While there is a lot of education and awareness about the female pelvic floor muscles, particularly during pregnancy and after childbirth, there is very little education regarding male pelvic floor muscles.

Believe it or not, but many men are completely unaware that they have a pelvic floor and have no idea how important it is! The pelvic floor is vital in males, particularly for continence, pelvic organ support and sexual function.

Anatomy and Physiology

To begin to understand just how important our pelvic health is, a great start is to understand the mechanics of how it all works and quite simply what it does.

The pelvic floor muscles are a series of muscles that form a ‘hammock’ which attaches to the pubic bone (just above the genitals) at the front and the coccyx (tail bone), at the back. It has several really important functions:

• It allows us to control urine (wee), wind and stool (poo) by opening and closing the urethra and anus as needed,
• It supports the pelvic organs directly above it, which includes the prostate, bladder and rectum,
• It plays an essential role in sexual function. It maintains the ability to completely contract and relax the pelvic floor muscles, improves sexual functioning and heightens our sense of pleasure. Conversely, chronic pelvic floor tension or tightness, or even persistent weakness can lead to sexual dysfunction and pain, as well as a diminished pleasure,
• It acts reciprocally with the diaphragm during breathing
• It is one of the core muscles, working alongside the abdominals, back muscles and diaphragm. The core muscles are responsible for both stability and mobility of the spine

Slow and Fast Twitch Fibres

The pelvic floor consists of two types of fibres, slow and fast twitch. The slow twitch muscle fibres help with endurance, for example, think of a time where you’ve needed to use the toilet while you’re out and there is no toilet immediately available.  You are aware that you need pass urine, but the slow twitch muscles work in a way where you are able to wait until you’ve found a bathroom.

The fast twitch fibres however are able to produce a quick, sudden, strong contraction, but they fatigue more easily.  These fibres are all about fast responses as opposed to endurance.  They are active in maintaining continence when you cough, sneeze or run, but not for a sustained period. It is important to do exercises to strengthen both the slow and fast fibres to fully support and develop your overall pelvic health.

Pelvic floor dysfunction can occur either when the pelvic floor muscles become weak or damaged or conversely if they are overactive and tight. Pelvic floor dysfunction can lead to a number of conditions in men, which pelvic health physiotherapy can help with.

Common Men’s Health Issues

There are a number of common conditions pelvic health specialist physiotherapists see in clinic each week.  So, it’s important to understand that if you experience any one of the below problems, these are conditions we are very familiar with in treating.

These can include:

• Stress Urinary Incontinence
• Overactive Bladder
• Erectile Dysfunction and Peyronie’s Disease
• Ejaculatory Dysfunction
• Prostate surgery – pre-op and post-op care
• Pain in the groin, pelvis, bowel, or genitals
• Return to exercise

Pelvic floor muscles can be weakened by a number of things including:

• surgery for bladder, bowel or prostate problems
• constipation
• being overweight
• persistent heavy lifting
• high impact exercise
• long-term, persistent coughing (such as smoker's cough, bronchitis or asthma)
• normal ageing process
• Cancer treatment such as radiotherapy to the pelvic region

An overactive pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax adequately. Many men with an overactive pelvic floor may experience constipation, painful sex, pelvic pain, erectile dysfunction and bladder and/or bowel urgency

More Common Than You May Think

While many men may feel alone and be reluctant to seek medical help, pelvic floor dysfunction is more common than you might think!

• 1 in 10 men may experience pelvic floor or continence issues during their lifetime
• 1 in 5 men suffer from erectile dysfunction in the UK (more than 20% of men under 40 years of age and more than 50% of men over 40 years of age)
• 16% of men over 18 have overactive bladder
• Up to 70% of men suffer from urinary incontinence following prostatectomy surgery

What can you do about it?

If you have symptoms of pelvic floor dysfunction, see a specialist pelvic health physiotherapist. They will assess you and determine whether your pelvic floor is overactive or weak and give you appropriate exercises which will aim to both support and build upon your pelvic health

They will also give you lifestyle advice which can make a big difference in your symptoms, this can range from introducing appropriate exercise into your weekly routine, to other lifestyle indicators such as diet.  There is excellent evidence-based research to suggest that pelvic floor training (either strengthening or relaxation exercises) is effective in treating most pelvic conditions. In some cases, you may be referred to a urologist or andrologist for further investigations, medication or surgery etc.  Being referred to a specialist is just another way in which specialist pelvic health physiotherapist can support you.

What happens during the session?

Your initial consultation will include an assessment and explanation of your treatment plan. Some assessments may involve an internal rectal examination, however, in many cases, this is not necessary.  Your physiotherapist may have access to real-time ultrasound diagnostic tools which can be used on the abdomen or lower tummy to allow them to assess your pelvic floor function and effectively teach you pelvic floor exercises, without the need of an internal examination.  Ultrasound examinations can take around 30 minutes to complete and are usually painless, however some clients may experience temporary discomfort when pressing on an area that is already tender. 

Treatment may include education and advice, manual therapy and exercise, with a focus on self-management. For the treatment of erectile dysfunction, shockwave therapy may be used.  Shockwave therapy is an alternative, non-invasive treatment, which involves a low-intensity shockwave being applied to the penis.  The treatment stimulates new blood vessel growth which helps increase penile blood flow, which in turn may improve erectile dysfunction.

When it comes to our overall health and wellbeing, our pelvic health has a huge part to play.  So, understanding what conditions can be treated and finding a clinician you feel comfortable with is key in planning treatment.  Many conditions can be effectively treated or managed through physiotherapy as well as some simple lifestyle changes.

Want to keep learning? Find out more about the author Farhana Sonday - PhysioReform