After 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, had to deal with double incontinence, meaning he had no control over his bladder or bowel movements, and he was unable to function sexually.
‘For six months, I had to use pads — like someone 50 years older than me — because I was having leakages 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 upsetting.’
To cap it all, Joe was told by doctors that he would probably have to use catheters (thin tubes inserted into his bladder to empty it) for life.
After 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
But amid the gloom, Joe was shown a simple way to help improve these problems, using pelvic floor exercises.
The pelvic floor is made up of muscles and ligaments that support the bladder, the rectum and other tissues (such as the vagina). It’s usually discussed in terms of women’s health, as 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 those who have had prostate surgery or who suffer from sexual dysfunction.
So 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.
He thinks all men over 50 should learn and do pelvic floor exercises to prevent incontinence later in life. This is especially important for those who are overweight, have asthma or smoke.
These all increase stress on the pelvic floor — asthma because of coughing, and smoking because it can lead to coughing but also because it weakens all muscles due to toxic ingredients in cigarettes, says Mr Sridhar, who is also based 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, a pelvic health physiotherapist at Six Physio in London, says: ‘Many men don’t even know they have a pelvic floor.
At just 30, Joe, from London , had to deal with double incontinence, meaning he had no control over his bladder or bowel movements, and he was unable to function sexually (stock image)
‘It’s spoken about much more in terms of women’s health, especially in relation to 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 events management, learned about the importance of the pelvic floor only after a medical emergency.
He had started to experience lower back pain for no obvious 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 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 emergency surgery.
The abscess was pressing on his spinal cord, blocking the nerve signals from his pelvic area. As a result, his bladder and bowel were not working properly, and he’d lost sexual function.
Worse, the abscess had triggered sepsis — a potentially deadly condition where the immune system overreacts to an infection and begins damaging healthy tissue.
Joe was later told that he’d been around 12 hours away ‘from not making it’. He spent a month in hospital, but the abscess had damaged the bundle of nerves at the bottom of the spine which control bladder and bowel function and sensation around the genitals and anus.
As well as having to use catheters to pass urine, probably for the rest of his life, poor bowel function means Joe also has to remove stools manually.
He was left ‘shell shocked’ by what had happened. ‘It was a confusing mix of despair and gratitude,’ he says. ‘For a while I was convinced I would be single for ever; but I also felt grateful to be alive.’
The turning point came two months after surgery when he started learning about pelvic floor muscles and doing the exercises with a physiotherapist.
‘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 learnt how to retrain my brain to recognise nerve signals from the area.
‘Around a month later, my control started to return and my sexual function is nearly back to what it was.’
The exercises, which involve lifting and squeezing the pelvic floor muscles as if you were trying to stop yourself from passing wind, have been transformative.
He still needs catheters and his bowel doesn’t open properly, but his control has improved enough that he rarely has accidents.
The hope is that his bowel function will improve further with 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 issue that Prostate Cancer UK has launched the Boys Need Bins campaign, calling for legislation to provide sanitary bins in men’s public toilets so incontinence pads can be discreetly disposed of.
Men often feel they cannot leave their house because there is nowhere to put the pads, causing anxiety and depression, says Heather Groarke, a specialist nurse from the charity.
She recommends starting pelvic floor exercises four to six weeks before surgery to strengthen the muscles, as these can be harder to do immediately after surgery, due to bruising and pain. However, it’s crucial not to overdo it as the muscles cannot function properly when overworked, says Heather Groarke, warning that 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 while he’s ‘not thrilled’ 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 bowel problems,’ she says.
But how can a man tell if he is exercising the correct muscle?
Heather Groarke says the best way to do this is to stand in front of a mirror while performing the exercises, and check that the scrotum and the base of the penis lift up slightly as you do them.
Or put your fingers just behind the scrotum: you should feel the muscles lift up away from your fingers when you tighten them.
Once the technique is right, the exercises can be done while sitting, standing or lying down.
Ideally, you perform ten of them slowly, when the muscles are tightened for ten seconds every time; then ten fast ones, tightening the muscles for one second each time, she says.
Apps including Squeezy, endorsed by the NHS, offer useful reminders to do the exercises.
As well as leaking when coughing, sneezing, laughing or during impact exercises such as running, the signs of a weak pelvic floor include urinating more than seven times during the day (between five to seven times is normal), feeling the need to urinate all the time or feeling that you have not fully emptied your bladder, says Lucy Burrows.
Joe says that while he’s ‘not thrilled’ 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 in a relationship. Now that I’m educated about the importance of pelvic floor exercises, it seems crazy that this isn’t something which is regularly discussed with men.
‘For the average man, it can help with so many things. Doing them feels like a no-brainer.’