Pelvic Floor Dysfunction in Men: Causes, Symptoms, and Treatment

Your pelvic floor is kinda like your house’s plumbing: You never really think about it unless there’s something wrong. Indeed, your pelvic floor muscles make many everyday bodily functions possible, and when they’re off, you’ll definitely notice.

Pelvic floor dysfunction in males can lead to erectile dysfunction (ED), incontinence, pelvic pain, back pain, and more.

So, while these muscles aren’t exactly ones you’ll be flexing in front of the mirror in the weight room, your pelvic health shouldn’t be ignored. Let’s discuss your pelvic floor muscles, the symptoms of male pelvic floor dysfunction, and some ways to keep these muscles as healthy as possible.

First, if you’re unsure what your pelvic floor is or does, here’s a quick biology refresher. Your pelvic floor muscles provide support to the organs in your pelvic area, including your intestines, bladder, and urethra. These muscles span across the floor of your pelvis in a hammock-like shape.

You know the muscles you’d clench if you were trying to stop yourself from urinating mid-stream? Those are your pelvic floor muscles. (You’re squeezing them now, aren’t you?).

You use this group of muscles throughout the day, mostly without even realizing it. Whenever you go to the bathroom, your pelvic floor muscles help you control the flow of urine and your bowel movements.

Pelvic floor dysfunction — or PFD — is a term for a variety of disorders that affect the muscles in your pelvic floor. If the connective tissue or muscles in your pelvis weaken over time or get injured, it can lead to pelvic floor problems like incontinence. If the connective tissue or muscles are too tight from stress, injury, or inflammation, it can lead to pain and difficulty urinating.

The male pelvic floor also plays a role in penile health, so pelvic floor dysfunction may lead to sexual health issues like erectile dysfunction and ejaculatory disorders.

So basically, pelvic floor health is a really important part of men’s health — which is why it’s important to keep an eye out for the signs of a weak pelvic floor and to seek medical advice if you think you’re experiencing any of these issues.

Pelvic floor dysfunction can affect one or more of your pelvic organs. Symptoms can range from mild to severe.

Common Symptoms of Pelvic Floor Dysfunction

Weak pelvic floor symptoms in males include:

• Difficulty urinating, even when trying to “push” with your muscles

• Urinary incontinence (involuntary urinary leakage), especially when coughing, sneezing, or exercising

• Painful urination

• Constipation

• Fecal incontinence (inability to control your bowel movements)

• Difficulty controlling gas

• Chronic pelvic pain

• Muscle spasms

• Bulging in the perineum (between the scrotum and buttocks)

Less Common Signs of Pelvic Floor Muscle Dysfunction

Although it’s rare, you may experience pelvic organ prolapse, which is when a pelvic organ moves out of place. Pelvic organ prolapse in men usually affects the rectum, causing it to protrude out of the anus.

You might also experience sexual dysfunctions, including erectile dysfunction or different types of ejaculatory dysfunction like:

• Delayed ejaculation

• Premature ejaculation

• Retrograde ejaculation, which is where semen flows into your bladder instead of through your urethra

Not every man with pelvic floor dysfunction will experience all of the above symptoms. For some men, a tight or weak pelvic floor may mostly affect their ability to urinate, while others might primarily experience difficulty with bowel movements.

But as you can imagine, pelvic floor issues of all types can affect your quality of life. That’s why it’s a good idea to speak with a healthcare professional if you notice any signs of pelvic floor dysfunction.

What Are Hypertonic Pelvic Floor Muscles?

When people talk about pelvic floor dysfunction, they usually mean pelvic floor weakness. Another type of pelvic floor dysfunction is hypertonia, when the pelvic muscles become too tight.

Pelvic floor muscle tension can cause symptoms like chronic pelvic pain, sexual problems, and lower quality of life.

Contributing factors include holding in urine too long, stress, and sexual abuse.

The causes of pelvic floor dysfunction aren’t well understood.

Experts know that weakened pelvic muscles and connective tissue and injuries to the pelvis can contribute to it.

There are also other risk factors for pelvic floor dysfunction, including:

• Advanced age

• Obesity

• Prostate surgery (prostatectomy)

• Bladder, bowel, or anal surgery

• Smoking

• Regular or extreme heavy lifting

Women are more likely to develop pelvic health issues than men because pregnancy and childbirth can be risk factors for pelvic floor disorders. In fact, women who give birth at least once have about a 50 percent chance of developing pelvic floor dysfunction.

So, how is pelvic floor dysfunction diagnosed?

Generally, you can make an appointment with a healthcare professional, like your regular primary care provider or a urologist.

They’ll start by asking you about your symptoms and medical history. Then, they may use a number of different tests to examine whether your pelvic floor is functioning correctly.

They might use:

• A physical evaluation to check for muscle spasms, bulging muscles, or weakness

• A visual inspection of the bladder and urethra, known as a cystoscopy

• Urodynamic testing to measure your ability to store and release urine

• Anorectal manometry, a noninvasive procedure that measures the strength of the anorectal sphincter, which includes the anus and rectum

• Electromyography (EMG), which is where electrodes are used to measure muscle response to stimulation

Your provider might perform additional tests to confirm your diagnosis or look for other causes of your symptoms. These could include:

• An endoscopy, where a tube with a small camera is put into your body. This could be a colonoscopy, sigmoidoscopy, or anoscopy, all of which look at different parts of your digestive tract

• MRI or CT scan of the abdomen and pelvic region

If necessary, you might be referred to another healthcare professional. For example, you may need pelvic floor physical therapy or physiotherapy for ED to address your muscle tone.

Pelvic floor dysfunction can greatly affect your quality of life — but fortunately, a few different treatments are available.

Pelvic Floor Exercises

Contrary to popular belief, pelvic floor exercises (Kegels to strengthen muscles or techniques to relax muscles) aren’t just for women. Many men can also benefit from pelvic floor physical therapy.

Also called pelvic floor muscle training, these exercises might help:

• Improve urinary incontinence

• Reduce erectile dysfunction

• Provide relief from pelvic pain

• Increase time to ejaculation in people with lifelong premature ejaculation

The good news is that even a few minutes per day of pelvic floor exercises can make a difference.

Kegel exercises are a popular type of pelvic floor exercise for a weak pelvic floor. This is how you do them:

1. Empty your bladder, and then locate your pelvic floor muscles — they’re the same muscles you’d use if you’re trying to stop urinating. When you squeeze those muscles, you’re activating your pelvic floor muscles.

2. Clench your pelvic floor muscles and hold them for five seconds.

3. Relax those muscles fully.

4. Repeat steps two and three 10 to 20 times, three to four times a day.

You can do a similar exercise using the muscles in your anus.

Pelvic floor muscle exercises are often done with biofeedback. Biofeedback uses special sensors to monitor how you relax and contract your muscles. This allows a healthcare professional to observe your muscles and instruct you on how to improve your coordination. Research shows that biofeedback is effective at helping with pelvic floor issues.

A pelvic floor physical therapist or urology expert can also advise you on how to continue your pelvic floor dysfunction treatment at home, whether it’s through Kegel exercises, relaxation exercises, lifestyle changes, or other techniques.

Habits and Lifestyle Changes

A number of lifestyle changes may help prevent pelvic floor dysfunction or reduce the severity of your symptoms.

Try the following:

• Stop or limit your intake of alcohol. Alcohol may increase bowel movements and urination, which can aggravate some symptoms of pelvic floor dysfunction.

• Reduce caffeine. Like alcohol, caffeinated drinks can increase your need to use the bathroom.

• If you’re overweight, try to lose weight. Research shows that obesity is a risk factor for pelvic floor issues and that weight loss may improve your symptoms. A healthcare professional can advise you on safe ways to lose weight.

• Increase your fiber intake. Fiber-rich foods include whole grains, vegetables, fruits, beans, and lentils, which can improve digestion and make bowel movements easier.

• Keep exercising. Exercise benefits many aspects of your health, including pelvic floor function. Physical training that targets your abs, core, and lower back may improve your pelvic floor muscles.

• Stay hydrated. In addition to benefiting pretty much all your bodily functions and organs, getting enough water will keep your bowel movements regular and make it easier to pass stools.

While these lifestyle changes can benefit your pelvic floor muscles, it may take a while before you notice an improvement. For best results, you might have to practice these healthy habits alongside regular pelvic floor exercises — and, if necessary, medication.

Medications

We’d love to tell you that there’s a medication that strengthens weak pelvic floor muscles, but sadly, that’s not the case.

With that said, some common medications can improve the symptoms of pelvic floor dysfunction. Depending on your symptoms, you may have a few different treatment options.

For urinary incontinence, a healthcare provider may prescribe:

• Anticholinergic medications, which target the neurotransmitters that control urination

• Beta-3 agonists, which relax the smooth muscle in your bladder and reduce the urge to urinate

• Tofranil^® (imipramine), a tricyclic antidepressant, which may also relax your bladder

• Botox^® injections to keep your bladder muscles from spasming

For issues with bowel movements (fecal incontinence), you may be prescribed:

• Imodium^® (loperamide) for treating diarrhea and improving bowel control

• Medications containing diphenoxylate and atropine, like Lomotil^®

• Fiber laxatives to reduce constipation, such as Benefiber^® and Metamucil^®

If you’re experiencing erectile dysfunction, your healthcare provider may prescribe ED medication like:

• Viagra^® (sildenafil)

• Cialis^® (tadalafil)

• Stendra^® (avanafil)

• Vardenafil

If you’re looking for something more discreet, Hims Hard Mints are a chewable ED medication containing the active ingredients in Viagra and Cialis in safe, effective doses.

Lastly, if you’re experiencing premature ejaculation, you can look into premature ejaculation treatments like SSRIs or topical anesthetics. Clockstopper Climax Delay Wipes are non-prescription wipes made with benzocaine, which reduces sensitivity in your penis to help you last longer.

Although pelvic floor muscles may not always be at the top of your mind, they play an important role in your overall well-being. Remember:

• Your pelvic floor muscles are important. Pelvic floor dysfunction in males can affect your bowel movements, urinary continence, and sexual function. In fact, a tight or weak pelvic floor in men is associated with erectile dysfunction and ejaculatory conditions.

• But pelvic floor dysfunction is treatable. To keep those muscles healthy, you can practice pelvic floor exercises. Lifestyle changes can also help with the symptoms of pelvic floor dysfunction — think: exercising, staying hydrated, and avoiding beverages that irritate your bowels.

• No medication strengthens the pelvic floor. However, certain medications can help with the symptoms of pelvic floor dysfunction. For example, a healthcare practitioner might prescribe medications for bladder incontinence or erectile dysfunction medications if necessary.

Looking for relief from ED and premature ejaculation related to pelvic floor dysfunction? Reach out to a healthcare professional to get advice today.