Men’s Guide to Pelvic Floor Health: Symptoms, Causes, and Solutions

The health of the pelvic floor is often considered a uniquely female-centric concern, but men have a pelvic floor as well, and dysfunction in the pelvic floor can lead to incontinence, erectile dysfunction, and chronic pain.

Knowing this, prioritising pelvic floor health is likewise critical for men. Explore the signs of pelvic floor dysfunction, the many areas of life it can impact, and what your next steps should be.

What Is the Pelvic Floor?

The pelvic floor comprises a group of muscles and connective tissues surrounding the bladder, prostate, penis, and rectum in a sling-like fashion. As a set of muscles, they have three very important actions: contracting, relaxing, and stretching.

The ability of the pelvic floor to contract is what helps to maintain bowel and bladder control. In comparison, the ability of the muscles to relax and stretch is what allows us to empty our bowels or bladder. If the muscles struggle with any of these areas, dysfunction within the pelvic floor can arise.

Signs Of a Weak Pelvic Floor

Understanding the role of the pelvic floor muscles in contracting and relaxing to control bowel and bladder function can help explain the signs of a pelvic floor in poor health.

First, if your pelvic floor muscles are too weak, you may experience incontinence. This is because one responsibility of the pelvic floor muscles is to give you control over when to empty your bowel and bladder and when to “hold it.” If the muscles are weak, they do not have as much control over the passages that urine and faeces flow through (also known as “sphincter function”), leading to incontinence.

On the opposite end of the spectrum, if the pelvic floor muscles are too tense and cannot relax, you may be unable to completely empty your bowel or bladder when using the restroom. This may cause you to frequently feel the need to use the bathroom, yet very little comes out when you do. If this continues, it may contribute to constipation.

The implications of a weak pelvic floor extend beyond bowel and bladder control, as well. Men with pelvic floor dysfunction may experience erectile dysfunction, which is difficulty with getting or maintaining an erection. This can then extend to problems with fertility, sexual satisfaction, and mental health. Furthermore, for those with a frequent urge to urinate, especially during the night, exhaustion can occur due to the frequent sleep interruptions.

Signs of poor pelvic floor health in men may include:

Incontinence

Constipation

Erectile dysfunction

Chronic pain

Painful urination

Frequent need to urinate

Starting and stopping urinating several times while going to the bathroom
Frequent soiling of undergarment

Pelvic pain in men is often misdiagnosed. As a result, many men may experience these symptoms but are unsure of how to address them. This can, understandably, be frustrating.

What Causes Pelvic Floor Dysfunction?

If you have symptoms of poor pelvic floor health, it is natural to wonder what can cause this dysfunction to develop. As it stands, there are many different factors for its development, which contributes to the large number of men in Hong Kong who suffer from pelvic floor dysfunction.

Some of the contributors to male pelvic floor dysfunction include:

Aging - As men get older, their pelvic floor muscles naturally weaken.

Being overweight - Excess weight can put additional pressure on the male pelvic floor, leading to weakened muscles.

Surgery to remove the prostate (Prostatectomy) - This procedure can lead to weakened pelvic floor muscles.

Straining from constipation or frequent coughing - The repeated strain on the pelvic floor muscles can cause them to weaken over time.

Chronic pain - Chronic pain in the back or hips can cause tense or tight pelvic floor muscles.

High-impact sports – High impact sports can cause an increase in intra-abdominal pressure, leading to potential pelvic floor dysfunction, muscle laxity, and a higher risk of injury in the pelvic region.
Pelvic trauma – Direct damage to the pelvic floor muscles and tissues can lead to incontinence, sexual dysfunction, and chronic pain.

When symptoms first appear, many men attribute them to normal changes associated with aging. However, working with a pelvic floor physiotherapist can help mitigate symptoms, regardless of their cause. Even if it is a by-product of aging, progress can be made to reduce the symptoms and restore quality of life.

How Men Can Strengthen Their Pelvic Floor

For men who are struggling with pelvic floor dysfunction, working with a pelvic floor physiotherapist can help improve pelvic muscle strength and control.

The treatment for each patient will be individualised, often guided by your symptoms. Some men may need to work on strengthening their pelvic floor muscles, while others may need to learn how to relax and stretch them.

One technique used in pelvic floor physiotherapy is diaphragmatic breathing, which is an abdominal breathing technique used to calm the nervous system. When completing this breathing technique, the abdominal wall expands, and the pelvic floor muscles relax.

Kegel exercises are another option within pelvic floor physiotherapy. They are completed by tightening and then releasing the muscles that control urine flow. However, on occasions, in many cases, Kegel exercises can make symptoms of bladder urgency or pelvic pain worse, which is why it is recommended to discuss a treatment pathway with a physiotherapist and allow them to suggest exercises. This risk is often tied to incorrect technique or lack of professional guidance.

Supporting Your Pelvic Floor

The pelvic floor is a complex network of muscles that surrounds the bladder, bowel, and genitals. While it is most often considered in women, men have it as well, and its health in men is just as important.

A weak pelvic floor can lead to incontinence issues, bladder urgency, erectile dysfunction, mental health problems, and pain. Reaching out to your family doctor is a great first step in finding a treatment pathway. Your doctor can assess your symptoms, rule out underlying conditions, and refer you to the appropriate specialists—such as a pelvic floor physiotherapist—if needed. This helps address the dysfunction at its core and allows for the development of a personalised treatment plan to alleviate your discomfort.

Dr Ray SH Ng

Family Medicine, General Practice, Sports Medicine

MBBS (London)
MRCP (UK)
MRCGP (UK)
PgDipPD (Cardiff)

View Profile

Health Articles by Dr Ray SH Ng

Interviews

Reference

Toprak, N., Sen, S. and Varhan, B. (2022). The role of diaphragmatic breathing exercise on urinary incontinence treatment: A pilot study. Journal of Bodywork and Movement Therapies, 29, pp.146–153. doi:https://doi.org/10.1016/j.jbmt.2021.10.002.
Yaacov, D., Nelinger, G. and Kalichman, L. (2022). The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review. Sexual Medicine Reviews, 10(1), pp.162–167. doi:https://doi.org/10.1016/j.sxmr.2021.02.001.
Janesh Lakhoo, Khatri, G., Elsayed, R.F., Chernyak, V., Olpin, J., Steiner, A., Tammisetti, V.S., Sundaram, K.M. and Arora, S.S. (2019). MRI of the Male Pelvic Floor. Radiographics, 39(7), pp.2003–2022. doi:https://doi.org/10.1148/rg.2019190064.
Dorey, G. (2005). Restoring pelvic floor function in men: review of RCTs. British Journal of Nursing, 14(19), pp.1014–1021. doi:https://doi.org/10.12968/bjon.2005.14.19.19944.
Puppo, V., J. Abdulcadir, A. Mannucci, Catania, L. and D. Abdulcadir (2008). T09-P-13 The importance of the Kegel exercises for the erection of the male and female erectile organs (male and female penis). Sexologies, 17, pp.S136–S136. doi:https://doi.org/10.1016/s1158-1360(08)72894-9.