It is estimated that 10 million Americans suffer from fibromyalgia. May is fibromyalgia awareness month, a chance to shed light on this misunderstood condition.

Fibromyalgia is a condition defined by having at least eleven of nineteen predetermined tender points, severe fatigue, and poor memory. Symptoms must persist for at least three months and all other possible explanations for these symptoms must be ruled out. Fibromyalgia is most prominent among women, making up about 90% of all those diagnosed. The root causes of fibromyalgia are not entirely clear, however, stress and poor sleep habits may contribute to its onset. Many clients we work with at Comprehensive Therapy Services have the diagnosis of fibromyalgia. While there is not one cure-all, there are many ways to manage this condition.

While this may seem daunting at first, regular aerobic exercise is one of the best ways to manage fibromyalgia.

Start small by taking the stairs instead of the elevator or parking further away from the store. Finding an exercise you enjoy is one of the best ways to stick to a work out plan. A group exercise class is great way of having friends keep you accountable to a new program. Listen to your body and begin any new exercise slowly, allowing your body to accommodate to any new exercise plan. Pushing past high levels of pain is not beneficial. Importantly, everybody is different and it is important you modify as needed. Physical therapists are movement experts. We can help tailor a program to your specific needs.

Practice healthy sleep habits. Getting into a good sleep pattern is an extremely important aspect of fibromyalgia management. Here are some basic sleep hygiene tips:
  • Be sure to fall asleep and wake up at about the same time everyday.

  • Exposure to outdoor light is important for the body's master clock. Spend about 30-60 minutes a day in the sun.

  • Consider getting rid of caffeine. Studies have shown that some people have difficulty metabolizing it efficiently, leaving them feeling the effects long after consumption.

  • Consider taking a hot shower at night before bed. The temperature drop signals to the body that it is time for sleep.

  • Avoid snacks before bed, this raised blood sugar and delays sleep.
Practicing mindfulness may be beneficial for some with fibromyalgia. Mindfulness is the practice of focusing your attention on the present moment in order to notice current thoughts, emotions, and surroundings. Studies have shown mindfulness is an effective method of stress reduction. There are many ways to practice mindfulness. One has to only go as far as the internet to find good starting resources.

A healthy diet is an important foundation for any healing body to have. Provide your body with enough water and avoid highly caffeinated or sugary beverages. Avoid heavily processed foods. Dark leafy greens and healthy fats give your body the building blocks it needs to repair itself.

The diagnosis of fibromyalgia can be daunting. By taking care of the things you can control, there is a method of management... and hope.
Anne Shea, DPT, OCS
Ask a guy what his pelvic floor does and odds are he might have no idea.

Or if he does know, he may not want to talk about it due to social stigmas. But the truth is all men have pelvic floors and just like it does in women, the male pelvic floor serves multiple functions. 
The male pelvic floor is made up of multiple layers of muscles some of which contribute to sexual function ( ischiocavernosus and bulbospongiosus ), others contribute to urinary function ( bulbospongiosus and the urethral sphincters ) and some help with bowel function ( levator ani group ). Not to mention it does all of this while being the ground floor in your body that is supporting all of your pelvic organs. It even has muscles that can affect hip motion ( obturator internus ). All of these muscles work in concert to make these important activities go smoothly and the strength, coordination, and mobility of these muscles is something some men may never have to think about. For anyone that is having pelvic floor dysfunction though, it can be a whole different story.

There are many conditions affecting men that may have links to their pelvic floor. For example, consider the prostate, a pelvic organ that is specific to men - according to the American Cancer Society prostate cancer is the second most common cancer in American men. This means prostatectomy (the surgical removal of the prostate) is an extremely common procedure here in the US. Men who have had their prostate removed may have trouble with their urinary and sexual function afterwards due to the effect the surgery may have on the muscles and nerves of the pelvic floor. Or you may have heard of prostatitis, which is an infection or inflammation of the prostate, and according to the National Institute of Health, is the most common urinary tract problem for men under the age of 50. Prostatitis can cause men to experience pelvic pain, have difficulty or pain urinating, and affect their sexual function - all of which is influenced by the muscles and nerves of the pelvic floor.

Since the pelvic floor serves so many functions, there are many ways pelvic floor dysfunction can present.

Men may be dealing with urinary issues such as difficulty starting a stream, post-void dribbling, painful urination, or straining to urinate. Or they may be dealing with sexual function issues such as erectile dysfunction, painful ejaculation, or premature ejaculation. Or they may just have chronic pelvic pain syndrome which can come in a variety of forms such as penile pain, perineal pain, scrotal pain, pudendal nerve dysfunction, and many more. Many of these conditions can be linked to the function of the muscles of the pelvic floor and all of them can have a profound effect on a man's life. With the social stigmas he faces, he may be unsure of where to turn or what resources are out there.

One resource is pelvic floor physical therapy.

A physical therapist can examine and treat pelvic floor conditions in a variety of ways. During the exam the PT will look not only at your pelvic floor (externally and internally as needed), but also at your hips, low back, diaphragm and abdomen. After all, our bodies are intricately connected and just as the hip can influence the position of the foot, what our diaphragm is doing while we breathe can affect the position of pelvic floor. From there they can help strengthen the muscles, stretch the muscles, learn to coordinate them more effectively and discover strategies to help manage symptoms. This means that for men who have had their prostate removed, physical therapy can help them regain control of urinary function and improve sexual function. For men with urinary issues, it can give them strategies to reduce their symptoms and teach their muscles how to function properly. For men with chronic pelvic pain, it can help them find relief through soft tissue work, exercises, and lifestyle modification. Just as physical therapy helps people return to the activities they love after injury to a shoulder or hip, physical therapy can also help when any of the problems listed above are keeping you from doing what you love.

If you or any man you know is dealing with pelvic floor related issues, have them reach out to the physical therapists at CTS to find out more about how we can help them. You can also come check out the next meeting of our Men's Pelvic Health Support Group. The Men's Pelvic Health Support Group is a safe and open space for men to share their stories, experiences, and successes with pelvic floor dysfunction.
Milan Patel, PT, DPT


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