Prostate Health & The Pelvic Floor

March 17, 2023

One of our earlier posts focused on prostatectomy, and in particular on tips to prepare for the procedure and to recover more quickly and smoothly. However, a lot of readers asked about prostate health more broadly, and where the pelvic floor fits in. So, by popular demand, with today’s post we have zoomed out to cover prostate health and the pelvic floor, with a particular focus on how you can prevent and address various types of prostate problems and their symptoms.

What is the prostate, anyway?

The prostate is a walnut-sized gland in men that is located below the bladder and in front of the rectum, with the urethra passing through it (see diagram below).

The prostate has two main jobs:

1. It is the switch that controls whether the body is ready for urination or ejaculation.
2. It also produces and holds fluids that are part of semen.

What kind of trouble can the prostate cause?

Unfortunately, however, there are a number of ways the prostate can cause trouble – especially as you get older. Three of the most common issues are:

1. Enlargement: the prostate commonly gets bigger as you get older, and there are numerous potential causes. The most typical cause is probably BPH (or benign prostatic hyperplasia), which is prostate enlargement due to cell growth that is not caused by any malignancy. Considering that the urethra passes through the prostate, it makes sense to learn that an enlarged prostate can push on the urethra to constrict or even fully block the flow of urine through it. Common symptoms of an overly enlarged prostate thus include needing to pee a lot (urinary frequency), or delays in getting started when you try to pee (urinary hesitancy). When the urethra becomes totally blocked, it can cause urinary retention, which can cause bladder enlargement and backflow of pee into the kidneys.
2. Inflammation (prostatitis): there are multiple types of prostatitis. Acute prostatitis is typically caused by a bacterial infection (with the bacteria coming from the urinary tract), and is more of a short term condition. Chronic prostatitis can be a recurring incidence of bacterial prostatitis but also can occur without any signs of infection – this presentation is imperfectly understood but may be caused by nerve irritation, stress, or repeated urinary tract infections (UTIs). Symptoms of prostatitis include painful or difficult urination (or inability to urinate altogether), pain in the pelvic region, abdomen or genitals, blood in the urine, or trouble / pain with ejaculation. Chronic prostatitis with no infection can present indistinguishably from chronic pelvic pain syndrome (CPPS), which is sometimes caused by excessive tension in the pelvic floor muscles (you may have seen this called overactive, high tone, or hypertonic).
3. Cancer: prostate cancer is the 2nd most common form of cancer in men (behind skin cancer). It is often very treatable, but can be tricky to catch since men with prostate cancer don’t always have symptoms (especially in the earlier stages of the disease’s progression). When they are present, the symptoms are often similar to those discussed above that are associated with prostate enlargement / BPH (e.g. urinary frequency, urgency, and hesitation). In addition to the symptoms caused by the cancer itself, common treatments such as surgery to partially or fully remove the prostate (called prostatectomy) often cause symptoms like urinary incontinence and erectile dysfunction.

What does the pelvic floor have to do with prostate health?

Pretty much all of the symptoms caused by prostate problems are connected to the pelvic floor. But first, you may be wondering what the pelvic floor actually is. The pelvic floor is a sort of hammock of muscles, ligaments and other connective tissue at the bottom of your pelvic region. It provides support for the pelvic organs such as the bladder, bowel and prostate and also plays a key role in urinary and sexual function. As one example, the pelvic floor muscles act like a valve that can open / close the urethra.

And while the pelvic floor is typically not the root cause of prostate health problems, it can certainly play a role in preventing or ameliorating many of their symptoms. There are three categories of symptoms in particular where pelvic floor health / fitness can have a strong impact.

• Bladder control / urinary incontinence: we already mentioned that the pelvic floor muscles function as a sort of valve controlling opening of the urethra – from that it’s easy to understand how if your pelvic floor muscles are weak, that can cause bladder control problems (in particular if the muscles aren’t strong enough to keep the valve closed). Pelvic floor (aka Kegel) exercise to strengthen those muscles has been shown to help prevent or mitigate incontinence for prostatectomy patients and more generally for those experiencing a variety of prostate-related bladder control challenges. (Tools like our Boost non-insertable pelvic floor trainer can help stick with a more consistent pelvic floor exercise routine).
• Pelvic pain: this is one area where pelvic floor fitness can both help but also be part of the problem. Chronic prostatitis and chronic pelvic pain syndrome (CP / CPPS) are commonly considered to be part of the same symptom complex (basically a diagnosis of exclusion when pelvic pain is present and other causes such as infection, malignancy and BPH have been ruled out). One of the potential causes is having an overactive or high tone pelvic floor – this is basically when the muscles become too tense and are unable to relax appropriately. In this case, ‘down-training’ your pelvic floor to help practice relaxing the muscles can be helpful (note that this is basically the opposite of Kegels or pelvic floor strengthening, and that overdoing it on Kegels can cause or exacerbate overactive pelvic floor issues).
• Sexual function: erectile dysfunction (ED) is an extremely common side effect of prostatectomy surgery (so is urinary incontinence). Doing pelvic floor exercise / strengthening both before and after the surgery can help prevent or resolve both ED and UI symptoms that are caused by the procedure.

How else can I avoid or improve prostate health problems?

Pelvic floor fitness (whether you’re talking about strengthening or down-training your pelvic floor) is definitely not the only weapon in the arsenal to avoid or improve pelvic health issues. There are a number of recommendations that have been specifically linked to prostate health (although most of them are also good “be healthy” tips, even beyond prostate health specifically):

• Hydrate regularly (with an emphasis on water)
• Watch your diet: in particular, more fruit/vegetables and less red meat is a great goal
• Seek to maintain a healthy weight. Obesity is a risk multiplier for prostate cancer as well as other types of prostate dysfunction
• Exercise regularly
• Avoid smoking
• Try to get some sun. Getting enough Vitamin D can reduce your risk of prostate cancer (although you should make sure to use sunscreen, since skin cancer is the only type of cancer that is even more common in men than prostate cancer)

The Bottom Line

Unfortunately, prostate health issues become pretty common for men as they get older. Conventional wisdom is that all men will have an enlarged prostate if they live long enough, and inflammation and even prostate cancer are quite common as well. Any of these can cause bladder control problems and there are other symptoms that can crop up, too, depending on the situation.

But despite being common, prostate dysfunction symptoms are not inevitable, and there are definitely avenues you can pursue to improve the situation if you do start experiencing issues. Pelvic floor (Kegel) exercise can be a powerful tool against incontinence / bladder leakage (across a variety of root causes) and down-training the pelvic floor muscles also has an important place for men experiencing chronic pelvic pain. And of course, many “healthy living” lifestyle tips have been shown to contribute to maintaining good prostate health specifically. So take heart – getting older may have its challenges, but prostate health doesn’t have to be on top of the list.