Pelvic floor exercises and advice for men

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Role and location of the pelvic floor

The pelvic floor is a group of muscles and tissue stretched like a hammock across the floor of the pelvis, from the pubic bone at the front to the tailbone at the back. It has two openings:

The urethra (the bladder outlet)
Anus (back passage)

These muscles support and help to control the pelvic organs (bladder and bowels). Healthy pelvic floor muscles may also improve your sex life by helping to achieve and maintain an erection.

Symptoms of pelvic floor weakness

Leaking small amounts of urine on coughing, sneezing or lifting
Sudden urgent or frequent need to pass urine
Difficulty in controlling leakage of wind or faeces from the bowel
Post-micturition dribble (leaking a few drops of urine after finishing emptying the bladder)
Erectile dysfunction
Premature ejaculation

What can weaken the pelvic floor?

Prostate surgery
Straining regularly to open your bowels (constipation)
Repeated heavy lifting
Chronic cough, especially associated with smoking
General lack of fitness
Direct injury to perineum or cycling
Long periods of inactivity (due to illness or following surgery)
Some neurological conditions e.g. MS or stroke

How to exercise the pelvic floor muscles

If you are having prostate surgery, it is best to start your pelvic floor exercises before your operation. Do not do the exercises while there is a catheter in place. After it has been removed, start your exercises again. Start by sitting in a comfortable position with your feet flat on the floor. Imagine that you are trying to stop yourself passing urine or ‘wind’, by ‘squeezing and lifting’ the openings of the bladder and bowels. Try and hold for five seconds before relaxing and repeat this 5 times. This is a ‘slow’ squeeze.

Now tighten the pelvic floor muscles quickly 5 times, with a little rest between each contraction, making sure you relax the muscle fully between each ‘squeeze and lift’. This is a ‘quick’ contraction.

The slow squeezes help to build up endurance in the pelvic floor to support the organs in the pelvis and also help you to ‘hold on’ for longer. The quick squeezes help your pelvic floor to react quickly when you cough, sneeze or change position.

How often do you need to do pelvic floor exercises?

Try 5 slow hold squeezes, followed by 5 quick squeezes, at least 4 times a day.
For those men post-prostatectomy, your pelvic health physiotherapist may increase this to 6 sets per day.
As your muscles get stronger, try holding the slow contractions for longer, to a maximum of 10 seconds.
You can gradually increase the number of pelvic floor squeezes to a maximum of 10 ‘slow’ and 10 ‘fast’ contractions – (don’t over-tire the muscles).
It can be hard to remember to do these exercises routinely. Try to think of a good time in your day to practice them so they become a habit.

Check out the NHS approved ‘Squeezy for Men’ app – available on all smart phones and mobile devices

Don’t try to stop and start your flow while passing urine – this can interfere with normal bladder function.

You can check that you are doing your exercises correctly by placing your fingertips on the perineum (the area just behind the scrotum, in front of the anus) you should feel this area lift upwards. Stand in front of a mirror – you should see the base of your penis draw inwards and your testicles/scrotum lift. If you are unable to feel definite tightening/lifting in the pelvic floor muscles, you should consider seeking professional advice. Your GP can refer you to a Specialist Pelvic Health Physiotherapist.

General advice for a healthy bladder, bowel and pelvic floor muscles

After emptying your bladder, tighten the pelvic floor muscles strongly to help prevent dribble.
Tighten your pelvic floor muscles prior to coughing, sneezing, or lifting, to increase your control and prevent leakage of urine.
Avoid caffeinated and fizzy drinks (e.g. tea, coffee, cola and some sports/energy drinks) as these can irritate the bladder.
Aim to drink 1.5-2 litres of fluid/day (more in hot weather or when exercising)
Avoid going to the toilet ‘just in case’. It is normal to empty the bladder 6-8 times a day. If you get the ‘urge’ to go more frequently, try to overcome it by tightening your pelvic floor muscles strongly for a few seconds.
You could try sitting on something hard (e.g. the arm of a chair) or distracting your mind from the urge.
Avoid constipation: drink adequate fluids, take regular exercise (walking helps) and eat a healthy, varied diet containing fruit, vegetables and wholegrain (e.g. brown bread / porridge).
Seek help for asthma, hayfever and giving up smoking, to prevent chronic coughing and sneezing.

Preventing problems

Tighten your pelvic floor muscles before you do anything that may put them under pressure, such as lifting, coughing or sneezing.

Being overweight puts extra strain on your pelvic floor; your symptoms may improve if you lose weight.

If you ride a bicycle for long periods, make sure that you raise yourself off the seat at regular intervals to take the pressure off your perineum. You can also consider wearing padded shorts or purchasing a specialist saddle. It can take 3-6 months to notice significant improvement – keep persevering!

Once your pelvic floor muscles are back to full strength, you will need to do one set of ‘fast’ and ‘slow’ exercises daily to keep them strong.

Useful Websites and Apps:

You can access information videos on the MKUH Pelvic health physiotherapy team website.

NHS ‘Squeezy’ App
You can download the NHS approved ‘Squeezy’ app to your phone or tablet to help you with your pelvic floor exercises. www.squeezyapp.com

The POGP
Further information is available at www.thepogp.co.uk or a more detailed leaflet about
https://thepogp.co.uk/Resources/122/pelvic_floor_muscle_exercises_for_men
https://thepogp.co.uk/mens_health.aspx for an audio link