As women we seem to have some understanding that we need to do our pelvic floor exercises. But what about men? Do men even have a pelvic floor? Well actually, they do! And things can go wrong in the male pelvic floor, just like the female pelvic floor. Well, not exactly like the female pelvic floor, men do have a bit of an anatomical advantage. Despite this, 1 in 6 men suffer from incontinence, and this is often seen in men who have an enlarged prostate, have undergone some form of prostate surgery, experience constipation, are overweight or have a chronic cough (such as smoker’s cough or chronic bronchitis).

 

Where is the male pelvic floor?

Just like the female pelvic floor muscles, the male pelvic floor muscles extend like a hammock between the pubic bone at the front and the tail bone at the back. It sits like a trampoline, and when it contracts, it compresses the front and back passages (helping to prevent urine and bowel leakage), and elevates the bladder and the bowel.

 

male pelvic floor anatomy

Male pelvic floor anatomy: Source: The Continence Foundation of Australia

 

Now, this system seems pretty sturdy right? The male pelvic floor is designed with a slightly better mechanical advantage than the female pelvic floor. The female pelvic floor muscles have more organs to hold, and an extra hole that… (for lack of better terminology)…more stuff can fall through. A speaker that I recently listened to succinctly phrased it: “Women have a lot of work to do and not many tools to do it with… (sound like any other areas of life girls?). This is why men tend to have less issues than women. It is usually not until later in life, when the other mechanisms that men rely on to maintain continence are affected, such as from prostate problems/surgery, that we see problems start to form.

 

Top 5 pelvic floor tips for blokes:

Learn how to do your pelvic floor exercises.

Even if you are having no issues currently, it is a good idea for men to at least be aware of their pelvic floor, learn how to use it, and keep it strong (especially when doing heavy work, high impact activities, or coughing and sneezing). Try this…

  • Squeeze and draw in the muscles around your front passage, as if you are trying to stop the flow of urine. In doing this, try to  imagine you are shortening the penis.
  • Hold this muscle contraction for 8 seconds, and then relax the muscles fully. You should focus on letting these muscles go      completely before the next contraction. Just like our biceps (or any other muscle in the body), it is important to let the muscles  recover before you work them again.
  • Repeat 8-10 x, and perform them 3-4 times throughout the day to improve your strength.

 

Contract your pelvic floor muscles before any heavy lifting, jumping, high exertion, sneezing or coughing.

Pre-contracting your pelvic floor muscles will protect them from excessive downward forces that would otherwise stretch and potentially damage the muscle fibers. The more you practice the pre-contraction, the more likely it is to become automatic, so that if you do face difficulties in the future, the pelvic floor muscles will be able to protect you and help prevent any bladder leakage.

 

Sit down on the toilet while urinating.

Now… a lot of men will be resistant to this one. This is a trick that you can keep up your sleeve for later in life. As a man, if you do find yourself facing pelvic floor difficulties, bladder or bowel dysfunction, sitting down on the toilet can be a good way to help the pelvic floor muscles relax and take the pressure off the urethra, helping create a good flow and allowing you to completely empty. 

After thinking about this one for a bit longer, my husband quietly suggested…“Actually, at least if I sit for a while it would give me some peace and quiet”…. Gosh they are hard done by! 😛 

 

Contract the pelvic floor muscles after going to the toilet.

OK… you are standing up again. After going to the toilet, urine can get stuck in the urethra (the passage that carries urine along the length of the penis). This can result in not feeling completely empty, and in some case, in can result in ‘after-dribble’, in which urine leakage occurs after you have been to the toilet. Men sometimes have automatic tricks for this, like ‘the shake’, but if you are having difficulty, a few quick pelvic floor muscle contractions can help move the remaining urine along the passage.

 

Stay hydrated and eat lots of fibre.

This one is not unique to men! Maintaining good hydration is good for our whole body. It allows our bladder to stretch to the correct size and prevents irritation of the bladder lining. You should be aiming  for 1.5-2.5 litres of water per day. If you are a bigger guy or work in the heat you should aim to drink a bit more. Check the colour of your urine! It should be pale straw in colour if you are well hydrated.

Maintaining good fibre and diet habits are also important to prevent constipation that can lead to excessive straining while on the toilet. This straining can stretch and damage the pelvic floor muscle fibers, and as we learnt, you will need them down the track!

 

When things go wrong with the pelvic floor it can be upsetting, humiliating, emasculating and can affect a man’s work, family role and relationships. As confronting as it is, it is important to speak up early. Help is available, and in many cases, bladder and bowel problems in men can be greatly improved or cured over time and with treatment.

General practitioners, pelvic floor physiotherapists, sexual health counsellors and resources such as The Continence Foundation of Australia are great place to start if you are having difficulties, or would like to find out more. You are not alone.

 

Coming up…

The Christmas countdown is on! In my next blog we will discuss all the naughty and nice things that we are likely to do this holiday season that can impact on our pelvic floor, and how mindfulness can greatly improve our Christmas cheer. Until then…

 

Be kind to yourself

 

Julia Berger

Physiotherapist