Pelvic Floor Physical Therapy for Men

The Male Pelvic Floor's Functions:

• Urinary control: Helps maintain continence and control urine flow
• Bowel control: Supports fecal continence
• Erectile function: Pelvic floor muscles contribute to erections and rigidity
• Ejaculation: Rhythmic contractions during orgasm
• Core stability: Works with abdominal, hip, and back muscles
• Prostate support: Surrounds and supports the prostate gland

Before strengthening, you need to identify the correct muscles. Here are several methods:

Method 1: Stop the Stream (for identification only)

• While urinating, try to stop or slow the urine flow
• The muscles you use are part of your pelvic floor
• Important: Only do this once to identify the muscles—don't practice Kegels while urinating

Method 2: Lift the Testicles

• Try to lift your testicles using only internal muscles (no hands!)
• You should see the base of the penis draw in slightly and testicles lift
• This is your pelvic floor contracting

Method 3: Shorten the Penis

• Try to make your penis retract or "shorten" without using your hands
• Imagine pulling the penis inward toward your body
• This engages the pelvic floor muscles

Method 4: Tighten the Anus

• Squeeze as if trying to hold in gas
• You should feel a tightening around the anus and lifting sensation

Keys to Effective Male Kegels:

• Breathe normally — never hold your breath
• Isolate the pelvic floor — don't clench buttocks or abs
• Visualize the lift — imagine drawing everything up and in
• Be consistent — results take 6-12 weeks of daily practice
• Quality over quantity — one good contraction beats ten weak ones

Exercise 3: Bridge with Kegel

1. Lie on your back, knees bent, feet flat on floor
2. Engage your pelvic floor muscles
3. Lift your hips into a bridge while maintaining the Kegel
4. Hold for 5-10 seconds at the top
5. Lower slowly while releasing the pelvic floor
6. Repeat 10-15 times

Benefit: Integrates pelvic floor with hip and core muscles for functional strength

Exercise 4: Standing Kegels

1. Stand with feet hip-width apart
2. Contract your pelvic floor (lift and squeeze)
3. Hold for 5-10 seconds
4. Release and repeat
5. Progress to doing these while walking

Benefit: Trains the muscles in functional positions—this is how you'll use them in daily life

Exercise 5: Squats with Pelvic Floor Engagement

1. Stand with feet shoulder-width apart
2. As you lower into a squat, let your pelvic floor relax
3. As you stand up, contract and lift your pelvic floor
4. Repeat 10-15 times

Benefit: Builds coordinated strength for lifting and daily activities

Exercise 6: Diaphragmatic Breathing with Pelvic Floor

1. Lie on your back or sit comfortably
2. Inhale: Breathe deeply into your belly; let your pelvic floor gently relax
3. Exhale: As you breathe out, gently engage and lift your pelvic floor
4. Practice for 3-5 minutes daily

Benefit: Improves coordination and awareness; essential for those with tight pelvic floors

"The Knack" is a technique where you contract your pelvic floor just before and during activities that cause leakage. This is especially important after prostate surgery.

How to Use The Knack:

1. Anticipate the triggering activity
2. Contract your pelvic floor just before the activity
3. Hold through the activity
4. Release after

Use The Knack When:

• Standing up from sitting
• Coughing or sneezing
• Lifting anything
• Bending over
• Laughing
• Changing positions

This technique can significantly reduce or eliminate stress incontinence episodes, especially after prostate surgery!

Urinary incontinence after prostatectomy (prostate removal) is common but often temporary. Pelvic floor exercises are the first-line treatment and can dramatically improve recovery.

Why Incontinence Occurs After Prostatectomy:

• The internal urethral sphincter (part of the prostate) is removed
• Continence now depends primarily on the external sphincter and pelvic floor
• These muscles need to be strengthened to compensate

Timeline for Recovery:

Timeframe	What to Expect
Catheter removal	Most men have significant leakage initially
1-3 months	Gradual improvement; many men regain nighttime control first
3-6 months	Significant improvement continues; daytime control improves
6-12 months	Most men achieve satisfactory continence; ~95% are pad-free or using 1 security pad

Research shows that pelvic floor exercises can improve erectile function by strengthening the muscles that help maintain blood flow in the penis during erection.

How the Pelvic Floor Supports Erections:

• The ischiocavernosus and bulbocavernosus muscles surround the base of the penis
• When contracted, they compress veins and help trap blood in the penis
• Stronger muscles = better rigidity and maintenance of erection

Exercise Protocol for ED:

• Perform Kegels 3 times daily (same exercises as above)
• Focus on maximal contractions — squeeze as hard as possible
• Hold for 5-10 seconds, fully release
• Studies show improvement after 3-6 months of consistent practice
• Can be combined with other ED treatments (PDE5 inhibitors, etc.)

Important: Men with chronic pelvic pain syndrome (CPPS/chronic prostatitis) often have hypertonic (tight) pelvic floors. For these men, relaxation is as important—or more important—than strengthening.

Relaxation Exercise 1: Deep Belly Breathing

• Lie on your back with knees supported
• Place one hand on your belly
• Breathe in slowly; let your belly rise and pelvic floor relax/descend
• Exhale slowly and completely
• Practice 5-10 minutes daily

Relaxation Exercise 2: Happy Baby Pose

• Lie on your back
• Bring knees toward armpits
• Hold outer edges of feet
• Gently rock side to side
• Breathe deeply and focus on releasing the pelvic floor
• Hold for 1-3 minutes

Relaxation Exercise 3: Reverse Kegels

• Instead of squeezing, focus on gently bulging/releasing the pelvic floor
• Imagine the muscles opening and dropping
• Hold the release for 5-10 seconds
• This teaches chronically tight muscles to let go

Relaxation Exercise 4: Child's Pose

• Kneel, then fold forward with arms extended
• Rest forehead on floor or pillow
• Breathe into your belly and low back
• Allow complete pelvic floor relaxation
• Hold for 2-5 minutes

General Strengthening Program

Time	Exercise
Morning	10-15 slow Kegels (hold 10 sec), 10-15 quick flicks
Afternoon	10-15 slow Kegels, 10-15 quick flicks, practice standing
Evening	10-15 slow Kegels, 10-15 quick flicks, 10 bridges with Kegel
Throughout Day	Use "The Knack" before all triggering activities

For Pelvic Pain (add relaxation)

• Morning: 5 min deep breathing, 5-10 gentle Kegels
• Afternoon: 5 min child's pose or happy baby stretch
• Evening: 10 min relaxation routine (breathing + stretches)
• Focus on relaxation more than strengthening

Consider seeing a pelvic floor physical therapist if:

• You're not sure if you're doing the exercises correctly
• You have pelvic pain or pain with the exercises
• Incontinence doesn't improve after 2-3 months post-surgery
• You have chronic prostatitis/pelvic pain syndrome
• You experience pain with erection or ejaculation
• You need biofeedback to learn proper muscle activation

A pelvic floor physical therapist can perform an assessment, provide real-time feedback, and create a personalized treatment plan.

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