Pelvic Floor Muscle Exercises and Advice for Men

Why are my pelvic floor muscles important?

Your pelvic floor muscles are important for bladder and bowel control. These muscles help to keep the bladder and bowel openings closed to prevent leakage of urine, faeces or wind. They also relax to allow the passage of urine and faeces out of the body. Your pelvic floor muscles are also important for sexual function. Good pelvic floor muscles help to maintain an erection, and may prevent premature ejaculation. Men of all ages can suffer from incontinence or erectile dysfunction. Exercising your pelvic floor muscles may help these problems.

Where are my pelvic floor muscles?

The pelvic floor is a sheet of muscle and connective tissue (fascia) that forms the floor of the pelvis. The pelvic floor muscles stretch from the pubic bone at the front to the coccyx/tailbone behind and to the inside walls of the pelvis, forming a broad muscular support across the base of the pelvis. Sphincters/ valves at the base of the bladder and underneath the prostate gland help to prevent urine leakage. The anal sphincter at the base of the back passage maintains bowel control. Importantly, portions of the pelvic floor muscle wrap around these valves to assist them in staying closed.

Why do pelvic floor muscles become weak or dysfunctional?

• Prostate surgery, for example a prostatectomy or TURP (transurethral resection of prostate), may affect the pelvic floor and its delicate nerve supply. Pelvic radiation therapy may have similar effects.
• Poor physical fitness due to a lack of regular exercise or being overweight may lead to poor muscle tone and excess strain on the pelvic floor muscles.
• Chronic constipation, prolonged heavy lifting or a chronic cough may also stretch the pelvic floor muscles, their nerve supply and supporting tissues.
• Certain conditions, for example, multiple sclerosis (MS), stroke and diabetes may affect the nerve supply to the muscles.
• Injury to the perineum (the area from the base of the penis to the back passage) by a direct blow or prolonged pressure e.g. cycling for long periods. 

Symptoms

Symptoms of a weak pelvic floor may include:

• Stress urinary incontinence: leakage during activities such as coughing, laughing, sneezing or sports.
• Urinary urgency/urinary urge incontinence: a sudden feeling that you need to rush to the toilet that may also result in leakage.
• Bowel/anal incontinence: accidental leakage from the bowel of faeces, or difficulty in controlling wind.
• Post-micturition dribble: leakage of a few drops of urine after you have finished passing urine.
• Erectile dysfunction: not being able to gain or maintain an erection.
• Premature ejaculation: ejaculation during sexual activity sooner than you/ your partner would like

Pelvic floor muscle exercises may be helpful for all of the symptoms listed above. It is useful to get into a good habit of doing them, even if you don’t have symptoms. A physiotherapist or other health professional may have already given you pelvic floor muscle exercises; or you can use the following advice to get your pelvic floor muscles working.

Working your pelvic floor muscles

It is important that you get the right muscles working in the right way.

Sit comfortably with your thighs, buttocks and tummy relaxed. Squeeze and lift from the front by either imagining you are trying to stop yourself from passing urine, or trying to shorten/draw your penis up and inwards. Now try lifting the muscles from the back as if stopping the escape of wind.

When you feel you have the hang of it, try lifting the front and back together. Don’t worry if you find it too difficult, after some practice you will find the method that is easiest and most comfortable for you. This is a pelvic floor muscle contraction.

To check that your pelvic floor muscles are working correctly: 

• Place your fingers on your perineum. You should feel the perineum lift upwards as you contract your muscles.
• Stand in front of a mirror; when you do a pelvic floor muscle contraction you should see the base of your penis draw inwards and your testicles/ scrotum lift

Try not to hold your breath while you contract your pelvic floor. You are more likely to breathe easily if you lift your pelvic floor on your out-breath. Do not actively clench your buttocks, but don’t be concerned if you feel a tightening in your buttocks and/or lower abdomen at the same time. This is normal.

If you are unable to feel a definite tightening in the pelvic floor muscles, you should consider seeking professional advice (see p9).

Your pelvic floor muscle exercise programme

You will need to do some long and short lifts

• Lift your pelvic floor muscles in, and count how many seconds you can comfortably hold on for. Now see how many times you can repeat this length of lift. This is the starting point for your exercises (e.g. if you can hold on for 5 seconds and can repeat this 6 times before your muscles tire, start your programme by doing 6 lifts held for 5 seconds each). To allow the muscles to recover, rest for at least 5 seconds between contractions before doing the next one.
• Now count how many short rhythmic lifts you can do before the muscles start to tire (e.g. if you can do 8, then your exercise programme will be 8 fast lifts after each set of long lifts).
• You should do your long and short contractions at least 3 times each day. You may find it easier to start your exercise programme when you are sitting or lying down. As your muscles improve, aim to do your exercises in other positions such as standing up.
• Make sure that you let your muscles fully relax after each long or short contraction, before repeating the squeeze up.

Progressing your pelvic floor muscles

Gradually increase the length and the number of repetitions over the next few weeks. Most men need to aim for up to 10 long squeezes, held for up to 10 seconds each, followed by up to 10 short squeezes. For some, this will be too easy; for others, this may be too difficult. Start with what you feel is a comfortable length of time for you to squeeze.

Tighten your pelvic floor muscles before and during any activity that makes you leak (e.g. coughing, sneezing, lifting or rising from sitting), so that this becomes an automatic habit.

After urinating, tighten your pelvic floor muscles strongly to empty the last drops of urine out. This may help to stop post-micturition dribble.

If you are sexually active, tighten your pelvic floor muscles during intercourse to maintain the quality of your erection.

Pelvic floor exercises are not a ‘quick fix’. It is important that you continue with your exercises even if they do not seem to be helping. If you practice your pelvic floor muscle exercises as above, you should notice an improvement in 3 - 6 months. Further advice is available from a specialist physiotherapist.

Remembering to exercise

It is easy to forget to do your pelvic floor muscle exercises. Try to make sure your exercises become part of your daily routine - just like brushing your teeth. You should continue doing the exercises on a regular basis for the rest of your life.

• Here are some suggestions to help you to remember:
• Use coloured stickers or reminder notes around the house or at work.
• Do your exercises after you have emptied your bladder.
• Set a reminder on your phone.
• There are some excellent apps to download to help you. Search for ’male pelvic floor exercise’ in your app store.

Preventing problems

Tighten your pelvic floor muscles before you do anything that may put them under pressure, such as lifting, coughing or sneezing.

Being overweight puts extra strain on your pelvic floor muscles. Your symptoms may improve if you lose weight. Straining to empty your bowels (constipation) may also weaken your pelvic floor muscles. If you are often constipated, you may need to seek advice from a health professional/pelvic floor physiotherapist.

If you ride a bicycle for long periods, make sure that you raise yourself off the seat at regular intervals to take the pressure off your perineum. Consider wearing padded shorts. Special saddles have been designed to help avoid this problem.

If your ability to follow the advice in this booklet is affected by any health problem or disability, contact your local specialist physiotherapist, who will be able to assess you and offer specific alternatives suitable for your needs.