After undergoing emergency back surgery and surviving sepsis, all within a week, Joe Ward felt lucky to be alive. But he left behind a tragic legacy.
Joe, from London, suffered from incontinence twice at the age of just 30, leaving him unable to control his bladder or bowel movements and unable to function sexually.
“For six months I had to use napkins like someone 50 years older than me because of 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. That was very upsetting.”
To end it all, Joe was told by doctors that he would probably have to use a catheter (a thin tube inserted into his bladder to empty it) for the rest of his life.
However, in the midst of his depression, Joe was taught a simple way to improve these problems using pelvic floor exercises.
The pelvic floor is made up of muscles and ligaments that support the bladder, rectum, and other tissues (such as the vagina). It’s usually discussed from a women’s health perspective, as childbirth weakens muscles and can lead to urinary incontinence.
But men also need a strong pelvic floor, which plays a role in erectile function, and this exercise is recommended for those who have had prostate surgery or are suffering from sexual dysfunction.
So should such training be noticed by everyone?
‘Most men don’t know what these muscles are, what they do or how to train them,’ says Ashwin Sridhar, consultant urologist at University College London Hospital. .
He believes all men over 50 should learn and perform pelvic floor muscle exercises to prevent future incontinence. This is especially important for people who are overweight, have asthma, or smoke.
All of these increase stress on the pelvic floor. This is due to asthma from coughing and smoking, which can cause coughing, but also because the toxic components in cigarettes weaken all the muscles, said Sridhar, who is also based at London’s Princess Grace Hospital. says. .
The muscles that control the opening and closing of the urethra and rectum may also weaken with age.
Lucy Burrows, pelvic health physiotherapist at Six Physio in London, says: ‘Many men don’t even know they have a pelvic floor.
“Women’s health is now being talked about more often, especially in terms of 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, first learned about the importance of the pelvic floor after a medical emergency.
He started experiencing back pain for no apparent reason last October, and within a few days it worsened to the point where he had difficulty getting 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 revealed he had an abscess in his back and was taken by ambulance to St Mary’s Hospital in West London for emergency surgery.
The abscess was pressing on the spinal cord and blocking nerve signals from the pelvic region. As a result, his bladder and intestines did not function properly and he lost sexual function.
To make matters worse, the abscess was causing sepsis. Sepsis is a potentially fatal condition in which the immune system overreacts to an infection and begins to damage healthy tissue.
Joe was later told he would “not make it” in 12 hours. He spent a month in the hospital, where the abscess had damaged nerve bundles at the base of his spine that control his bladder and bowel function, as well as sensation around his genitals and anus.
In addition to having to use a catheter to urinate, likely for the rest of his life, Joe has reduced bowel function and must manually remove stool.
He was left “shocked” by what had happened. “I felt a mixture 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 my surgery when I started learning about and exercising my pelvic floor muscles with my physical therapist.
“I still had the ability to control my pelvic floor, but it was very weak,” Joe says. “By doing this exercise three times a day, I learned how to strengthen my muscles and retrain my brain to recognize neural signals from that area.
“After about a month, my control started to return and my sexual function was almost back to normal.”
This exercise, which involves lifting and squeezing the pelvic floor muscles as if to prevent wind from passing through, was transformative.
He still needs a catheter and his bowels aren’t opening properly, but his control has improved enough that accidents are rare.
It is hoped that dietary changes, medications to stimulate the intestines, and irrigation (flushing with water) will further improve his intestinal function.
Surgery such as prostatectomy is a common cause of pelvic floor muscle weakness.
Incontinence after prostate cancer surgery is such a big problem, in fact, that Prostate Cancer UK has launched the Boys Need Bins campaign, putting incontinence pads in public men’s toilets so they can be disposed of discreetly. They are calling for the enactment of a law to install sanitary waste bins.
Heather Groake, a specialist nurse at the charity, said men often feel stuck at home because they don’t have a place to put their pads, leading to anxiety and depression.
She recommends starting pelvic floor muscle exercises four to six weeks before surgery to strengthen the muscles. This is because it is difficult to perform pelvic floor muscle exercises immediately after surgery due to bruising and pain. But it’s important not to overdo it, as your muscles won’t be able to function properly if you overwork them, says Heather Groke, who warns that more than three or four times a day can have the opposite effect. doing.
Physiotherapist Lucy Burrows explains that an overactive pelvic floor can cause chronic pain.
“When men contract their pelvic floor too much, it can cause pain in the lower abdomen, testicles, penis, and buttocks, as well as sexual dysfunction, constipation, and other intestinal problems,” she says.
But how can men know if they’re training the right muscles?
Heather Groark says the best way to do this is to stand in front of a mirror while exercising and notice that the scrotum and base of the penis lift slightly during the exercise.
Alternatively, place your finger just behind your scrotum. As you tighten, you should feel the muscle lift away from your fingers.
Once your technique is correct, you can perform the exercises while sitting, standing, or lying down.
Ideally, perform 10 times slowly, tensing your muscles for 10 seconds each time. Then she does 10 fast exercises, tightening her muscles for one second each time, she says.
Apps like Squeezy, which is approved by the NHS, provide handy reminders to exercise.
In addition to leaking urine when you cough, sneeze, laugh, or during high-impact exercise such as running, signs of a weak pelvic floor include urinating more than seven times a day (5 to 7 times is normal), all This includes feeling the need to urinate. It’s the time or feeling of not completely emptying your bladder, says Lucy Burrows.
Joe said he was “not thrilled” about using the catheter, but otherwise “pelvic floor muscle training has led to significant improvement.”
“I’m dating again and I’m going to be open about things early in a relationship. Now that I’ve learned about the importance of pelvic floor muscle training, it seems strange that this isn’t a regular topic of discussion among men.” It seems to me.
“For the average man, it’s useful for so many things. It feels like an easy thing to do.”
