After undergoing emergency back surgery and surviving sepsis, all within a week, Joe Ward felt lucky to be alive. But he was left with a miserable legacy.
At just 30, Joe, from London, suffered from double incontinence, meaning he had no control over his bladder or bowel movements, and was unable to function sexually.
“For six months, I had to use pads — like someone 50 years older than me — because I was having leaks and accidents,” he says. It was difficult, especially in social situations.
For a long time, I didn’t feel like a real man because I couldn’t function sexually, which was very annoying.
To top it all off, doctors told Joe he would probably have to use catheters (thin tubes inserted into his bladder to empty it) for life.
But amid the gloom, Jo was offered a simple way to help improve these issues, using pelvic floor exercises.
The pelvic floor consists of muscles and ligaments that support the bladder, rectum, and other tissues (such as the vagina). This is usually discussed in terms of women’s health, as childbirth can weaken muscles, leading to urinary incontinence.
However, men also need a strong pelvic floor, which plays a role in erectile function, and these exercises are recommended for those who have had prostate surgery or suffer from impotence.
Should such exercises be on every man’s radar?
“Most men don’t know what these muscles are, what they do and how to train them,” says Ashwin Sridhar, a consultant urologist at University College London Hospital.
It is believed that all men over the age of 50 should learn and practice pelvic floor exercises to prevent urinary incontinence later in life. This is especially important for those who are overweight, have asthma, or smoke.
All of these things increase pressure on the pelvic floor – asthma because of coughing, smoking because it can lead to coughing but also because it weakens all the muscles because of the toxic ingredients in cigarettes, says Mr Sridhar, who is also based at the Princess Grace Hospital in London. .
The muscles that control the opening and closing of the urethra and rectum can also weaken with age.
“Many men don’t even know they have a pelvic floor,” says Lucy Burrows, a pelvic health physiotherapist at Six Physio in London.
“There has been a lot of talk regarding women’s health, especially regarding childbirth and menopause [the drop in oestrogen can cause the muscles to weaken]And women are much better at talking about it.
Joe, who works in event management, only learned the importance of the pelvic floor after he had a medical emergency.
He had started experiencing lower back pain for no apparent reason last October, and within a few days it was so bad he could barely get out of bed.
He called NHS 111 but was told he had sciatica and was advised to continue taking painkillers.
Five days later, still in pain, Joe went to A&E, where an MRI scan revealed an abscess in his back, and he was taken by ambulance to St Mary’s Hospital in west London for emergency surgery.
The abscess was pressing on the spinal cord, blocking nerve signals from the pelvic area. As a result, his bladder and bowels no longer function properly, and he loses his sexual function.
Worse still, the abscess led to sepsis, a potentially fatal condition in which the immune system overreacts to the infection and begins damaging healthy tissue.
Joe was later told that he was about 12 hours away from not doing so. He spent a month in hospital, but the abscess damaged the bundle of nerves at the bottom of the spine that control bladder and bowel function and sensation around the genitals and anus.
In addition to having to use a catheter to pass urine, likely for the rest of his life, poor bowel function means Joe also has to manually remove stool.
He was left “traumatized” by what happened. “It was a confusing mix of despair and gratitude,” he says. “For a while I was convinced I would be single forever; But I also felt grateful to be alive.
The turning point came two months after surgery when he started learning about the pelvic floor muscles and doing exercises with the physical therapist.
“I still had control of my pelvic floor, but it was very weak,” Joe says. “By doing the exercises three times a day, I strengthened the muscles and learned how to retrain my brain to recognize nerve signals from the area.
“After about a month, my control started coming back and my sexual function was almost back to what it was.”
The exercises, which involve lifting and squeezing your pelvic floor muscles as if you were trying to stop yourself from farting, have made a dramatic difference.
He still needs a catheter and his bowels don’t open properly, but his control has improved enough that he rarely has accidents.
The hope is that bowel function will improve further through dietary changes, bowel-stimulating medications, and irrigation (using water to help flush it out).
Surgery — such as removing the prostate gland — is a common cause of pelvic floor weakness.
In fact, incontinence after prostate cancer surgery is such a big problem that Prostate Cancer UK launched the Boys Need Bins campaign, calling for legislation to provide sanitary bins in men’s public toilets so incontinence pads can be disposed of discreetly.
Heather Groarke, a specialist nurse from the charity, says men often feel like they cannot leave their homes because there is nowhere to put sanitary pads, which causes anxiety and depression.
She recommends starting pelvic floor exercises four to six weeks before surgery to strengthen muscles, as it may be difficult to do them immediately after surgery due to bruising and pain. However, it’s important not to overdo it because muscles cannot function properly when overworked, says Heather Groerke, warning that more than three or four times a day can be counterproductive.
Physiotherapist Lucy Burrows explains that pelvic floor overactivity can lead to chronic pain.
“If men contract their pelvic floor too much, it can lead to pain in the lower abdomen, testicles, penis, and buttocks, as well as impotence, constipation, and other bowel problems,” she says.
But how can a man know if he is exercising the right muscle?
Heather Groerke says the best way to do this is to stand in front of a mirror while performing the exercises, and make sure that the scrotum and base of the penis rise slightly while doing them.
Or place your fingers directly behind your scrotum: You should feel the muscle lift away from your fingers as you tighten it.
Once the technique is correct, the exercises can be performed while sitting, standing or lying down.
Ideally, you can perform ten of them slowly, when the muscles are tense for ten seconds at a time; Then ten quick movements, contracting the muscles for one second at a time, she says.
Apps including Squeezy, which has been endorsed by the NHS, offer helpful reminders to do exercises.
As well as leakage when coughing, sneezing, laughing, or during exercise such as running. Signs of a weak pelvic floor include urinating more than seven times during the day (between five and seven times is normal), and feeling the need to urinate in general. The time or feeling that you haven’t completely emptied your bladder, says Lucy Burrows.
Joe says that although he’s “not happy” with the catheter, “pelvic floor exercises have led to significant improvements” in other ways.
“I’m dating again, and plan to be open about things early in the relationship. Now that I’ve learned the importance of pelvic floor exercises, it seems crazy that this isn’t something that’s regularly discussed with men.”
“For the common man, it can help with many things. Doing it seems like a no-brainer.”
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