Men’s Pelvic Health
Pelvic health concerns are not just a women’s health issue. Men have pelvic floor muscles too, and problems with these muscles can affect bladder control, bowel function, sexual function, pelvic comfort, and recovery after prostate surgery. Symptoms can be difficult to talk about. You may be experiencing urinary leakage, pelvic pressure, pain with sitting, discomfort during sexual activity, constipation, or symptoms following prostate surgery. In other cases, you may simply know that something does not feel right.
At Reform Physical Therapy, men’s pelvic health physical therapy focuses on identifying the muscle, movement, strength, and coordination problems that may be contributing to your symptoms. Our pelvic health physical therapy services for men are available exclusively at our South Portland clinic.
What Is Men’s Pelvic Health Physical Therapy?
Men’s pelvic health physical therapy is specialized rehabilitation for conditions involving the pelvic floor and surrounding muscles. The pelvic floor is a group of muscles located at the bottom of the pelvis. In men, these muscles help support the bladder and bowel while contributing to urinary control, bowel control, sexual function, and core stability. Like other muscles in your body, the pelvic floor can become weak, overly tight, painful, or poorly coordinated. Physical therapy can evaluate these problems and create a treatment plan based on what your body actually needs.
What Does the Male Pelvic Floor Do?
The male pelvic floor performs several important jobs. These muscles help control when you urinate and have a bowel movement. They also contribute to sexual function and help support structures within the pelvis. Your pelvic floor works together with your abdominal muscles, diaphragm, hips, and back. This means pelvic health treatment often involves more than isolated pelvic floor exercises. Your physical therapist may evaluate how your entire trunk and pelvis work together during breathing, lifting, exercising, and everyday movement.
Signs of Pelvic Floor Dysfunction in Men
Pelvic floor dysfunction can look very different from one person to another. Some men primarily experience urinary symptoms. Others have pain, bowel problems, or difficulty following prostate surgery. Possible symptoms include urinary leakage, urinary urgency, frequent urination, difficulty starting or stopping urine flow, constipation, pelvic pain, rectal discomfort, pain with sitting, pain during or after ejaculation, and discomfort involving the penis, testicles, groin, or perineum. These symptoms can have several possible causes. A medical evaluation may be necessary to rule out prostate, urinary, gastrointestinal, neurological, or other medical conditions.
Male Pelvic Pain
Pelvic pain in men can occur in several locations. You might feel pain or pressure in the lower abdomen, groin, perineum, penis, testicles, rectal region, tailbone, hips, or lower back. Symptoms may be constant or come and go. Some men notice pain primarily while sitting. Others experience discomfort during exercise, urination, bowel movements, sexual activity, or ejaculation. When pelvic floor muscle tension or other musculoskeletal factors are contributing, physical therapy may be able to help.
Tight Pelvic Floor Muscles in Men
Pelvic floor problems do not always mean the muscles are weak. Sometimes they are too tight. An overly tense pelvic floor can contribute to pelvic pain, difficulty urinating, constipation, painful bowel movements, sexual symptoms, and discomfort with prolonged sitting. If your pelvic floor is already holding too much tension, repeatedly performing strengthening exercises may not be appropriate. Treatment may instead begin with breathing, relaxation, mobility, and improving muscle coordination.
Pelvic Floor Weakness in Men
Other men experience pelvic floor weakness. Weakness can contribute to urinary leakage or difficulty controlling pressure during everyday activities. This is particularly relevant following certain prostate procedures. Treatment may include pelvic floor strengthening, endurance exercises, breathing, core and hip strengthening, and functional movement. Your therapist can determine whether weakness, excessive tension, poor coordination, or a combination of these problems is present.
Men’s Pelvic Health After Prostate Surgery
Pelvic floor rehabilitation can be an important part of recovery following prostate surgery. Some men experience urinary leakage after a prostatectomy. Leakage may be more noticeable while coughing, sneezing, standing, walking, exercising, or lifting. Physical therapy can help you learn how to correctly activate and coordinate the pelvic floor while gradually rebuilding strength and endurance. Treatment can also address abdominal strength, breathing, mobility, and return to normal activity.
Urinary Leakage After Prostate Surgery
Urinary leakage following prostate surgery can be frustrating. You may notice small amounts of leakage with certain movements or need pads throughout the day. Pelvic floor muscle training is commonly incorporated into rehabilitation following prostate surgery. The goal is not simply to perform as many contractions as possible. Your therapist can help you improve the strength, timing, endurance, and coordination needed for everyday activities.
Urinary Incontinence in Men
Prostate surgery is not the only reason men can experience urinary leakage. Incontinence may also occur alongside other urinary, neurological, pelvic floor, or medical conditions. You might leak with coughing, sneezing, lifting, exercising, or a strong urge to urinate. A pelvic health physical therapist can evaluate the musculoskeletal and pelvic floor factors that may be contributing. Because urinary changes can also have medical causes, new or unexplained symptoms should be discussed with your healthcare provider.
Urinary Urgency and Frequency
Do you constantly look for the nearest bathroom? Urinary urgency creates a sudden and difficult-to-ignore need to urinate. Frequency means needing to use the bathroom more often than expected. Some men also wake several times during the night to urinate. Pelvic health treatment may include bladder retraining, urge-control strategies, pelvic floor coordination, breathing, and addressing habits that may contribute to symptoms.
Difficulty Urinating
Some men have difficulty starting their urine stream or feel as though they cannot completely empty their bladder. Others notice a weak or interrupted stream. A tight or poorly coordinated pelvic floor can sometimes contribute to difficulty relaxing during urination. However, these symptoms can also be related to prostate enlargement, urinary obstruction, medication, neurological conditions, or other medical concerns. Difficulty urinating should therefore be medically evaluated rather than automatically assumed to be a pelvic floor problem.
Chronic Pelvic Pain Syndrome
Chronic pelvic pain syndrome, sometimes called CPPS, can cause persistent or recurring pain in the pelvis, perineum, genitals, or surrounding areas. Symptoms may resemble prostatitis even when infection is not identified. Men may experience urinary symptoms, pain with sitting, discomfort with ejaculation, or muscle tension along with pelvic pain. Pelvic floor physical therapy may be one part of treatment when muscle tension, sensitivity, or movement problems are contributing.
Prostatitis-Like Symptoms
Not every symptom that feels like prostatitis is caused by an active infection. Some men experience ongoing pelvic pain, urinary symptoms, or discomfort even after testing does not show a bacterial infection. The pelvic floor may become tense and sensitive as symptoms persist. Physical therapy does not treat bacterial prostatitis or other prostate disease. Instead, treatment can address musculoskeletal and pelvic floor factors that may occur alongside chronic prostatitis-like symptoms.
Pain With Sitting
Sitting places pressure through the pelvis and surrounding tissues. For someone with pelvic floor muscle tension or pelvic pain, long periods at a desk, driving, cycling, or traveling can become uncomfortable. Your therapist may evaluate hip mobility, posture, pelvic floor tension, breathing, and how you position yourself while sitting. Treatment can also help gradually improve your tolerance for the activities that currently trigger symptoms.
Pain With Ejaculation
Pain during or after ejaculation can occur for several reasons. Discomfort may be felt in the penis, testicles, perineum, rectum, lower abdomen, or deeper within the pelvis. Pelvic floor muscles participate in sexual function, so excessive tension or poor coordination can sometimes contribute. However, painful ejaculation may also be associated with prostate conditions, infection, inflammation, or other medical concerns. Persistent symptoms should be discussed with a healthcare provider.
Erectile Dysfunction and the Pelvic Floor
Pelvic floor muscles contribute to sexual function. For some men, pelvic floor rehabilitation may be incorporated into a larger treatment plan when sexual dysfunction is present. However, erectile dysfunction can have cardiovascular, neurological, hormonal, medication-related, psychological, and other causes. Physical therapy should not replace an appropriate medical evaluation. Your therapist can address pelvic floor and musculoskeletal factors when they are relevant.
Bowel Dysfunction in Men
The pelvic floor also plays an important role during bowel movements. These muscles need to relax at the right time to allow stool to pass. If the pelvic floor tightens instead, you may strain, spend a long time in the bathroom, or feel as though you cannot completely empty. Treatment can focus on improving pelvic floor relaxation and coordination while also addressing breathing and toileting mechanics.
Constipation and the Pelvic Floor
Constipation is not always caused by the pelvic floor. Diet, hydration, medications, digestive conditions, and activity levels can all play a role. However, pelvic floor dysfunction can contribute when the muscles do not relax appropriately during a bowel movement. Biofeedback and pelvic floor retraining may be useful when coordination is part of the problem.
Pelvic Floor Dysfunction and Exercise
Pelvic symptoms can interfere with running, cycling, weightlifting, golf, sports, or normal gym workouts. Some men stop exercising because certain movements increase their symptoms. Others continue pushing through discomfort. Physical therapy can help determine which movements are contributing and gradually build your tolerance. The goal is usually not to avoid exercise forever. It is to help you return to activity with better strength, mobility, and control.
Men’s Pelvic Health and Cycling
Cycling creates prolonged pressure through the pelvic and perineal region. Some men notice numbness, pelvic discomfort, urinary symptoms, or increased pelvic floor tension during or after riding. Bike fit, riding volume, mobility, tissue sensitivity, and pelvic floor function may all need to be considered. A physical therapist can evaluate the musculoskeletal factors involved and help determine appropriate activity modifications.
Breathing and the Male Pelvic Floor
Your diaphragm and pelvic floor work together. As you breathe in, your diaphragm moves downward and the pelvic floor naturally lengthens slightly. As you breathe out, both return toward their resting positions. Constantly holding your breath or bracing your abdomen can interfere with this coordination. Breathing exercises may therefore be incorporated into pelvic floor rehabilitation, particularly when excessive tension is present.
Core Strength and Pelvic Health
The pelvic floor is part of your core system. It works with the abdominal muscles, back muscles, hips, and diaphragm to help manage pressure during movement. This is why pelvic health rehabilitation may include exercises that look more like traditional physical therapy than you expected. Squats, carries, hip strengthening, core exercises, mobility work, and lifting practice may all become part of treatment.
Are Kegels Good for Men?
Kegels are pelvic floor contractions, and they can be useful for some men. But they are not automatically the right answer. A man with pelvic floor weakness may benefit from strengthening. Someone with excessive muscle tension may need to learn how to relax instead. Performing large numbers of Kegels without knowing what your pelvic floor needs can be counterproductive. A pelvic health evaluation can help determine the right approach.
Pelvic Floor Biofeedback for Men
It can be difficult to know whether you are correctly contracting or relaxing muscles you cannot see. Pelvic floor biofeedback can provide additional information about muscle activity. Sensors allow your therapist to observe how the muscles respond while you attempt different exercises. Biofeedback may help with strengthening, relaxation, or coordination depending on the problem being addressed. Reform offers pelvic floor biofeedback through our South Portland pelvic health program.
Pelvic Floor Electrical Stimulation for Men
Pelvic floor electrical stimulation, or e-stim, is another tool that may be used in certain rehabilitation programs. Electrical stimulation delivers controlled electrical impulses to targeted muscles or nerves. It may be considered when someone has difficulty activating the pelvic floor or for other specific rehabilitation goals. E-stim is not necessary for every patient. Your therapist will determine whether it is appropriate based on your evaluation.
What Happens During a Men’s Pelvic Health Evaluation?
Your first appointment begins with a conversation. Your therapist may ask about urinary symptoms, bowel function, pain, prostate history, surgeries, sexual symptoms when relevant, exercise, work, and the activities affected by your condition. The physical evaluation may include breathing, abdominal function, hip mobility, lower back movement, strength, and pelvic floor coordination. An external pelvic floor assessment may provide useful information. An internal rectal examination may sometimes be discussed when clinically appropriate because it can help assess pelvic floor muscle strength, tension, tenderness, and coordination. Your therapist should explain why an examination is being recommended before proceeding.
Do I Have to Have an Internal Pelvic Floor Exam?
No. An internal pelvic floor examination is not required for you to begin treatment.
If your therapist believes an internal assessment could provide useful information, they will explain what it involves and why it may help. You decide whether you are comfortable proceeding. Your therapist can still evaluate many important factors externally, including breathing, movement, hips, abdomen, back, strength, and functional activities.
What Does Men’s Pelvic Floor Physical Therapy Include?
Treatment depends entirely on what your evaluation shows. Your plan may include pelvic floor strengthening or relaxation, breathing exercises, hip mobility, core strengthening, manual therapy, bladder or bowel retraining, biofeedback, electrical stimulation, and functional exercise. Someone recovering from prostate surgery will not receive the same program as someone experiencing chronic pelvic pain. Treatment should address the problem rather than simply following a generic men’s pelvic floor routine.
Manual Therapy
Manual therapy may be used when muscle tension, tenderness, or mobility restrictions are contributing to symptoms. Treatment may involve the lower back, hips, abdomen, or external pelvic region. Internal pelvic floor manual therapy may also be discussed in certain situations. Any internal treatment should be explained beforehand and performed only with your informed consent.
Returning to Normal Activity
The goal of pelvic floor physical therapy is not simply to perform exercises in a treatment room. Your pelvic floor needs to function while you live your life. Treatment may progress toward lifting, walking, running, cycling, gym workouts, work tasks, sports, and other activities that matter to you. Your therapist can gradually increase the challenge as your symptoms and function improve.
When Should Men See a Medical Provider?
Pelvic floor dysfunction is only one possible explanation for urinary, bowel, sexual, or pelvic symptoms. Talk with your medical provider about new or unexplained urinary changes, blood in the urine or semen, painful urination, fever, persistent pelvic pain, erectile dysfunction, painful ejaculation, difficulty emptying your bladder, or significant changes in bowel function.
Sudden severe testicular pain requires urgent medical attention.
Physical therapy should work alongside appropriate medical evaluation rather than replacing it.
Men’s Pelvic Health Physical Therapy in South Portland, Maine
Reform Physical Therapy provides specialized men’s pelvic health physical therapy at our South Portland clinic. We can help address musculoskeletal and pelvic floor factors associated with urinary leakage, pelvic pain, bowel dysfunction, prostate surgery recovery, muscle weakness, excessive pelvic floor tension, and other pelvic health concerns. Treatment is private and individualized. You will understand what your therapist is evaluating, why a treatment is being recommended, and what you can work on between appointments. Pelvic health concerns may feel personal, but you do not have to simply live with symptoms without finding out whether rehabilitation can help.
Schedule a Men’s Pelvic Health Evaluation
Whether you are preparing for or recovering from prostate surgery, experiencing urinary leakage, dealing with pelvic pain, or having difficulty with pelvic floor coordination, an evaluation can help identify what is contributing.
Contact Reform Physical Therapy to schedule a men’s pelvic health physical therapy evaluation at our South Portland clinic.