Why Men’s Pelvic Health Matters More Than You Think. And why Jeremy Clarkson’s story has the world finally talking about it.

When Jeremy Clarkson, one of Britain's most recognisable television personalities, recently went public about his prostate cancer diagnosis, something shifted. Suddenly, conversations that had long been whispered behind closed doors, at GP waiting rooms and over pints that never quite reached the real subject, started happening out loud. Men across Ireland and the UK began asking their doctors about their prostates. And that is a very good thing.

At GW Pelvic Health, we want to keep that conversation going. Because prostate health is not just a medical issue. It is a quality of life issue, and pelvic health physiotherapy has a vital and often overlooked role to play at every stage of it.

What Is the Prostate and Why Does It Matter?

The prostate is a small, walnut-sized gland that sits just below the bladder in men. It plays a key role in the reproductive system, producing fluid that nourishes and transports sperm. Its position, wrapped closely around the urethra, also means that when things go wrong with the prostate, the effects are often felt quickly in terms of urinary and sexual function.

There are three main prostate conditions men need to be aware of:

• Benign Prostatic Hyperplasia (BPH): Non-cancerous enlargement of the prostate, extremely common with advancing age

• Prostatitis: Inflammation of the prostate, which can be acute or chronic and is a common cause of pelvic pain

• Prostate cancer: The most commonly diagnosed cancer in men in Ireland, with approximately 4,000 new diagnoses every year (Irish Cancer Society, 2021; Mater Private Network, 2024)

Benign Prostatic Hyperplasia (BPH): When the Prostate Grows

BPH is something most men will experience to some degree if they live long enough. As the prostate gland enlarges with age, it can compress the urethra and irritate the bladder, leading to a group of symptoms collectively known as Lower Urinary Tract Symptoms (LUTS) (Body Co Toronto, 2023). BPH is not cancer, and it does not increase the risk of prostate cancer, but it can have a very real impact on daily life.

Common symptoms of BPH include (Dr Barber Clinic, 2025):

• Needing to urinate frequently, especially at night (nocturia)

• A weak or slow urinary stream

• Difficulty starting to urinate (hesitancy)

• A feeling of incomplete bladder emptying

• Urgency: a sudden, strong urge to urinate that is difficult to control

• Post-void dribbling

When symptoms are mild, lifestyle modifications are recommended as a first-line approach: managing fluid intake, reducing caffeine and alcohol, and timed voiding (Paquette et al., 2025). When symptoms progress, medication or surgery may be considered. But at every stage, pelvic health physiotherapy has a role to play.

How Pelvic Health Physiotherapy Helps with BPH and Urinary Changes

Many men do not realise that the pelvic floor muscles sit in close relationship with the prostate, bladder, and urethra. When the prostate enlarges, men often unconsciously begin to brace and guard these muscles, leading to tightness, poor coordination, and symptoms that go above and beyond what the prostate itself is causing.

Pelvic Floor Muscle Training (PFMT) has been shown to be a first-choice therapy for overactive bladder in men, including those with BPH-related urinary storage symptoms (Huang et al., 2025). Clinical trials examining PFMT in men with BPH following surgery found significant improvements in urinary symptoms, erectile function scores, and quality of life (Huang et al., 2025).

A pelvic health physiotherapist can help by:

• Teaching correct pelvic floor activation: Many men are either too weak or, just as commonly, too tight in their pelvic floor. Assessment is key before prescribing exercises.

• Bladder retraining: Urgency suppression techniques, including timed voiding and relaxation strategies, to reduce urgency and frequency (Paquette et al., 2025)

• Relaxation techniques: Where muscles are overactive, learning to release and down-train the pelvic floor can reduce urgency, frequency, and bladder pressure

• Lifestyle guidance: Including fluid management, caffeine awareness, and postural habits that affect the bladder

Prostate Surgery: TURP and What Comes After

For men whose BPH symptoms are significant, or who have not responded to medication, surgery is often the next step. The most common surgical procedure is a Transurethral Resection of the Prostate (TURP), which involves removing a portion of the prostate tissue through the urethra, without any external incisions.

TURP can bring significant relief from urinary obstruction. However, research highlights that urinary incontinence remains a notable post-operative concern, with studies showing that up to 63% of patients who have undergone TURP reported some degree of urinary incontinence 12 months post-operatively (Ali et al., 2022).

Research confirms the benefit of pelvic floor rehabilitation clearly. A study of men following TURP found that those who received early pelvic floor muscle rehabilitation had (Body Co Toronto, 2023):

• Significantly fewer episodes of urinary incontinence and post-micturition dribbling in the first postoperative weeks

• A significant improvement in quality of life scores

• Significantly greater pelvic floor muscle strength after four weeks compared to those who did not receive physiotherapy

A pelvic health physiotherapist can support TURP recovery through:

• Correctly teaching pelvic floor exercises before or immediately after surgery

• Addressing post-micturition dribbling (a common and bothersome post-TURP complaint)

• Bladder retraining to manage urgency and frequency as the prostate cavity heals

• Monitoring recovery and progressing exercise programmes appropriately

Prostate Cancer: Pelvic Health Physiotherapy at Every Stage

Prostate cancer tends to grow slowly, and many men at diagnosis have no symptoms whatsoever (Beaumont RCSI Cancer Centre, 2021). This is exactly what makes awareness and early detection so crucial.

Getting Checked: What You Should Know

There is currently no national prostate cancer screening programme in Ireland (Beaumont RCSI Cancer Centre, 2021; Mater Private Network, 2024). That means men are not automatically invited for testing. This does not mean checking is discouraged. It means the conversation between you and your GP becomes even more important.

Who should consider getting checked?

• Men over 50 (Mater Private Network, 2024)

• Men over 45 with a family history of prostate cancer (Marie Keating Foundation, 2018)

• Men of African or African-Caribbean descent, who carry a higher risk (Irish Cancer Society, 2026)

Two main tools are used:

• PSA (Prostate Specific Antigen) blood test: Measures a protein produced by the prostate. Raised levels can indicate cancer, but can also reflect benign conditions like infection or enlarged prostate. Importantly, 2 out of 3 men with a raised PSA do not have prostate cancer (Irish Cancer Society, 2026).

• Digital Rectal Examination (DRE): A quick physical examination by your GP to feel for any abnormalities in the prostate (Irish Cancer Society, 2026).

If your GP has concerns, you may be referred to a Rapid Access Prostate Clinic (RAPC), where you can be seen by a urologist, with streamlined access to diagnostics (Mater Private Network, 2024; Ahern et al., 2024). The shared decision-making approach means your doctor will walk you through the benefits and risks of testing before anything begins.

Before Surgery: The Power of Prehabilitation

If prostate cancer is diagnosed and surgery (radical prostatectomy) is planned, one of the most valuable steps a man can take is starting pelvic health physiotherapy before the operation.

Known as prehabilitation, this approach prepares the pelvic floor muscles while they are still fully functional. A randomised controlled trial of 97 men undergoing radical prostatectomy found that those in the prehabilitation group demonstrated significantly less urinary leakage post-surgery and significantly improved pelvic floor muscle function at all follow-up time points, compared to those who did not complete prehabilitation (Milios, Ackland and Green, 2019). A systematic review of prehabilitation programmes prior to radical prostatectomy concluded that programmes combining pelvic floor exercises with aerobic and resistance training showed the best functional recovery and continence outcomes (Brea-Gómez et al., 2025).

After Surgery: Rehabilitation and Recovery

Up to 87% of men experience urinary incontinence in the immediate post-operative period following prostatectomy, and erectile dysfunction is also a significant concern (APTA Academy of Pelvic Health Physical Therapy, 2025). These are not conditions men simply have to accept.

Common post-prostatectomy symptoms treated with pelvic health physiotherapy include (Spell, 2025; Empower PT, 2025):

• Urinary incontinence (stress leakage with activity, urgency leakage)

• Post-micturition dribbling

• Pelvic pain and scar tissue restriction

• Erectile dysfunction and changes in sexual function

• Bowel dysfunction

Sexual Function: The Conversation Nobody Has

Sexual dysfunction following prostate treatment is one of the most common and least discussed consequences men face. It affects confidence, relationships, and overall wellbeing. Yet most men are never told that pelvic health physiotherapy can help.

The pelvic floor muscles play a direct role in sexual function. They support penile rigidity during erection, contribute to the force and sensation of orgasm, and are involved in ejaculatory control (Sahín, Demir and Kizilay, 2025). When these muscles are weak, overactive, or poorly coordinated, sexual function is affected.

A narrative review published in the International Journal of Impotence Research examining pelvic physiotherapy for male sexual dysfunction concluded that pelvic physical therapy is an evidence-based treatment for many pelvic floor disorders and sexual dysfunction in men (Sahín, Demir and Kizilay, 2025). Research has shown that an individualised pelvic floor muscle training programme can meaningfully improve erectile function, with a randomised controlled trial by Milios, Ackland and Green (2020) demonstrating significant improvement in erectile function scores in men who completed prehabilitative PFMT prior to and following radical prostatectomy.

Pelvic health physiotherapy for sexual function may include:

• Pelvic floor muscle training to improve vascular flow and neuromuscular control required for erection (Sahín, Demir and Kizilay, 2025)

• Biofeedback to help men understand and correctly activate the right muscles

• Manual therapy to address scar tissue, fascial restriction, and nerve sensitivity after surgery (Pelvic, Obstetric and Gynaecological Physiotherapy (POGP), 2021)

• Guidance on ejaculatory dysfunction, including premature or delayed ejaculation, which are also linked to pelvic floor coordination (Sahín, Demir and Kizilay, 2025)

• A biopsychosocial approach that acknowledges the psychological impact of sexual dysfunction alongside the physical (APTA Academy of Pelvic Health Physical Therapy, 2025)

Perineal and Pelvic Pain in Men

Pelvic pain in men is frequently misunderstood, under-diagnosed, and under-treated. It may present as pain or pressure in the perineum (the area between the scrotum and the anus), aching in the base of the penis, discomfort in the sit bones, or a deep, internal pelvic ache. It may be worse with sitting, after ejaculation, or during urination.

This type of pain often falls under the umbrella of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS), a diagnosis that affects up to 15% of men at some point in their lives (APTA Academy of Pelvic Health Physical Therapy, 2025). It is frequently linked to pelvic floor muscle dysfunction, not a bacterial infection or a structural prostate problem (Sukenick, 2025; Koch, 2025).

In men with overactive or hypertonic (too tight) pelvic floor muscles, the muscles go into a sustained pattern of guarding and tension. This can irritate the pudendal nerve, cause referred pain into the perineum and genitals, and create a cycle of pain that medications alone rarely break (Yani et al., 2022; Arkansas Urology, 2025).

The American Urological Association (AUA) guideline recommends that men with CP/CPPS should be assessed for a musculoskeletal source of pain through a standardised pelvic examination, and that pelvic floor physical therapy is an appropriate and recommended intervention (American Urological Association, 2025).

Pelvic health physiotherapy for perineal and pelvic pain addresses (Koch, 2025; Nickel et al., 2018):

• Trigger point release and manual therapy to tight, hypertonic pelvic floor muscles

• Breathing and relaxation retraining: learning to release the pelvic floor as part of natural breath and movement patterns

• Nerve mobilisation for pudendal neuralgia and referred pain

• Postural and movement retraining to reduce load on the pelvic floor

• Education: understanding the pain cycle and breaking it with self-management strategies

For many men, pelvic health physiotherapy is the first time anyone has examined and treated the pelvic floor as the source of their pain, rather than continuing to search for a prostate or urological explanation that cannot be found.

Breaking the Silence

Here is the honest truth: men are far less likely than women to seek help for pelvic floor problems. Stigma, embarrassment, and a general reluctance to talk about anything below the belt all play a role. When a high-profile figure like Jeremy Clarkson chooses to speak openly about his prostate cancer, it does something no awareness campaign can fully replicate. It normalises the conversation. It gives permission.

In Ireland, prostate cancer is the most commonly diagnosed cancer in men, with more cases each year than breast or lung cancer, and a survival rate of over 90% when caught early (Mater Private Network, 2024). The numbers make a compelling case for openness, for checking in with your GP, and for knowing that expert support is available throughout whatever journey follows a diagnosis.

But prostate health is not only about cancer. Whether the issue is a frustrating weak stream in the night from BPH, recovery after a TURP, managing incontinence after prostatectomy, reclaiming sexual confidence, or finally finding answers for years of unexplained pelvic pain, pelvic health physiotherapy has something to offer at every single stage.

Concerned about your prostate or pelvic health?

Whether you’re living with urinary symptoms, recovering after prostate surgery, managing pelvic pain, or simply want expert advice before treatment, specialist pelvic health physiotherapy can help.

At GW Pelvic Health, we provide confidential, evidence-based care tailored to every stage of your journey.

Book an appointment today or get in touch to learn how we can help.

📞 01 963 6936

✉ gwpelvichealth@gmail.com

🌐 gwpelvichealth.com

And if you are a man reading this who has been putting off that conversation with your GP, let this be the nudge you needed. Your health is worth talking about.

> A note on PSA testing in Ireland: PSA testing is available on request through your GP as part of a shared decision-making process. If you are over 45 and have no symptoms but want to discuss your prostate health, speak to your GP. They will guide you through the benefits and limitations of the test (Beaumont RCSI Cancer Centre, 2021).

References

Ahern, D., Buckley, C., Courtney, M., Galvin, N. and Kirby, M. (2024) 'Are we there yet? Closing the gap of prostate cancer presentation disparities in Ireland', Archives of Public Health, 82(1). Available at: https://link.springer.com/article/10.1186/s13690-024-01439-6 (Accessed: 29 June 2026).

Ali, A.S., Bhatt, J.R. and Kulkarni, M. (2022) 'A narrative review of pelvic floor muscle training in the management of incontinence following prostate treatment', Translational Andrology and Urology, 11(10). Available at: https://tau.amegroups.org/article/view/99491/html (Accessed: 29 June 2026).

American Urological Association (AUA) (2025) Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline. Available at: https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain (Accessed: 29 June 2026).

APTA Academy of Pelvic Health Physical Therapy (2025) Evidence Highlight: Male Pelvic Health. Available at: https://www.aptapelvichealth.org/evidence-highlight-male-pelvic-health (Accessed: 29 June 2026).

Arkansas Urology (2025) Male Pelvic & Perineal Pain (CP/CPPS): Symptoms & Treatment. Available at: https://arkansasurology.com/male-pelvic-pain-causes-and-treatment (Accessed: 29 June 2026).

Beaumont RCSI Cancer Centre (2021) Understanding Early Prostate Cancer [Patient booklet]. Available at: https://beaumontrcsicancercentre.ie/wp-content/uploads/2021/12/understanding_early_prostate_cancer1.pdf (Accessed: 29 June 2026).

Body Co Toronto (2023) 'The Role of Pelvic Floor Physiotherapy in Prostate Health', Body Co Blog. Available at: https://www.bodycotoronto.com/blog/pelvic-floor-physiotherapy-for-prostate-health (Accessed: 29 June 2026).

Brea-Gómez, B., Pazo-Palacios, R. and Pérez-Gisbert, L. (2025) 'Pelvic Floor Muscle Training with Preoperative Biofeedback in Patients with Postprostatectomy Incontinence: A Systematic Review and Meta-analysis of Randomised Clinical Trials', European Urology Focus. Available at: https://uroweb.ru/sites/default/files/26.05_(1).pdf (Accessed: 29 June 2026).

Bourne, C. and Constable, J. (2021) Is (P)rehabilitation Effective for Men Undergoing Prostatectomy? Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Available at: https://thepogp.co.uk/_userfiles/pages/files/Is%20(p)rehabilitation%20effective%20for%20men%20undergoing%20prostatectomy%20-%20Clare%20Bourne%20and%20Jenny%20Constable%20Pelvic%20Physiotherapists.pdf (Accessed: 29 June 2026).

Dr Barber Clinic (2025) Benign Prostatic Hyperplasia (BPH) and Dry Needling. Available at: https://drbarberclinic.com/benign-prostatic-hyperplasia-dry-needling (Accessed: 29 June 2026).

Empower PT NYC (2025) Maximizing Recovery: The Benefits of Pelvic Floor Physical Therapy for Prostate Surgery Patients. Available at: https://www.empowerpt.nyc/post/maximizing-recovery-the-benefits-of-pelvic-floor-physical-therapy-for-prostate-surgery-patients (Accessed: 29 June 2026).

Huang, Y. et al. (2025) 'Application effect of pelvic floor function exercise based on health belief model in patients with benign prostatic hyperplasia after electrocautery', PubMed Central. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12504352 (Accessed: 29 June 2026).

Irish Cancer Society (2026) Prostate Cancer Diagnosis and Tests. Available at: https://www.cancer.ie/cancer-information/cancer-types/prostate-cancer/prostate-cancer-diagnosis-and-tests (Accessed: 29 June 2026).

Koch, K. (2025) 'Pelvic Floor Physical Therapy for Prostatitis', Sage PT Denver Blog. Available at: https://www.sageptdenver.com/post/pelvic-floor-physical-therapy-for-prostatitis (Accessed: 29 June 2026).

Marie Keating Foundation (2018) Prostate Cancer: From Diagnosis to Recovery [Patient booklet]. Available at: https://mariekeating.ie/wp-content/uploads/2018/11/FINAL-Marie-Keating-PROSTATE-Cancer-booklet.pdf (Accessed: 29 June 2026).

Mater Private Network (2024) What You Should Know About Prostate Cancer: Expert Advice from Mr Gregory Nason. Available at: https://www.materprivate.ie/health-information/helpful-tips/prostate-cancer-expert-advice-from-mr.-gregory-nason (Accessed: 29 June 2026).

Milios, J.E., Ackland, T.R. and Green, D.J. (2019) 'Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence', BMC Urology, 19(1), p. 116. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6858748 (Accessed: 29 June 2026).

Milios, J.E., Ackland, T.R. and Green, D.J. (2020) 'Pelvic floor muscle training and erectile dysfunction in radical prostatectomy: a randomized controlled trial investigating a non-invasive addition to penile rehabilitation', Sexual Medicine, 8(3), pp. 414–421. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7471070 (Accessed: 29 June 2026).

Moradi, M. et al. (2023) 'Pelvic Floor Rehabilitation After Prostatectomy: Baseline Severity as a Predictor of Improvement — A Prospective Cohort Study', PubMed Central. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12193967 (Accessed: 29 June 2026).

Nickel, J.C. et al. (2018) 'Management of chronic prostatitis/chronic pelvic pain syndrome', PubMed Central. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6040620 (Accessed: 29 June 2026).

O'Brien, P. et al. (2025) 'Lived Experience of Men with Prostate Cancer in Ireland: A Qualitative Descriptive Study', PubMed Central. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12071202 (Accessed: 29 June 2026).

Paquette, I. et al. (2025) 'Management and Treatment of Benign Prostatic Hyperplasia Symptoms: Current Insights', PubMed Central. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12497387 (Accessed: 29 June 2026).

Preoperative Exercise Interventions to Optimize Continence (2021) PubMed Central. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8030653 (Accessed: 29 June 2026).

Sahín, S.C., Demir, O. and Kizilay, F. (2025) 'Pelvic physical therapy for male sexual disorders: a narrative review', International Journal of Impotence Research. Available at: https://www.nature.com/articles/s41443-025-01034-5 (Accessed: 29 June 2026).

Spell, J. (2025) 'The Role of Pelvic Floor Physical Therapy in Recovery Post-Prostatectomy', Performance Therapy Blog. Available at: https://www.performancetherapyms.com/post/pelvic-floor-physical-therapy-post-prostatectomy (Accessed: 29 June 2026).

Sukenick, R. (2025) 'Pelvic Floor Physical Therapy for Chronic Prostatitis in Men', Foundations Physical Therapy Blog. Available at: https://foundations-pt.com/pelvic-floor-physical-therapy-for-chronic-prostatitis-in-men (Accessed: 29 June 2026).

Yani, M.S. et al. (2022) 'Impaired Ability to Relax Pelvic Floor Muscles in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome', PubMed Central. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9618172 (Accessed: 29 June 2026).