Introduction
Many men suffer from weakness of their pelvic floor muscles. Common symptoms of weakness include:
- Leaking urine with activity, for example during running, jumping, coughing and sneezing
- A sudden and urgent need to pass urine
- Leaking urine before you get to the toilet
- Leakage of stool from the back passage
- Erectile dysfunction
This information is to be used as a guide alongside the advice and guidance from your physiotherapist.
The Pelvic Floor Muscles
The pelvic floor muscles are a supportive sling of muscles, stretching from the tail bone at the back to the pubic bone at the front. They are responsible for:
- Supporting the pelvic organs – the bladder and bowel
- Helping to maintain your continence (urine and stool)
- Helping you maintain an erection during intercourse
Factors leading to incontinence or weakness
● Poor physical fitness
● Prostate surgery
● Long term cough
● Constipation/straining to empty your bowels
● Being overweight
● Pelvic trauma or some surgery
● Certain conditions such as multiple sclerosis, stroke or diabetes
● Repeated heavy lifting (using a poor or incorrect technique)
● Injury to the perineum (area from the base of the penis to the back passage) by direct trauma or prolonged pressure
Pelvic floor muscles can be strengthened just like any other weak or damaged muscle. They need to be regularly exercised to work well.
How to exercise your pelvic floor muscles
Sit, stand or lie comfortably.
Imagine you are trying to stop yourself from passing wind at the same time as if you are trying to stop passing urine; slowly squeeze and lift the muscles. You may feel the base of your penis move up towards your abdomen.
You need to practice long squeezes to build up the endurance and short squeezes to enable the muscles to react quickly.
Long Squeezes:
Tighten and pull up the pelvic floor muscles as hard as you can for 12 seconds
Rest for 4 seconds and then repeat the contraction
Repeat 12 times
Short Strong Squeezes:
- Pull up and squeeze for 1 second and then relax
- Repeat 10 times
Complete 3 times per day
A feeling of gentle tightening in your lower abdomen is normal. Try to avoid pulling in your stomach, squeezing your legs together, tightening your buttocks or holding your breath. This will help to ensure that only your pelvic floor muscles are working.
You may find it easier to start your exercises when you are sitting or lying down. As your muscles improve, aim to do your exercises when standing. As you improve, you will notice that you can hold your squeeze for longer and do more repetitions in comparison to the start.
Personalised programme from your physiotherapist
Your physiotherapist may give you an individualised programme for your pelvic floor muscles based on their accurate examination of your strength and endurance.
Long squeezes:
- Pull up and hold as tightly as you can for seconds
- Rest for 4 seconds
- Repeat times
Short strong squeezes:
- Pull up and squeeze for 1 second and relax
- Repeat times
Complete the long and short strong squeezes per day
Position yourself in LYING SITTING STANDING to do your exercises
Pelvic floor exercises are not a quick fix
It is important that you continue with your exercises even if you feel they are not helping. It can take 3-6 months to notice an improvement in your symptoms.
Remembering to Exercise
It is easy to forget your pelvic floor exercises. Make sure your exercises are part of your daily routine – just like brushing your teeth or taking medication. You should continue with your exercises for the rest of your life.
- Use coloured stickers or reminder notes around the house or at work
- Use triggers for example when boiling the kettle, waiting at traffic lights
- Use the advert breaks between television programmes
- Set and alarm on your phone or watch
- Download the NHS ‘Squeezy’ App on your smart phone which alerts you and then counts you through your programme
Other useful tips and advice
Use ‘The Knack’
The knack is a squeeze of your pelvic floor muscles before you do anything that may put them under pressure, such as lifting, coughing or sneezing.
Avoid being overweight
Maintaining the correct weight can make a big difference to your symptoms by reducing the strain on the muscles that help to control bladder and bowel movements.
Avoid constipation
Straining to open your bowels stretches the pelvic floor muscles, making them weaker. It is important to drink plenty of fluids and you may need to adjust your diet. This is particularly important if you have had prostate surgery.
Drink enough fluids
Reduce your caffeine intake, as these drinks may irritate your bladder. Try to drink water and aim to drink 3-4 pints/1.5-2 litres of fluid per day. Do not restrict your fluid intake. This can make your symptoms worse as your urine will be more concentrated. Regular drinking throughout the day is recommended.
Exercise
If you take part in any regular exercise, discuss this with your physiotherapist. If you have pelvic floor muscle weakness it may be necessary to adapt or change some of your exercise habits for a period of time.
Bladder emptying
It is important to empty your bladder completely each time you go to the toilet. Take your time. If you think your bladder may not be completely empty, try rocking your pelvis forwards and backwards; it may help to empty a little more.
Try tightening your pelvic floor strongly following urinating to ensure you have emptied the last few drops. This may help with post micturition dribble.
Frequency of bladder emptying
The bladder normally empties between five and eight times per day. This usually means emptying your bladder every 2-5 hours. Leaving too little or too long between emptying may upset this normal function. Less than two hours or more than five hours may lead to problems. You may need to train your bladder to hold more by trying delaying techniques when you feel the urge to go, such as:
● Keep calm and tighten your pelvic floor muscles
● Sit on a hard surface
● Curl your toes hard
● Distract your mind by counting backwards, singing a song, etc
Holding too long can result in the bladder not working correctly in the long term as the bladder muscle can become overstretched.
Smoking
Try to reduce this or give up if you can. Speak to a healthcare professional if you need support with this.
If you have any problems completing the exercises or understanding this leaflet you should ask your doctor, nurse, continence advisor or specialist pelvic health Physiotherapist for advice.
Further information
Date of Review: May 2024
Date of Next Review: May 2026
Ref: PI_DS_305 (BRO)