After emergency back surgery and surviving sepsis, all within a week, Joe Ward was lucky to be alive. But he was left with a miserable legacy.
At just 30 years old, Joe, from London, was diagnosed with 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 sanitary pads, like someone 50 years older than me, because I suffered from leaks and accidents,” he says. ‘It was tough, especially in social situations.
“And for a long time I didn’t feel like a real man because I couldn’t function sexually, which was very disturbing.”
To top it all off, Joe was told by doctors that he would probably have to use catheters (thin tubes that are inserted into his bladder to empty it) for life.
After emergency back surgery and surviving sepsis, all within a week, Joe Ward was lucky to be alive. But he was left with a miserable legacy
But amid the gloom, Joe was shown a simple way to help improve these problems, through pelvic floor exercises.
The pelvic floor consists of muscles and ligaments that support the bladder, rectum, and other tissues (such as the vagina). It is usually discussed in terms of women’s health because childbirth can weaken the muscles, leading to urinary incontinence.
Yet men also need a strong pelvic floor, which plays a role in erectile function, and the exercises are recommended for people who have had prostate surgery or who suffer from sexual dysfunction.
So should exercises like this 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, consultant urologist at University College London Hospital.
He believes that all men over 50 should learn and do pelvic floor exercises to prevent incontinence later in life. This is especially important for people who are overweight, have asthma or smoke.
These all increase stress on the pelvic floor – asthma from coughing, and smoking because it can lead to coughing, but also because it weakens all the muscles due to toxic ingredients in cigarettes, says Mr Sridhar, who also works at Princess Grace Hospital in London. .
The muscles that control the opening and closing of the urethra and rectum can also weaken with age.
Lucy Burrows, pelvic physiotherapist at Six Physio in London, says: ‘Many men don’t even know they have a pelvic floor.
At just 30 years old, Joe, from London, was diagnosed with double incontinence, meaning he had no control over his bladder or bowel movements, and was unable to function sexually (stock image)
‘There is a lot more talk about women’s health, especially when it comes to childbirth and menopause (the drop in estrogen can cause muscles to weaken), and women are much more comfortable talking about it.’
Joe, who works in event management, only learned about the importance of the pelvic floor after a medical emergency.
Last October, he started having lower back pain for no apparent reason, and within a few days the pain 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 agony, Joe went to A&E, where an MRI scan revealed an abscess in his back, and he was rushed by ambulance to St Mary’s Hospital in West London for an emergency surgery.
The abscess was pressing on his spinal cord and blocking nerve signals from his pelvic area. As a result, his bladder and bowels were not working properly and he had lost sexual function.
Worse, the abscess had caused sepsis – a potentially fatal condition in which the immune system overreacts to an infection and begins to damage healthy tissue.
Joe was later told that it took about twelve hours for him to fail. He was in hospital for a month, but the abscess had damaged the nerve bundle at the base of the spine that controls bladder and bowel function and sensation around the genitals and anus.
In addition to having to use catheters to urinate, probably for the rest of his life, poor bowel function means Joe also has to manually remove feces.
He was shocked by what had happened. “It was a confusing mix of despair and gratitude,” he says. ‘For a while I was convinced I would stay single forever; but I was also grateful to be alive.”
The turning point came two months after surgery when he started learning about the pelvic floor muscles and doing the exercises with a physical therapist.
“I still had the ability to control my pelvic floor, but it was very weak,” says Joe. ‘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.
‘About a month later my control started to return and my sexual function is almost back to what it was.’
The exercises, which involve lifting and contracting the pelvic floor muscles as if you were trying to prevent wind from passing through, have been transformative.
He still needs catheters and his bowels don’t open properly, but his control has improved so much that he rarely has accidents.
The hope is that his bowel function will improve further with dietary changes, bowel-stimulating medications and irrigation (which uses water to flush out the intestines).
Surgery – such as prostate gland removal – is a common cause of pelvic floor weakness.
In fact, incontinence after prostate cancer surgery is such a big problem that Prostate Cancer UK has launched the Boys Need Bins campaign, calling for legislation to install sanitary bins in men’s public toilets so that incontinence pads can be disposed of discreetly.
Men often feel like they can’t leave their home because they have nowhere to put the sanitary towels, causing anxiety and depression, says Heather Groarke, a specialist nurse at the charity.
She recommends starting pelvic floor exercises to strengthen the muscles four to six weeks before surgery, as these may be more difficult immediately after surgery due to bruising and pain. However, it’s crucial not to overdo it, because the muscles can’t function properly if they’re overloaded, says Heather Groarke, who warns that doing more than three or four times a day can be counterproductive.
Physiotherapist Lucy Burrows explains that an overactive pelvic floor can lead to chronic pain.
Joe says that although he is ‘not enthusiastic’ about using catheters, ‘the pelvic floor exercises have led to significant improvements in other ways’
“If men contract their pelvic floor too much, it can lead to pain in the lower abdomen, testicles, penis and buttocks, as well as sexual dysfunction, constipation and other intestinal problems,” she says.
But how does a man know if he is training the right muscle?
Heather Groarke says the best way to do this is to stand in front of a mirror while you perform the exercises, and check to see if the scrotum and base of the penis rise slightly as you do them.
Or place your fingers just behind the scrotum: you should feel the muscles release from your fingers as you tighten them.
Once the technique is good, the exercises can be performed sitting, standing or lying down.
Ideally, perform ten of these slowly, tensing the muscles for ten seconds each time; then ten quick ones, tensing the muscles for a second each time, she says.
Apps including Squeezy, approved by the NHS, provide handy reminders to do the exercises.
In addition to leaking when coughing, sneezing, laughing, or during impact exercises such as running, signs of a weak pelvic floor include urinating more than seven times a day (between five and seven times is normal), feeling the need to urinate throughout the day . the time or feeling that you haven’t completely emptied your bladder, says Lucy Burrows.
Joe says that while he is “not enthusiastic” about using catheters, “the pelvic floor exercises have led to significant improvements in other ways.”
“I’m dating again and plan to be open about things early on in a relationship. Now that I’ve been educated about the importance of pelvic floor exercises, it seems crazy that this isn’t something that is discussed regularly with men.
“For the average guy, it can help with so many things. It feels like a no-brainer to do them.”