The male pelvic floor - what, where, how?
Most men are unaware that they also have a pelvic floor. Commonly referred to as "women's muscles" due to the effects of childbirth, and secondary to Men's Health being in it's infancy, we have a long way to go to correct this view.
However, although not as common an occurrence, men too can have problems with their pelvic floor muscles. Most commonly as a result of prostate issues but also secondary to pelvic trauma, sports injuries (eg. groin strains, sacroiliac joint dysfunction) and surgery.
Pelvic floor muscle dysfunction will reveal itself as continence issues (bladder or bowel), erectile dysfunction, pelvic pain or ongoing/non-resolving low back, pelvic, groin or hip pain.
What are the pelvic floor muscles?
Pelvic floor muscles form the base of the pelvis. They have multiple functions:
Form the anal sphincter – thus aid control of wind and faeces
Help to maintain urinary continence through a “pincer effect” across the urethra (the tube that extends from the bladder to the end of the penis to transport urine)
Aid erectile function and ejaculation
Form an essential component of the “core unit” i.e. core stability
Core stability is a generically used term for using your abdominal muscles to brace your trunk to make it rigid during exercises such as the plank and double leg lifts. However, true core stability is much more refined than that.
The core muscles are the deep abdominal (transverse abdominis) and deep back (multifidus) muscles together with the diaphragm and the pelvic floor muscles. They work together as a coordinated unit to support the trunk at all times, not just under heavy load.
Inside the core unit is the abdominal cavity. The pressure within the abdominal cavity is known as the intra-abdominal pressure (IAP). At rest the IAP is relatively low but it increases with activity. For example, when lifting heavy weights (either functionally at work, or in the gym) there is a massive increase in IAP as the muscles of the trunk stiffen to form a rigid base for the upper and lower limbs to work off. The same occurs during the plank exercise, or double leg lifts and many other similar exercises.
Now if one component of this unit is dysfunctional, the pressure will try to escape through the path of least resistance. That may be the pelvic floor (causing haemorrhoids, anal prolapse, incontinence or erectile dysfunction), or the abdominals (causing hernias). It may also cause low back or pelvic girdle pain
Where are the pelvic floor muscles?
Due to the obvious anatomical differences in men, the pelvic floor muscles are designed a little differently than in women but are basically the same. They span the gap between the pubic bone at the front (the hard bit of bone just above the base of the penis) and the coccyx (tail bone) at the back and also extend out sideways to the inside of the bones you sit on. You can see this in the adjacent picture which is looking up at the pelvic floor muscles and pelvis from below (skin has been removed). The muscles are the red stripy tissues. You can see the testicles at the front, anus in the middle and the pale sitting bones on either side.
If we look at a side on view, the muscles are still red. You can see that they wrap around the anal canal to form the anal sphincter and then extend forwards underneath the bladder and prostate gland (the round gland underneath the bladder). They also wrap under the base of the penis.
What should I be feeling when I’m doing a pelvic floor contraction?
There are 3 distinct contractions that you should be able to feel (don’t worry if you can’t feel them initially):
A contraction around the anus that squeezes it tight and lifts it forwards.
A feeling of shortening the penis – drawing it back into your body
A feeling of lifting your testicles upwards “nuts to guts”
Easy ways to find the pelvic floor muscles:
Try to stop your urine mid-flow. If you can stop it or slow it, these are your pelvic floor muscles working. Once you have finished emptying your bladder, try to contract them again and feel them working. This is not an exercise to perform but it is a useful quick check once/week to see if your strength is improving.
Stand naked in front of a mirror and try to lift you testicles upwards and see your penis draw inwards.
Imagine you’re stopping yourself from passing wind and feel the squeeze around your anus.
Imagine you’re walking into a cold lake and you don’t want the cold water to touch your testicles.
What do I need to do to strengthen my pelvic floor muscles?
Stage 1: Coordination: Practice lifting all three components of the pelvic floor muscles at once whilst keeping your abdominals, thighs and buttocks relaxed, and breathing normally. This is actually really hard to do when you’re not used to it but breathing is vital! We cannot function in our daily lives or sport without breathing so you must develop this coordination. Practice this exercise little and often through the day as you learn to coordinate.
Stage 2: Strength/Endurance: Lift all 3 components of the pelvic floor muscles as strongly as you can whilst still maintaining a relaxed breathing pattern and relaxed buttocks, thighs and abdominals. Aim to hold the contraction for 10 seconds x 10 repetitions but build up to it gradually. Do this really well x1/day. You should feel some fatigue in your muscles at the end of the session.
Speed: lift all 3 components of the pelvic floor muscles quickly and maximally, then relax them fully, repeat this contract/relax pattern as quickly as you can x20, x3/day.
Prevention: lift and hold your pelvic floor muscles before you perform any heavy lifting, coughing, sneezing, and “core stability” work.
Advanced pelvic floor work:
If you are able to do Stage 1 and 2 easily but are still having symptoms, or if you have a sports injury that needs addressing alongside the pelvic floor, you will need a more refined, specifically tailored programme. To get this, make an appointment with a physiotherapist specifically trained in men’s health. For details of what this assessment entails, please read the "pelvic floor assessment".
Other times to seek a formal physiotherapy assessment:
If you cannot feel your pelvic floor muscles working even after practising a few times.
If your symptoms are not changing even though you have been practising your pelvic floor exercises regularly.
If you are experiencing any pain or difficulty with emptying your bladder or bowel.