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Pelvic Health for Men – a conversation with Dr Lance Frank
18 Plays17 days ago
Dr Lance Frank is a Doctor of Physical Therapy. He operates a private practice, Flex PT ATL, in Atlanta Georgia USA. His pelvic health physical therapy services support cisgender and transgender people who are managing sexual health and intimacy concerns, pelvic pain, and urinary or bowel dysfunction.
Host Michael Millward decided to find someone who could discuss pelvic health for men because the common belief is that only women need to worry about their pelvic health.
So! In this episode of the Abeceder podcast Fit For My Age Lance explores with Michael why male pelvic health is so often not discussed.
Their own discussion covers what men need to know about maintaining and improving their pelvic health.
All too often these men are too embarrassed to talk about the more intimate aspects of their health and well-being. Dr Lance delivers advice that is perfectly balanced between direct facts and sensitivity to the issues. Any man will feel empowered to discuss pelvic health with their health care provider.
Fit For My Age is made on Zencastr, the all-in-one podcasting platform, on which you can create your podcast in one place and then distribute it to every platform.
Zencastr really does make making content so easy.
If you would like to try podcasting using Zencastr visit zencastr.com/pricing and use our offer code ABECEDER.
Thank you to the team at Matchmaker.fm for introducing me to Lance.
Matchmaker.fm is where matches of great hosts and great guests are made. Use our offer code MILW10 for a discount on membership.
Travel to California
Lance Frank is based in Atlanta Georgie USA. Members of The Ultimate Travel Club can book travel to Atlanta or anywhere else in the world at trade prices. Use our offer code ABEC79 to receive a discount on club membership fees.
Visit Abeceder for more information about both Michael Millward, and Lance Frank.
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Access York Test and use this discount code ABECEDER2.
Being a Guest
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Remember, the aim of all the podcasts produced by Abeceder is not to tell you what to think, but we do hope to make you think!
Until the next time, thank you for listening.
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Transcript
Introduction to Fit for My Age Podcast
00:00:05
Speaker
Made on Zencaster. Hello, and welcome to Fit for My Age, the health and wellbeing podcast from Abecedah. I'm your host, Michael Millward, the managing director of Abecedah.
00:00:18
Speaker
As the jingle at the start of this podcast says, fit for my age is made on Zencaster. Zencaster is the all in one podcasting platform on which you can make your podcast in one place and then distribute it to the major platforms like Spotify, Apple, um Amazon, and YouTube music. It really does make making podcasts so easy.
00:00:44
Speaker
If you would like to try podcasting using Zencaster, visit zencaster.com forward slash pricing and use my offer code ABACEDA. All the details are in the description.
Guest Introduction: Lance Frank
00:00:56
Speaker
Now that I have told you how wonderful Zencaster is for making podcasts, we should make one. One that will be well worth listening to, liking, downloading and subscribing to.
00:01:08
Speaker
Very importantly, on fit for my age, we don't tell you what to think, but we do hope to make you think. Today, my guest who I met on matchmaker dot.fm is Lance Frank. Lance is an expert in pelvic health and its importance for both men and women. Lance is based in Atlanta, USA. I've not been to Atlanta, but I'm sure when I do go, I will be making my travel arrangements at the Ultimate Travel Club.
00:01:37
Speaker
because that is where I get trade prices on flights and hotels. You will find a link and a membership discount code in the description. Now. Hello
Understanding Pelvic Health
00:01:47
Speaker
Lance. Hello Michael. Please could we start by you just explaining a little bit about what you do and how you got involved with pelvic health. Yeah, absolutely. My name is Lance Frank. I'm a pelvic health physical therapist, which is just a doctor of physical therapy that I've done advanced training in the pelvic, the the pelvis specifically. The pelvic floor is a group of muscles that sits inside the pelvis and
00:02:17
Speaker
is primarily responsible for peeing, pooping, sexual functions, and then provides more of a and also kind of stabilizes the upper and lower half of our bodies together. and so From a musculoskeletal standpoint, if people are having problems with those kind of basic functions of um going to the bathroom or experiencing sex or if they're having any sort of pelvic related pain, hip pain, tailbone pain, it could be a pelvic floor muscle issue. And not a lot of people know that that we have a pelvic floor. Most people when they think of pelvic health or pelvic floor physical therapy, they think of women, mostly postpartum women. I got into this field but when I was going through my clinical education.
00:03:03
Speaker
We had one lecture and one lab over pelvic health and it was only about the population that I just described, postpartum women that had just given childbirth that had issues peeing on themselves that needed a little bit more strengthening work.
00:03:18
Speaker
And while there is very much a need for pelvic PTs for that specific population, there are other so many people out there that could benefit ro from pelvic health that might not necessarily know that A, that they need pelvic health or B, that it's even a thing to go look for. And so when I was going through my my clinical work,
00:03:41
Speaker
I worked with an instructor who was a dual pelvic PT ortho PT that really kind of opened my eyes to all of the different types of pelvic patients that are out there, including men.
00:03:56
Speaker
And so that's really what kind of ignited my interest in pelvic health as ah as a career. That was almost 10 years ago when I was in physical therapy school and now I have my own practice treating men's pelvic floor disorders. So all I see, and I shouldn't say all, most of my caseload day in and day out.
Challenges and Misconceptions in Pelvic Health
00:04:14
Speaker
consists of men in the 20 to 50 range that are having issues with their pelvic floor. I see a lot of pain complaints, but it's mostly pelvic floor disorders with a sprinkle of of orthopedic patients. The challenges of pelvic health are much more widespread than simply women who are getting their bodies back into synchronicity following childbirth. Right, that's absolutely correct. And it's interesting when you started off that description by I was describing the pelvic area of our bodies as being the foundation on which our upper bodies sit and the core part of our body that holds everything together. Yep.
00:04:59
Speaker
It's our it's the foundation of our of our core, essentially. We haven't got video on it. It's probably so it's probably a really good thing because um'm umm I'm here sort of like with my hands in sort of the shape of a pelvis. What I imagine is the pelvis looks like and sort of thinking like, yes, you've got the spine coming out of your pelvis and then all of the organs there. That's in a place, but it's the pelvis that holds those or gives them structure, right? I suppose. Yep.
00:05:26
Speaker
Yeah, it's it's ah it's a key part of our bodies. You also mentioned that the training that you had was one lecture and it focused on those post childbirth problems that some women have. Nail pelvic health wasn't covered. So why don't, well, I was going to ask, why don't men think about their pelvic health? But it it also seems that a large part of the medical profession doesn't think about male pelvic health either.
00:05:56
Speaker
Why is that? Yeah. Um, well, I should say I should kind of, I don't want to backpedal, but that my, my statement about one lecture in one lab about pelvic health, that was in my, my doctorate program.
Education and Training in Pelvic Health
00:06:10
Speaker
right I went on after that and did advanced training. So in that instance, pelvic health, even though technically it falls in any, the field of orthopedic physical therapy, it's still considered a specialty because it's even, it's an even refer the refined.
00:06:28
Speaker
specialty of orthopedic physical therapy. And so there are other specialties like pediatrics or geriatrics or neurological disorders. I mean, there's, there's, I think at least 20 different specialties within the degree of physical therapy that you could specialize in a certain kind of niche population. And so there's just not a lot of time in a doctorate program to go over each special. I mean, we go over the specialties, but not in kind of refined detail, like you would need to come come out and be able to treat that population. It's kind of like going to medical so medical school and then after that going into residency. A lot of the specialties in physical therapy require a residency to then go on and and work in that specific niche.
00:07:16
Speaker
There is some coverage of it, but it's not it wasn't until I got into my like advanced training where I really got the bulk of of my male public health information and and education.
00:07:28
Speaker
and so in the initial stages in the talkate stages of medical training, the the field is so broad that things get touched on. It's only when you decide that that is an area that you want to go into, you want to focus on and specialise in. That's when you get this specialist training to support your interest in working in that area. Right, absolutely.
Male Pelvic Health Awareness
00:07:50
Speaker
I understand.
00:07:51
Speaker
So the other part of the question, though, was why don't men think about their pelvic health in the same way as women do? I get this question a lot. And, you know, honestly, I don't really even think women know or notice or pay attention to pelvic health.
00:08:09
Speaker
until they get to around childbearing years. And everyone's always talking about, you know do your Kegels. you know You don't want to pee on yourself whenever you have a baby, but that's I'm just here to set the record straight that that is not ah a true statement and we'll get into that. Well, we might get into it a little bit later, but Kegels are not always the answer for everybody.
00:08:28
Speaker
And we know't most people know of or think of kegels in the instance of like pelvic floor strengthening. Most people think you know you have a baby, the the pelvic floor might get a little weak, so I just need to work on strengthening my my pelvic floor so that after childbirth, things you know still work correctly. And while that's not incorrect logic, it's also not completely true and it's not the complete picture. you know Men,
00:08:58
Speaker
there isn't other than you know peeing, pooping, and being able to get an erection. most people don't really pay attention to what happens with their pelvises. We just kind of expect them to work, and especially like our genitals and our our ability to evacuate urine and feces. And so it's not until things go wrong with those systems when people start to pay attention to what's happening down there. But you know even then, and ah in in the medical community, with know particularly physicians that in the medical education that they receive,
00:09:35
Speaker
There's not a lot of coverage about the role that the muscles themselves play in our ability to pee and poop and be able to have sex the way that we that the way that we want to. I work with a lot of urologists and a lot of colorectal surgeons that didn't know about pelvic floor physical therapy until I approached them with it or later in there their medical education, like their fellowship years that they learned about pelvic floor physical therapy.
00:10:03
Speaker
And so I think there are a lot of factors as to why men don't know or don't assume that they have a pelvic floor, but ultimately, you know, it's always kind of focused historically on females and people being postpartum.
00:10:22
Speaker
And so I think that has a lot to do with it. But men also have pelvic floors. They have the exact same muscles. They're just oriented a little differently. And they play just a slightly different role in what they do to to help us function. But they're very much there. Yeah. And of course, the pelvis bones are the only gender specific bones in the body. Is that true? That's right. The female pelvis is a little bit wider, a little bit more outset, and the inlet of the pelvis and the outlet of the pelvis are just a little bit more oval-shaped to allow for childbearing capabilities. And I suppose that's why women get hourglass figures as well. Yep, the the the tops of the hip bones are just a little bit wider. What you're saying, I suppose, is that like so many other health-related issues,
00:11:17
Speaker
we only really get interested in them when what's supposed to be healthy is unhealthy and we have a problem. right So it's like ah so many different things, but it's the prevention of the problem is becoming increasingly important.
00:11:32
Speaker
Here in the UK, we have the National Health Service, but the best way to have an efficient national health service is not to actually use it.
Maintaining Pelvic Health: Tips and Techniques
00:11:41
Speaker
You know, I used to work in the National Health Service, and the joke we had was like, we built a new hospital, it'll be perfect until a patient arrives. And the best way to use it the National Health Service or any health service is not to use it at all.
00:11:55
Speaker
because you've maintained a good physical and mental health. And I'm sort wondering like, what can we do as men? Because I'm a man. So what could I do as a man to and ensure that I have good pelvic health? At what time in life do I need to start thinking about making sure that I've got good pelvic health?
00:12:17
Speaker
That's a great question. I think the most obvious answers that I'm going to give are what any you know you of what your primary any of your primary care providers would give you for overall health. you know Maintain a healthy diet. Make sure that you're getting regular exercise. Make sure that you're not over consuming with smoking or alcohol. and Um, making sure that you're just generally lead leading a healthy life is going to make sure that everything in the pelvis also works correctly. And the most optimally for, from a muscular standpoint, most people think that they have a, uh, their pelvic floor is too strong. Most people think that they, if they have issues with incontinence or if they have issues with leaking or if they have.
00:13:10
Speaker
urgency or frequency or constipation or erectile dysfunction. Most people think that their pelvic floor is just weak and they just need to do a bunch of kegels. When in fact, it and this what I'm about to say now mostly pertains to my male patients or people with penises, I would argue that most people actually need to learn how to relax their pelvic floor and unclench and do a reverse kegel to allow more blood flow and more relaxation and more flexibility.
00:13:38
Speaker
Because if we're constantly living in an upregulated, tense, clenched state, those muscles can't function the way that they need to. And that makes peeing and pooping and, you know, having sex even more problematic.
00:13:52
Speaker
And so I always give more relaxation, flexibility-based recommendations when people are asking me for just general recommendations for how to improve their pelvic health. Things like yoga or Pilates or a lot of like breath work and meditation, diaphragmatic breathing to help with down training the nervous system, down regulating all of the muscles so that we're getting adequate blood flow so the muscles are relaxing well.
00:14:21
Speaker
A lot of times in my male patients, I would say eight times out of 10, I'm working on getting the pelvic floor to relax, not necessarily getting it to strengthen or develop more muscle tone. It's interesting.
Complexities of Pelvic Floor Problems
00:14:39
Speaker
as Listening to you, I was thinking like, who's going to mention yoga and Pilates?
00:14:44
Speaker
I know he's going to say that. I tried both. I prefer the Pilates. It makes an awful lot of sense that you can't be constantly working your muscle. soul It does need some time to relax in the same way as every other part of your body.
00:15:02
Speaker
Sort of like thinking that when you have a pain in your pelvis, you might be thinking it's a muscular pain, but it could actually also be lots of other conditions as well. right It could be an indicator of something else, for example.
00:15:18
Speaker
Right. I mean, there are a lot of nerves that travel down into the pelvis. And so I see a lot of the conditions called pudendal neuralgia or a lot of people have heard of sciatica or their their sciatic nerve is acting up. The sciatic nerve also has branches that go down into and near the pelvis. So there are a lot of nerve conditions that can impact pain or symptoms down to the pelvic floor as well. Wide range of different conditions can be then indicated by pelvic pain rather than pain in the area of the particular organ like an appendix or kidneys or those sorts of things. So many nerves, it's almost like the pain is in one area but the nerve transfers, well sorry, the cause of the pain is in one area but the nerves transfer the feeling of pain to another area in the pelvis.
00:16:09
Speaker
Right. So with all those muscles and ligaments and bones and things, we can think about, you know, there will be pain, but can there also be problems without any symptoms? That's a good question. Most people who have symptoms will likely present with some kind of pelvic floor impairment. But that's a fair question that if people don't have pelvic floor impairments, will they have symptoms? And i' i' I don't know. I doubt it. I don't think so. I mean, if people most, I would say when people come ah into the clinic to see me, they have, they usually present in one of two ways. Somebody has an overactive pelvic floor, which is kind of what I was talking about earlier, where
00:16:54
Speaker
They're just, their pelvic floor is constantly squeezing. They're clenched. They're stuck in a, essentially they're stuck in a Kegel all day long, all of the time, and they don't ever relax. Or the other side of the spectrum is somebody who has an underactive pelvic floor. Their pelvic floor is weak and isn't able to, is not strong enough to hold in urine or bowel or gas, or they're not able to get an erection. Sometimes people have an underactive pelvic floor. And so.
00:17:23
Speaker
The main symptoms that I see people come in with are urinary urgency or frequency or incontinence, whether that's leaking, leaking with laughing coughing or sneezing or dribbling after they use You know, after the urinate, after using the restroom, I see a lot of bowel issues like constipation and hemorrhoids and fissures or pain with urination or bowel movements. I see a lot of chronic pain, diagnoses, penile pain, testicular pain, pelvic pain, just general pelvic pain, tailbone pain. Typically when people come into the the clinic with one of those symptoms, honestly, I would argue eight
00:18:03
Speaker
eight times out of ten, it's a function of somebody has an overactive pelvic floor, meaning, again, the muscles are just qui squeezing all of the time, or rarely, at least in my clinic, patients come in and they have an underactive pelvic floor. right and so if ah And sometimes patients will have willll have symptoms.
00:18:24
Speaker
But doesn't it's not necessarily an indication of a muscular pelvic floor problem. Sometimes it is a medical problem. Sometimes there are other things going on that might be and impacted. But it would be rare for somebody to come in with a symptom of pelvic floor dysfunction and not have an actual pelvic floor impairment. You've mentioned these key goals three or four times now.
00:18:49
Speaker
What are
Kegels and Pelvic Floor Exercises
00:18:50
Speaker
they? So kegels are what we call a pelvic floor muscle contraction. And so for, you know, just like if you were to go to the gym and you were to lift a dumbbell with your hand and do a bicep curl, that would be a bicep muscle contraction. So you're squeezing the muscle to activate it to lift the weight with the pelvic floor. If you do a pelvic floor contraction or a pelvic floor muscle contraction,
00:19:18
Speaker
That is squeezing those muscles to think about. I always give people, you know, it, by doing a pelvic floor contraction and squeezes those muscles to stop the flow of urine or to hold back gas or you to ah most people with, if you have a penis, if the cues try to make your penis jump or try to lift your testicles up inside your body or try to.
00:19:46
Speaker
hold back gas, like all of those contractions are squeezing and activating the pelvic floor. And so whenever people do those contractions, we could call that a key goal. Right. Okay. So flatulence, for example, is you have, we all have gas inside our bodies, part of the digestive process. How that gas is released is almost like ah a function or a dysfunction of the muscles in the pelvis. If they are operating effectively.
00:20:19
Speaker
you won't have those releases of gas, you won't have the flatulence. But if they're not operating effectively, then you could have the flatulence. Or even, you know, if you're an eight year old boy, you're probably practicing so you can have flatulence on demand. That's all part of the the control and use of your pelvic muscles. That's correct. Wow.
00:20:42
Speaker
So you learn something new every day. So and of how so i'm and but I'm a man, so let's talk about some of the specific issues of pelvis operation and being a man because it's one of the areas that I suppose lots of men don't actually get to know about.
00:20:59
Speaker
So you've mentioned pelvic muscles and the ability to the impact that pelvis, mur pelvic muscles have on blood flow. And of course, blood flow is essential for erections and sexual performance. So other exercises, these Kegel exercises, if you get the right exercises, you could actually improve your erectile function. Yeah.
00:21:25
Speaker
um i I mean, a lot of the patients that I see in the clinic, I make sure that they have the ability to contract their pelvic floor or to do a Kegel. And I also make sure that they have the ability to fully relax their pelvic floor. And so a reverse Kegel and making sure that they have the ability to go through that full range of motion is important to make sure that we build adequate strength. And so when I'm giving Kegel exercises to people or pelvic floor strengthening exercises to people, I'm giving them
00:21:56
Speaker
I mean, there are some times where it's appropriate for patients to just sit and go home with, do 10 or 20 or 30. I call them elevators rather than kegels. um The exercise that I give is called elevator. So I have them think about taking taking their pelvic floor if it's an elevator, having them do a contraction or squeezing.
00:22:16
Speaker
Like they're trying to make their penis jump up, squeezing their elevator all the way up into the to the penthouse. And then whenever they have them do a reverse Kegel, I'm having them think about dropping their elevator all the way down into the basement. And so I give exercises like that in addition to pelvic floor strengthening exercises or pelvic floor Kegel exercises whenever people are doing an exercise like a squat or a deadlift or a bridge or a lunge.
00:22:41
Speaker
so that they their body learns to coordinate when the pelvic floor should contract and when it should relax. um I also give patients, there are tools that I use in the clinic all the time that I send patients home with that they can use to to work on blood flow and strengthening the pelvic floor and making sure that we're getting blood flow to that area. um I always send patients home with a, it's called a hydro pump. It's a vacuum, penile pump that they can use that uses water as the vacuum
00:23:14
Speaker
to help draw in blood into the penis, to help with erections, and while people are erect, I'll have them practice these elevator exercises and these pelvic floor strengthening exercises to pump more blood flow into the pel into the penis and then relax the pelvic floor to allow more blood flow in as
Resources and Seeking Help
00:23:31
Speaker
well. And so it's this constant pump mechanism that keeps blood in the penis, that keeps things erect. Very interesting. These exercises that you're talking about, you have information about those on your website? I do.
00:23:44
Speaker
Yeah. What is the address for your website, please? Yeah, my website is flex.com. dot com And of course, you're based in Atlanta, in Georgia, in the US. But from what you were telling me earlier, there are lots of physiotherapists around the world who have specialist knowledge in this area as well.
00:24:07
Speaker
That's right. yeah i mean There are so many public PTs around the world that people can can see if they have help or if they need help with but any of these issues that we were just talking about. Now, if I'm going to see my general practitioner and i'm I've listened to this, I'm thinking that this may be the sort of solution. What sort of questions or things should I be saying to my GP to start the ball rolling of getting a referral to someone like you?
00:24:35
Speaker
I would say, you know, I am having issues with, you know, XYZ symptom. Normally, they're going to want to do a couple tests to make sure that it's nothing medical that's causing their symptoms, which is appropriate. um But if patients are seeing their physicians and they're asking these questions and they're doing these tests and everything keeps coming back normal,
00:24:58
Speaker
A lot of times it could be a function of the muscles being impaired. And so that's where I would be like, okay, you know we've done these tests. can Can I get a referral to go see a pelvic floor PT to see if it's the muscles that are involved in what's and what's happening here? And a lot of times, ah assuming the physician knows what pelvic floor physical therapy is, a lot of physicians are open to more conservative, less aggressive techniques that don't involve pharmaceuticals or don't involve any sort of you know surgery procedure. So I'm learning so much. It's like if you think you've got a medical condition, which would be some sort of illness or chronic condition,
00:25:43
Speaker
and the treatments that you're being prescribed for that do not appear to be solving the problem. The next thing to do is to have a conversation around muscular skeletal health and asking for a referral to someone like yourself who can investigate that in more detail. That's right.
00:26:04
Speaker
yeah You know, Lance, it has been really interesting. Really do appreciate your time. Thank you so much. Yeah, thank you so much for having me. It's been a pleasure. Thank you. I am Michael Millward, the managing director of Abeceda. And in this episode of Fit for My Age, I have been having a conversation with Lance Frank, who is a specialist pelvic health physiotherapist based in Atlanta, Georgia. You can find out more about both of us at abeceda.co.uk. There is a link in the description.
00:26:37
Speaker
I must remember to thank the team at matchmaker dot.fm for introducing me to Lance. If you are a podcaster looking for interesting guests, or if like Lance, you have something very interesting to say, matchmaker dot.fm is where matches of great hosts and even greater guests are made.
00:26:56
Speaker
There is a link to matchmaker dot.fm and an offer code in the description. If you're listening to Fit For My Age on your smartphone in the UK, you may like to know that 3 has the UK's fastest 5G network with unlimited data. So listening on 3 means you can wave goodbye to buffering. There is a link in the description that will take you to more information about business and personal telecom solutions from 3 and the special offers available when you quote my referral code.
00:27:25
Speaker
That description is going to be well worth reading because it also has links to all of Lance's web pages as well. If you've liked this episode of Fit For My Age please give it a like and download it so that you can listen anytime, anywhere. To make sure you don't miss out on future episodes please subscribe.
00:27:46
Speaker
Remember, the aim of all the podcasts produced by Abisida is not to tell you what to think, but we do hope to make you think. All that remains for me to say is until the next episode of Fit For My Age. Thank you for listening and goodbye.