’t have to go to the gym for exercise and most of us don’t have the time.

Eat a balanced diet of fruit vegetables and reduce stress where possible. Easier said than done for most of us.

Don’t ignore that time when your bowel says ‘hey it’s time to go’ it possibly won’t occur again until the next day. Travelling long distances and variations to time zones does affect most bowel functions so try to stick to your bowel’s routine where possible. But if we maintain a balance diet, good liquid intake and exercise our bodies appreciate this and hopefully we stay healthier for far longer!

I often connect my clients to a nutritionist or fitness trainer that can go to their home or workplace making life a little less stressful I our time short busy days.

Share any final thoughts or messages regarding men's health physiotherapy.

Finally, I would say to all men please listen to your body if your bodily functions are changing or simply don’t feel the same your right!

Seek medical advice – Doctor Google is not the answer to self-diagnose. The longer you wait to seeking treatment, often the more serious your presentation, symptoms and longer it may take to resolve your symptoms.

Seek help and advice sooner rather than later you’re never going to regret taking action towards better health but most often -

I often hear from my clients – which is so great -

“I wish I had meet you sooner Danielle and found out there was physiotherapy treatment available to me!”


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