Male pelvic floor exercises

Men experience a variety of problems with their urinary system, leading to unwanted leakage of urine.

Some also have difficulty controlling wind or leakage from the bowels. Often this is due to a weakness of the muscles of the pelvic floor, which have an important function in preventing these troublesome conditions.

In particular, pelvic floor exercises have been shown to be effective following surgery on the prostate and when men experience a dribble after passing water.

The floor of the pelvis is made up of layers of muscle and other tissues stretching from side to side like a hammock and attached to your tail bone (coccyx) at the back and to the pubic bone in front. The urethra (bladder outlet) and the rectum (back passage) pass through the pelvic floor muscles. The hammock of muscle supports the bladder and the bowel and plays an important role in bladder and bowel control.

The pelvic floor muscles can be weakened by:

• some operations for an enlarged prostate gland.
• continual straining to empty your bowels, usually due to constipation.
• a chronic cough, such as smoker’s cough or chronic bronchitis or asthma.
• being overweight.

Although there is no research evidence, it is thought by many that lack of general fitness and persistent heavy lifting tend to result in weakening of the pelvic floor.

Neurological damage (e.g., after a stroke or spinal injury, or resulting from multiple sclerosis or other conditions) can also produce poor pelvic muscle function. People in this group need to seek advice from a healthcare professional.

You can improve control of your bladder and bowel by doing exercises to strengthen your pelvic floor muscles. These exercises may also be useful in conjunction with a bladder retraining programme aimed at improving bladder control in people who experience the urgent need to pass urine frequently and may not always ‘make it in time’.

The first thing to do is to identify correctly the muscles that need to be exercised.

1. Sit or lie comfortably with muscles of your thighs, buttocks and abdomen relaxed.
2. Tighten the ring of muscle around the back passage as if you are trying to control diarrhoea or wind. Relax it. Practice this movement several times until you are sure you are exercising the correct muscle. Try not to squeeze your buttocks or tighten your thighs or tummy muscles.
3. Imagine you are passing urine, trying to stop the flow mid-stream, then restarting it. If your technique is correct, each time that you tighten your pelvic floor muscles you may feel the base of your penis move up slightly towards your abdomen.

You can do this ‘for real’ if you wish, but do so only to learn which muscles are the correct ones to use: do not make a practice of it or it may interfere with normal bladder emptying. You must relax when you are passing urine to ensure you empty your bladder.

If you are unable to feel a definite squeeze and lift action of your pelvic floor muscles (or are unable to even slow the stream of urine as described in point 3), you should seek professional help to get your pelvic floor muscles working correctly. Even men with very weak pelvic floor muscles can be taught these exercises by a physiotherapist or continence advisor with expertise in this area.

Now that you can feel the muscles working, you can start to exercise them:

1. Tighten and draw in strongly the muscles around the anus and the urethra all at once. Lift them up inside. Try and hold this contraction strongly as you count to five, then release slowly and relax for a few seconds. You should have a definite feeling of ‘letting go’.
2. Repeat (‘squeeze and lift’) and relax. It is important to rest in between each contraction. If you find it easy to hold the contraction for a count of five, try to hold for longer – up to ten seconds.
3. Repeat this as many times as you are able up to a maximum of 8-10 squeezes. Make each tightening a strong, slow and controlled contraction.
4. Now do five to ten short, fast, but strong contractions, pulling up and immediately letting go.
5. Do this whole exercise routine at least 4-5 times every day. You can do it in a variety of positions – lying, sitting, standing or walking.

While doing the exercises:

DO NOT hold your breath.

DO NOT push down instead of squeezing and lifting up.

DO NOT tighten your tummy, buttocks or thighs.

Do your exercises well. The quality is important. Fewer good exercises will be more beneficial than many half-hearted ones.

Once you have learnt how to do these exercises, they should be done regularly, giving each set your full attention. It might be helpful to have at least five regular times during the day for doing the exercises – for example, after going to the toilet, when having a drink, when lying in bed. You will wish to tighten your pelvic floor muscles also while you are getting up from a chair, coughing or lifting. Some men find that by tightening before they undertake such activities they assist themselves in regaining control.

Good results take time. In order to build up your pelvic floor muscles to their maximum strength you will need to work hard at these exercises. You will probably not notice an improvement for several weeks and you will not reach your maximum performance for a few months.

When you have recovered control of your bladder or bowel you should continue doing the exercises twice a day for life.