By writing in Pakistan Journal of Rehabilitation, I would like to draw attention of the readers toward the ignorance on the need of physical therapy in pelvic floor rehabilitation among males. Urinary incontinence is prevalent by 1.8-30.5% in Europe, 1.7-36.4% in USA and is 1.5-15.2% in Asian population due to pelvic floor muscle dysfunction1. By recent studies, it has been observed that urinary incontinence in males has less emphasis when compared with females2. Urinary incontinence among males is possibly an outcome of prostatitis, trauma, chronic infection, obesity3, heavy lifting, benign prostate hyperplasia, prostatectomy4, and many other age-related diseases. Globally, pelvic pain and dysfunction influence millions of males worldwide and till date little evidence is present regarding pelvic floor rehabilitation among males. A major concern is the lack of awareness in male patients regarding pelvic floor dysfunction. Moreover, other issues include unfamiliarity with physical therapy, hesitation to discuss genital issues, referral issues by physicians and less number of available pelvic floor physiotherapist. Pelvic floor rehabilitation utilizes the concept of physical therapy to contribute in an organized program for strengthening pelvic floor muscles. According to study conducted by Terzoni S et al 2015, the first line intervention to decrease involuntary urine leakage is pelvic floor rehabilitation5. Another study was conducted in United States in 2016, revealed that the current approaches in the management of pelvic floor dysfunction among males includes the major role of physiotherapist by means of pelvic floor muscle strengthening, use of different electrical modalities6, biofeedback, bladder training and urgency suppression techniques4. In 2016, Eaton K in his systemic review provides the evidence about physical therapy intervention before and after prostatectomy have significant role in pain management and in improving muscular strength7.
Awareness regarding the importance of pelvic floor rehabilitation among males needs to be intensified by all the health care professionals. I would like to recommend the readers of the letter to spread awareness and work in collaboration with other concerned health care professionals to promote more efficacious treatment and improve quality of life of the patients.
Sadia Shafaq
House Officer
Dr. Ziauddin Hospital (Clifton)
REFERENCES
[1] Milsom I, Coyne KS, Nicholson S, Kvasz M, Chen CI, Wein AJ. Global prevalence and economic burden of urgency urinary incontinence: a systematic review. Eur Urol. 2014;65(1):79–95
[2] Tikkinen KA, Agarwal A, Griebling TL. Epidemiology of male urinary incontinence. Curr Opin Uro. 2013;23(6):502-508
[3] Masterson TA, Masterson JM, Azzinaro J, Manderson L, Swain S, Ramasamy R. Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study. Transl Androl Urol. 2017;6(5):910-915
[4] Stallings RA, Diane BF. Treatment of male urinary incontinence post–radical prostatectomy using physical therapy interventions. J Women’s Health PT. 2016;40(3):129-138
[5] Terzoni S, Montanari E, Mora C, Ricci C, Destrebecq A. Developing a rehabilitation program for male urinary incontinence: detailed schemes and results on 122 patients. Int J Urol Nurs. 2015;9(3):149–155
[6] Ohtake PJ, Borello-France D. Rehabilitation for women and men with pelvic-floor dysfunction. Phys Ther. 2017;97(4):390-392
[7] Eaton K. Benefits of Pelvic Floor Rehabilitation for Urinary Incontinence after Prostatectomy: A Review of the Literature. MOJ Yoga Physical Ther. 2016;1(1)