Updated: May 31
When talking about pelvic floor dysfunction (PFD), it's often thought of as something that only women experience. Although it's true that about 1 in 4 women due experience pelvic floor dysfunction, men can experience this as well. It's estimated about 16% of men experience pelvic floor dysfunction, which is about 25 million men in the United States.
And, if you factor in the rest of the male population who avoid their doctor visits (or going to the doctor in general) but at the same time complain about pelvic floor issues on a forum, then we're looking at a higher percentage/number that is underreported and undiagnosed.
The pelvic floor is made up of a number of muscles and ligaments that provide support for the bladder, uterus, and rectum. Although most people don't think about it often, taking care of your pelvic floor health is important for maintaining quite a few things in your body.
These muscles work together to control urine flow, defecation, and sexual function. When the pelvic floor muscles are healthy and strong, they help you have better control over your bladder and can improve sexual function. However, when these muscles are weak or damaged, they can lead to urinary incontinence, fecal incontinence, pelvic prolapse, and sexual dysfunction.
So today we're going to discuss everything you'll want to know about your pelvic floor and how to keep it healthy!
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Summary On Pelvic Floor Dysfunction In Men
Some of you have had questions related to pelvic floor dysfunction in men. This post will include topics on:
What is male pelvic floor dysfunction what can cause it
How to tell if you do have pelvic floor dysfunction
Understanding the differences between weak versus tight pelvic floor
"Hard Flaccid Syndrome" and pelvic floor dysfunction
How is pelvic floor dysfunction related to erectile dysfunction in men
How to treat pelvic floor dysfunction
Pelvic floor exercises for tight or weak pelvic floor
Principles and concepts on tight and weak pelvic floor
Functional Patterns For Pelvic Floor Dysfunction In Men
Male Anatomy and understanding the roles of the pelvic floor muscles
Research behind pelvic floor training and improvements in erectile dysfunction, "venous leakage", etc.
What is Male Pelvic Floor Dysfunction & What Causes it
Let's start with the basics, what is the pelvic floor? We touched briefly on this a second ago, but let's dive into a bit more. The pelvic floor are the muscles and the ligaments that support and reinforce your bladder, the uterus, and your rectum. These muscles work together to keep these organs in place and functioning properly.
Over time, however, these muscles can weaken due to many different reasons. Such as:
Prostate cancer treatments (surgery involving cutting muscles and even nerves)
Poor eating habits and obesity (excess weight pulls on the spine and can lead to muscle imbalances that can exacerbate pelvic tilt and a lordotic curvature that’s already outside the normal range.
Constant straining and constipation
trauma / stress
Sedentary lifestyle (sitting incorrectly with poor posture for prolong periods of time can cause ED)
When the pelvic floor muscles are weak, they may not be able to provide the same level of support for the organs they are meant to hold in place. This can lead to incontinence (leakage of urine or stool), prolapse (when organs drop out of place), erectile dysfunction, or pain during sex.
How to Tell if You Have Pelvic Floor Dysfunction
There are a few different ways to tell if you may have pelvic floor dysfunction. If you have any of the following symptoms, it's worth talking to your doctor about whether or not you have a weakened pelvic floor:
Urinary incontinence (leakage of urine when coughing, sneezing, laughing, etc.)
Fecal incontinence (leakage of stool)
Pain during sex
Prolapse (when organs drop out of place)
Erectile dysfunction (trouble maintaining an erection or achieving one)
If you think you may have pelvic floor dysfunction, the first step is always to talk to your doctor and specifically one the specializes in reproductive health (Urologist). They will be able to help diagnose the problem and from there, you can find a treatment option that is going to be best for your case (Most likely a referral to see a physical therapist who specializes in male sexual dysfunction).
Pelvic Floor Muscles Can Be Both "Too Tight" or "Too Weak"
Pelvic floor problems can occur when the pelvic floor muscles are stretched, weakened, or too tight.
Weak Pelvic Floor
When the pelvic floor muscles are too weak, they may not provide enough support for the organs they are meant to hold in place. A weak pelvic floor can happen for a couple of reasons.
Anterior Pelvic tilt and other global dysfunctions (other muscle group imbalances, ie. weak glutes, abs, hip flexors) affecting the strength of the pelvic floor muscles
Sitting for too long (desk job or sedentary lifestyle)
Not stretching your pelvic floor
Improper exercise techniques or explosive workouts that pull on the pelvic floor muscles due to an imbalance of other muscle groups to stabilize proper function
Surgery on your bladder
Intense coughing from things such as smoking or bronchitis
Pelvic floor muscle training is usually beneficial in restoring weak pelvic floor muscles. Which we will talk about here shortly.
Tight Pelvic Floor (also known as toned pelvic floor or associated with hypertonic pelvic floor)
On the other hand, when the pelvic floor muscles are too tight, they may put too much pressure or strain on the organs they are meant to support. They can also be in a constant state of spasm, or tension also known as a hypertonic pelvic floor. This can also lead to problems such as incontinence and prolapse. This is usually caused by the following things.
Exercising your pelvic floor too often (Doing too many Kegels with a mindset that "more is better")
Improper pelvic floor exercising (Someone who Kegels incorrectly or pushes/squeezes these muscles too hard)
Pelvic surgery or infection
Emotional or mental abuse (anxiety and stress can cause muscle groups like your pelvic floor muscles to tense up)
Bad posture (anterior pelvic tilt is an example)
Holding onto your bladder for too long or Incorrectly
Poor application of certain penis exercises or misuse of penis-enhancing equipment (I'll address you P.E guys briefly below)
There are even cases where men strain their pelvic floors to a point where they develop "hard flaccid" symptoms. Sometimes doing penis stretching exercises without prioritizing safety, can also cause a strain to the pelvic floor. So, it's important for these types of guys to consider a more safer approach to penis enlargement including more education on the topic to avoid this and other penis enlargement-related injuries.
Hard Flaccid Syndrome And The Male Pelvic Floor
I've read on forums of guys claiming "hard flaccid" or "Soft glans syndrome" because of injuries or trauma to their penises (during sex, masturbation, or from penis enlargement exercises) as well as trauma due to stress or over-contracting their pelvic floor muscles while this incident occurred. At this time "hard flaccid syndrome" is not exactly defined by the medical community as there are too many factors to narrow down the true cause of this issue. But men with these symptoms experience one or more of the following:
The feeling of being “hard” or “semi-rigid” even when the penis is in a flaccid state
Penile pain and/or pain in the perineal region (between the scrotum and the anus)
A sensation of cramping or clenching that shortens the penis
Difficulty getting or maintaining erections (erectile dysfunction)
Painful urination or a weak urine stream
Underlying anxiety and/or depression
Penile deformity (indentation), which is often variable with erections
*** It’s important to note that it is NOT suggested for guys with hard flaccid to perform normal Kegel exercises that focus on contracting the BC and PC muscles as it could make the spasm or strain potentially worse.
***If these symptoms were caused by injury to the penis (and I'm talking to you guys on penis enlargement forums), then seek medical attention and monitor pain and or plaque calcification (Peyronie's disease). Again, I'm not a doctor, and it's better to get a diagnosis from a Urologist for penile pain or injuries as this may lead to future complications.
The reasoning I'm including hard flaccid in this post is because men claim there is pain in the perineal region (where the pelvic floor muscles are located) which could potentially be related to tight pelvic floor dysfunction or a state of contraction of these muscles. Obviously, that's not the only issue, but because this article is dedicated to pelvic floor dysfunction in men, there is some correlation/relevance.
Fortunately, there are things that you can do to help relax your pelvic floor (if it’s tight) as well as help strengthen the pelvic floor muscles (if they’re weak) and improve your health. Let's talk about the different ways you can treat pelvic floor issues.
How is The Pelvic Floor Related To Erectile Dysfunction?
For example, when the pelvic floor is too tight, this is called an overactive pelvic floor which can cause compression to the artery that supplies your penis with blood. Whereas when your pelvic floor is too weak, it's preventing the outflow of blood, making it almost impossible to maintain your erection.
There are important nerves that connect from the spine to the penis. I mentioned in a previous post that we have 3 different types of erections; Reflexive, psychogenic and nocturnal erections. The brain sends signals through the spine, then through the pelvis and lastly to the penis to obtain these types of erections.
Erectile dysfunction that is caused by a weak or tight pelvic floor limits the ability for a man to obtain and maintain an erection. Whether you like it or not, these muscles are important for sexual health. Men who are afraid of their perineum area (where these muscles are located), or anus because they feel as though they'll be judged for exercising these muscles or "exploring" this area through anal play, need not to worry as anal play is not specific to one gender type or sexual orientation, etc.
Exploring these muscles and narrowing down other global dysfunctions (weak muscle groups and imbalances) can potentially help normal erectile function allowing your penis to become adequately rigid and hard for sex. This allows you to penetrate and sustain a strong enough and long enough healthy erection for intercourse. I think this matters more, than feeling judged over something that should not be associated to one type of sexual orientation. It's 2022, and we've explored these muscles and are not afraid to speak on it (That's an example of what BDE is all about...being able to talk about these topics with confidence).
Treating Pelvic Floor Dysfunction In Men
Fortunately, the majority of pelvic floor problems can be treated through biofeedback, physical therapy, and medication. If you think you may have a pelvic floor problem, it is best to consult with your doctor.
However, we'll take a look at these three common ways of treating pelvic floor dysfunction.
Biofeedback For Your Pelvic Floor
This is a process where sensors are placed on the skin to measure muscle activity. The information is then relayed to a machine that displays the results so that you can see how your muscles are working. This feedback can help you learn how to properly contract and relax your pelvic floor muscles.
Physical Therapy for Male Sexual Dysfunction
A physical therapist can help you manage or control your pelvic floor muscles. They can help you stretch and strengthen your pelvic floor muscles through a variety of exercises helping you relearn or learn how to locate these muscles while alleviating symptoms from pelvic floor dysfunction.
These exercises usually involve contracting and relaxing the muscles in a specific pattern. Physical therapy can also help improve your posture and teach you how to correctly engage your pelvic floor muscles.
It's also important to note that if you decided to go with physical therapy treatment for your pelvic floor, first check if your physiotherapist even offers treatment for male sexual dysfunction.
Most PTs don’t offer rehabilitation for “male sexual dysfunction”. You literally have to look on their website or call and ask if they do it and how they do it. So before you plan a visit to your PT, get on their website or call them beforehand to see if they offer physiotherapy for male sexual dysfunction.
There is also some evidence that points toward prostate massage helping with erectile dysfunction caused by a tight or weak pelvic floor.
In some cases, medication may be necessary to treat pelvic floor dysfunction like prostatitis. Medications such as muscle relaxants (although we don't suggest it as medications can cause other types of sexual dysfunctions) and botox injections can help relax the muscles and ease the pain. Surgery is also an option for some people, but it is usually only recommended if other treatments have failed.
But since, you guys are here, let's avoid this and learn more about pelvic floor training for men.
Pelvic Floor Exercises Are More Than Just "Kegels"
People often assume that pelvic floor exercises only mean "Kegels". But, that's not the only thing you can do to help your pelvic floor from becoming too tight or weak. As we just discussed, physical therapy can help strengthen your pelvic floor muscles. But, what about pelvic floor exercises you can do at the comfort and privacy of your own home?
Not to contradict what we just said above, but let's start off with Kegels as the most common one for not only women, but an important exercise men should do as well for strengthening these muscles.
Pelvic Floor Exercise #1: Kegels For Men
Kegel exercises are one of the most effective exercises for improving pelvic floor muscle function when it is "weak"...not tight or hypertonic pelvic floor. Kegels help to tone and strengthen the muscles of the pelvic floor.
How to perform a Kegel:
When you go online to find out how to perform a Kegel, most experts suggest that you locate these muscles when stopping the flow of your own urine stream (regular Kegel). When you stop the flow of urine you're actually contracting your pubococcygeal (PC) muscles.
How to perform a reverse Kegel:
This is the opposite of a Kegel. Some say it's like reversing the process of contracting the muscles and more of a lengthening and relaxing exercise. Some say this targets the IC muscles which are responsible in the role of trapping blood for the erections. A good way to figure out these muscles (they're smaller than the BC and PC muscles) is by pushing the stream of urine flow and or pushing a fart or poo.
Some physiotherapists recommend a combination of reverse and regular Kegel exercises. But, reverse Kegels do hold a lot of importance because we normally do regular/normal Kegels throughout the day without realizing it. For instance, when doing a workout or going from sitting to standing, we are unintentionally doing some form of a contraction to these pelvic floor muscles.
Pelvic Floor Exercise #2 Scrotum Lift
By relaxing and loosening the pelvic floor muscles, you may experience relief from pelvic pain. Begin by:
Slowly lift the testicles upwards towards the body.
This helps to tighten the pelvic muscles.
Relax the pelvic floor and the testicles will hand loose.
Repeat this movement and focus on the relaxation stage.
Some men can do this exercise while sitting down or standing. Just make sure you're not in front of people as this is a gesture of "Eff you" in some countries (or they'll just think you're a perv).
Should I Kegel If I Have A Tight Or Toned Pelvic Floor?
NO. I'm repeating this again here as I've mentioned before that this can continue spasm and discomfort in the pelvic floor area. This appears to the consensus among other physiotherapist's websites and research when it comes to pelvic floor training and considering what to do for weak versus tight pelvic floor muscles.
It's important that men with tight pelvic floor muscles should consider other options to drop or relax their pelvic floor muscles as opposed to doing Kegel or strengthening exercises. Doing Kegels with a tight or toned pelvic floor may aggravate your pelvic floor and could potentially make things worse.
The goal to think about when doing exercises to relax the male pelvic floor include:
Deep breathing exercises into the diaphragm to relax and relieve tension (remember stress and anxiety can also indirectly cause you to tense up in those areas)
Being able to pinpoint areas of tension or stress in the pelvic floor muscles (biofeedback/body scanning with the help of a physiotherapist)
Maintaining pelvic floor muscle relaxation while lying down, standing up, walking and then everyday activities
Doing trigger point releases or myofascial release tension around the surrounding muscles (some physiotherapists suggest using a tennis ball or a foam roller)
Other considerations for guys when doing pelvic floor training:
Some men (especially younger men) who consider themselves as "athletic" and/or "healthy" often confuse symptoms of erectile dysfunction with pelvic floor dysfunction. If you have no health abnormalities or your doctor had run tests and you have no health concerns, then chances are it could be pelvic floor related. You need to be more "body" aware or keen on what is causing these tensions in your pelvic floor and check with your doctor about symptoms of pelvic floor issues...
It's also important to consider fitness activity (if you are active in the gym) and avoid exercises that cause a lot of tension or stress to the pelvic floor:
Full sit ups are an example that may cause unnecessary pressure or tension to the pelvic floor (not good for you if you have a tight pelvic floor).
Squatting is also something to reconsider. Some people swear by them, but others suggest that improper technique/form of squatting may lead to injury or too much pulling on the pelvic floor muscles.
Here's a fun fact for all of you. In the 2021/2022 NFL season, it was mentioned that the Buffalo Bills eliminated squats from their conditioning/workouts. In this article, there was some speculation on this being a reason as to why their team reported less injuries than any other teams during the season.
This can easily be relatable to anyone into bodybuilding or weight lighting. Most guys who get into weight lifting and activities as such, don't understand moving in a "functional" and sustainable way that minimizes injury, joint pain, etc.
Which leads me to my rant on functional patterns...
Functional Patterns For Pelvic Floor Dysfunction In Men
Most people only see weak or tight pelvic floor as one problem they need to work on, but there are actually other global dysfunctions and imbalances throughout the body that led to pelvic floor dysfunction and erectile dysfunction to begin with.
Functional patterns is more than just a concept about correcting global dysfunctions. It teaches you how to stand, walk, run and throw in a more functional and sustainable way versus what society does everyday. For instance, 'gym culture' is filled with contradicting principles and theories on how to build muscle. This often leads men down weightlifting journeys of doing exercises incorrectly, which lead to injuries and dysfunctions like poor posture, imbalances in certain muscle groups, pain, fatigue, pelvic floor dysfunction, anterior pelvic tilt, etc.
Functional patterns address this and focus on arriving at a solution on how to correct these dysfunctions, and ultimately will help you function at your best in sports, and in everyday life as well (this indirectly includes sex).
We mentioned earlier how anterior pelvic tilt is very common in men. Although pelvic tilt is considered normal and there should be a natural degree of anterior pelvic tilt, an excessive tilt could cause weak glutes, hamstrings, transverse abdominous, and other imbalances causing us to be "stuck" in these patterns (or bad habits) over time. I suggest every guy reading this post to look into Functional patterns because pelvic floor issues are not only common in older men, but younger guys too.
Younger guys may also have some of these imbalances causing a weak or tight pelvic floor caused by any of the causes mentioned earlier. You can imagine, video games (sitting for long periods of time), improper approach to weight lifting, vigorous masturbation and "edging" and a numerous of other activities could potentially cause pelvic floor issues in younger guys.
Worried about Weak Pelvic Floor, Stamina In The Bedroom And/Or Premature Ejaculation?
If you're worried about weak /tight pelvic floor issues and your own bad habits of masturbation, we suggest using a Fleshlight as oftentimes, some guys can get carried away with improper hand techniques while over-contracting their pelvic floor at the same time (edging can potentially be bad). A Fleshlight simulates real-life sex and they do offer a stamina trainer if you're worried about this particular issue in the bedroom.
Just keep in mind, a Fleshlight is not THE solution. It's only a solution (singular) as you will still need to work on pelvic floor training, postural issues, weak or tight muscle groups, and making lifestyle changes to alleviate symptoms related to pelvic floor dysfunction. Think of it like a multi-strategy approach.
How Long Will It Take For Pelvic Floor Exercises And Functional Patterns To Work?
I'm mentioning both pelvic floor work and functional patterns in the same section, but each are different on its own. Pelvic floor work targets the muscles in that area, but functional patterns will correct the underlying causes for these weak and tight muscles in the long term (think longevity).
Everyone has a different "chapter 20" meaning that one can see the benefits of pelvic floor work and being more aware of their bodies in a matter of weeks while some could take months or even years to fix these global dysfunctions.
Functional patterns is considered a "slow cooker" and retraining the body to stand, walk, run, and throw in a more functional way can take a long time. This can take months or even years to correct bad patterns and unlearn teachings about weightlifting that have caused you injury, pain or imbalances in certain muscle groups.
Understanding Your Pelvic Floor Muscles And The Male Anatomy
Exercises that actually target your pelvic floor muscles have been shown to help those with erectile dysfunction by improving erections. As we already discussed in the beginning of the article, the pelvic floor muscles are an essential part of maintaining blood flow to your penis as well as sustaining erections.
Your bulbocavernosus muscle is one of the muscles within your pelvic floor that does exactly that. It does this by putting the right amount of pressure on your penises veins. This pressure controls the blood from leaving those veins, which is what is making your erection possible.
By performing good pelvic floor exercises, it will strengthen and enhance the tone of your pubococcygeus. On the other hand, training your IC muscles with reverse Kegels and being conscious about your posture, hips, pelvic tilt, lower abs, and your feet, show that it can help guys retrain or relax their pelvic floor muscles.
Research Behind Pelvic Floor Training In Men With Erectile Dysfunction
Some of you might not be convinced that pelvic floor training can help alleviate symptoms of erectile dysfunction or premature ejaculation or pelvic floor issues in general. For this reason, I gathered some research on this for you to educate yourselves, form your own conclusions, and make better choices about your sexual health.
In this medical article on NCBI, half or 50% of the participants in this study that was diagnosed with venous leak recovered after pelvic floor exercises.
This publication concluded that pelvic floor training helped 75% of the participants with proven/diagnosed venous leakages who were scheduled for surgery for erectile dysfunction. This study showed that pelvic floor work massively improved their condition where they refused the surgery. Of the participants who did not experience this improvement (25%) either did not stick to the regimen or dropped out due to personal reasons.
In this article, the researchers concluded that there is involvement of the ICM or ischiocavernosus muscle, especially during the process of rigidity/during sex. "Coital penile rigidity is achieved according to the following sequence: coital movement → glans pressure variations → ICR triggering → ICM contractions → SS ICP → penile rigidity." is a quote to consider from this medical article.
In this PDF, it shows research on how biofeedback can help with pelvic muscle training.
There are more articles out there supporting the benefits of pelvic floor training in men to alleviate symptoms related to sexual dysfunction (erectile dysfunction, weak pelvic floor, premature ejaculation, prostatitis, etc.). This list is not exhaustive and you can easily search publications like PubMed, NCBI, and other platforms for more research on this topic.
Does The Phoenix Li-ESWT Device Treat Pelvic Floor Dysfunction In Men?
In short, no
The Phoenix device uses Li-ESWT technology is used to help men improve sex and make it easier for them to "rise again" but it does not have an effect on their pelvic floor muscles.
Li-ESWT has been researched to help men prevent sexual decline, enhance bedroom performance, and makes getting it up easier.
The pelvic floor is something that can be affected by lifestyle choices (as we mentioned all those examples and associations earlier) causing a weak or tight pelvic floor. We encourage you to learn more about the pelvic floor as it can affect your erections; being able to obtain an erection and maintain one.
Men often neglect their pelvic floor muscles and feel awkward about doing anything related to touching, relaxing, or strengthening that area (because they think it's taboo). This is something to explore so you don't scratch your head at the doctor's office or get a misdiagnosis because sometimes Urologists are well versed or not considering pelvic floor issues as a factor as to why you're having trouble in the bedroom.
As mentioned earlier and throughout this post, pelvic floor dysfunction can be caused by numerous amount of factors, which Is why I addressed them multiple times throughout as a starting point for you to explore/discover yourself.
***Again, It's best to seek guidance and advice from a trained Physiotherapist who specializes in sexual dysfunction in men so that you can identify the problem and add on knowledge and body awareness so that you can obtain a more quality sex life.
Living With & Treating Your Pelvic Floor Dysfunction
The pelvic floor is an important group of muscles and ligaments that support the bladder, uterus, and rectum. Taking care of your pelvic floor health is important for maintaining bladder and bowel control, as well as sexual function in men.
By making simple lifestyle changes and maintaining a healthy body can usually help you prevent PFD from ever occurring. Things such as simply eating healthy can prevent some of the causes such as obesity, constipation, or sickness that causes extreme coughing.
However, if you do find yourself with PFD, there are plenty of ways that you can treat it, so there's no need to panic. The first step is to simply find the reason why you may be experiencing it. From there you can begin treating it through the most appropriate method.
For instance, the best way to keep your pelvic floor healthy is to do exercises that strengthen the muscles if they're weak (such as Kegel exercises) and/or learn relaxation techniques (such as deep breathing) and certain postural/stretches to release tension in the muscles.
But, to really solve the root cause of these problems, you need to reflect on your lifestyle and make the necessary changes that are causing a weak or toned pelvic floor in the first place. I suggest anyone reading this to look into functional patterns because it can help address global dysfunctions like excessive anterior pelvic tilt and improper function when weight lifting or moving in general. But, sometimes that's not enough either.
Maybe your 9-5 job requires a lot of sitting or maybe you're doing something dangerous that could cause trauma or stress to your pelvic floor like some of the riskier penis enlargement exercises. The point is, make a list and narrow down the possible causes and work on them so you can alleviate these symptoms. It's definitely not an easy fix, but in time, you'll soon be able to recognize these dysfunctions and start having a mindset of getting into a better functioning state.
As always, if you guys have questions about pelvic floor dysfunction, feel free to leave a comment down below or send us a message. We're here to help you guys live a happier and healthier lifestyle!