Many men are reluctant to discuss issues related to their sexual function and incontinence. As a physical medicine and rehabilitation specialist, Rakhi Vyas, DO, gets it.
“Men are often less likely to seek care than women,” says Dr. Vyas. She often sees patients who believe their symptoms are rare, however pelvic floor dysfunction is much more prevalent than most people realize. It affects millions of men in the U.S. Some of the most common issues are pelvic pain, incontinence, urinary urgency or frequency, and sexual dysfunction.
“When it comes to symptoms that are personal, it can be difficult for men to open up. Patients often feel isolated, like they are the only ones having these symptoms,” she says. “Educating patients about anatomy and discussing bowel, bladder and sexual symptoms can help patients understand and feel more comfortable.”
About the male pelvic floor
The pelvic floor includes a network of muscles that supports internal organs — including parts of the male reproductive system — as well as the connecting joints, tissues and nerves. The pelvic floor muscles support organs inside the pelvis and abdomen, including the bladder, prostate, colon and rectum. A healthy pelvic floor allows for these three primary functions:
- Sex — Able to have erections and ejaculate
- Defecation — Able to control gas and bowel movements
- Urination — Can hold and release urine, as needed
Causes of pelvic pain in men
“The causes of pelvic pain and pelvic floor dysfunction in men can vary greatly — musculoskeletal issues from overuse in exercise, hernias, long-standing gastrointestinal issues, history of urologic infections and stress, just to name a few,” explains Dr. Vyas, who stresses the importance of discussing your personal health history with a doctor to determine factors contributing to your symptoms. “Often, it’s not just one thing that causes pelvic pain and dysfunction.”
Male pelvic floor treatments
Your personalized treatment plan will be based on the severity of your issues. Possible treatments may include:
- An individualized course in pelvic floor physical therapy (pelvic floor PT)
- Oral medications
- Compounded topical or suppository medications
- Trigger point injections into the pelvic floor muscles
- Nerve blocks to the peripheral nerves in the pelvic region
- Spinal injections or procedures
- Surgical treatments, if needed
“Patients should seek care as soon as symptoms begin,” stresses Dr. Vyas. “The earlier you can get evaluated and treated, the better the outcome.”
Kegel pelvic floor exercises for men
Unfortunately, Kegels are not always the answer to all pelvic floor issues, says Dr. Vyas.
“Male Kegel exercises have a place for pelvic floor pain and dysfunction, but it’s important to get evaluated first,” she says. “If it’s an appropriate approach for you, you want to ensure you are doing the pelvic muscle training correctly.”
If a provider determines it should be included in your treatment plan, Kegel training for men can be very useful as part of a comprehensive home exercise program. Pelvic muscle strengthening can help treat current symptoms — and prevent future issues.
Kegel exercises help strengthen the pelvic floor muscles, also known as the levator ani and coccygeus muscles, that support the bladder and bowel and affect sexual function. Men and women both have these muscles.
“If a patient’s pelvic floor is tight or hypertonic, we do not recommend Kegels initially since you are activating and tightening an already tight muscle,” explains Dr. Vyas. “When they come in, the initial goal is to down train the neuromuscular system. Then the patient is taught to effectively activate and release their pelvic floor. Once they can appropriately do a Kegel, it can improve their pelvic floor strength, which helps with symptoms such as incontinence, weakness and overall function.”
Tips to improve your pelvic floor health
“Being aware of your pelvic floor is the first step, and learning full pelvic floor excursion with deep diaphragmatic breathing,” Dr. Vyas says about learning to feel the full range of movement along the pelvic floor muscles. “These muscles work in conjunction with your diaphragm, back and core muscles, so it’s important to focus on keeping those strong as well.”
Incorporating a good stretching routine into your exercises is key, with a focus on the lower back, hips and legs.
“The more awareness we bring to these topics and the more we explain the variety of treatment options, the more likely patients will be to reach out for help,” she says. “No one should suffer in silence.”
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