Why Men Should Care About Their Pelvic Floor

This piece has been medically reviewed by Susie Gronski, PT, DPT in collaboration with Aeroflow Urology.

The pelvic floor plays a highly important role in everyday physiological functions, like pooping, peeing, and sex. I recommend thinking of the pelvis like a large bowl of cereal. The pelvic floor muscles make up the bottom of the bowl and the pelvic organs rest inside like cheerios floating around in your breakfast bowl.

To find your pelvic floor muscles while sitting, you can slide your hands under your sitz bones (the bony parts of the butt that you’re sitting on). Your pelvic muscles are located in-between those sitz bones, extending from your pubic bone (at the front) to your tailbone (at the back).

The Layers of the Pelvic Floor

There are three muscle groups that make up the pelvic floor:

The outermost layer of muscles helps with orgasm, ejaculation, urination (allowing the urethra and bladder to empty), and bowel function. The middle layer is a group of muscles that adds another layer of support around the urethra to keep you from peeing during times of exertion, strengthens fascial connections with your urogenital structures and helps stabilize the pelvis and lower spine during movement.

Lastly, the innermost layer of the pelvic floor is a group of muscles called the levator ani, which means to "lift the anus." This group of muscles is commonly known as the pelvic diaphragm. These muscles support the pelvic organs (bladder, prostate, and rectum) that are also nestled in the pelvic bowl, and help you poop. These tiny little muscles are marathon runners. Their endurance and function are necessary to help reinforce the structural integrity of the pelvis provided by ligaments and connective tissue.

The Function of the Male Pelvic Floor

The pelvic floor supports the following structures:

  • Bladder
  • Rectum
  • Prostate
  • Erectile tissues 
  • Digestive organs

The pelvic floor serves many functions. We’ll summarize their job with what I call the Five ‘S’es:

  • SPHINCTERIC CONTROL: The pelvic floor muscles clamp down on the tubes that empty your bladder and bowel to keep you continent. They relax when you pee or poop.
  • SUPPORT: These muscles support your abdominal and pelvic organs and work with your breathing muscle to regulate your body’s intracavitary pressure systems. When you cough, laugh, or sneeze, the pelvic muscles reflexively engage to work with the change in pressure coming down from your abdomen into your pelvis.
  • STABILITY: The pelvic floor muscles work together with the rest of your body to optimize movement and help with postural support and adaptability. The same as other skeletal muscles in your body, they’re constantly adjusting and adapting to your activity and posture. Normally, you don’t have to think about activating these muscles because a lot of these functions happen automatically, thank goodness!
  • SEXUAL APPRECIATION: Yes, you read that right. Your pelvic floor (the muscles in addition to peripheral nerves, ligaments, blood vessels, spinal cord, and brain) helps with your ability to get an erection, keep an erection, ejaculate, and experience orgasm.
  • SUMP PUMP: Just like any plumbing system, you need to have good flow. When you ejaculate, the pelvic muscles squeeze and release to pump out ejaculate fluid. These muscles also help squeeze the penile urethra after peeing to get the last drops of urine out, so you don’t have to be embarrassed after dribbling pee on your pants.

The Connection Between the Pelvic Floor & Incontinence

1 in 20 men experience concerns with urinary incontinence. Even though these concerns are common, you don’t have to live with soggy cheerios and other pelvic floor dysfunction concerns that can show up as:

Pain: This may cause secondary pelvic floor dysfunction but is not usually primary. This pain can be penile, testicular, scrotal, prostate, anorectal, lower back, or abdominal.

Stress urinary incontinence: Stress incontinence is the involuntary loss of urine during physical and/or exertional activities such as coughing, laughing, sneezing, lifting, and jumping.

Urge urinary incontinence: Urge incontinence is the involuntary loss of urine following a sudden, strong urge to urinate.

Fecal incontinence: Fecal incontinence is the experience of involuntary loss of stool with activity or following a sudden strong urge to have a bowel movement.

Sexual health difficulties: Erectile dysfunction, premature ejaculation, or delayed ejaculation

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Date of Birth

The most common causes for changes in bladder function and urinary continence mechanisms is from the result of a disease, condition, or injury that alters the nerves and/or supporting organs involved with continence mechanisms, including: 

  • Diabetes 
  • Pulmonary conditions like asthma, chronic obstructive pulmonary disease, and emphysema
  • Neurological conditions such as stroke, Parkinson’s disease, multiple sclerosis, and spinal cord injury
  • Surgical interventions to the prostate that result in the removal of supporting structures or alter nerve function related to bladder and sexual function, such as:
    • Benign prostate hypertrophy (BPH) procedures like TURP, which stands for transurethral resection of the prostate.
    • Prostate cancer treatments like radical prostatectomy and/or radiation. A radical prostatectomy removes the internal urethral sphincter located at the bladder neck and may also impair the nerves that help with bladder continence and sexual function.

Other factors that can influence bladder function and continence control include:

Medications. Medications such as alpha-blockers, blood pressure medications, certain antihistamines, diuretics, and antidepressants can all have an adverse effect on the bladder.

Constipation. The rectum and bladder share the same space within the pelvis. Chronic constipation results in excessive stress and strain on the bladder and pelvic muscles which can contribute to stress and urge urinary incontinence, nocturia, urgency and frequency.

Caffeine and Alcohol Intake. These are considered “natural” diuretics that chemically interact with your body to increase urine production. Although there is no direct link to caffeine or alcohol causing urinary incontinence, it has been postulated that they may act as bladder and bowel irritants/stimulants which may contribute to or exacerbate nocturia, urge incontinence, urgency and frequency.

Smoking. Nicotine has been shown to irritate the bladder muscle. In addition, smoking may lead to chronic coughing which adds excessive stress and strain on the bladder and pelvic muscles causing or exacerbating stress and urge urinary incontinence. (Not to mention the side effects of erectile dysfunction, yikes!)

Sedentary Lifestyle. Physical activity is anything that encourages your body to kick into gear, exerting effort beyond your typical baseline. Sitting on the couch clicking your TV remote doesn’t count as physical activity, sorry fellas. This is what we would call sedentary behavior. Exercise is physical activity that is intentionally scheduled, structured, and repetitive in nature with the goal of upping your health and fitness game. Both physical activity and exercise promote health and wellbeing including lowering your risk of incontinence and erectile dysfunction.

Identifying Red Flags with Your Pelvic Floor

Your body is resilient. You don’t toss your cereal bowl because the color fades; some concerns naturally come and go in the body. However, when your cereal bowl has a crack down the side and the milk keeps spilling out, that raises a red flag that you need the help of a master cereal bowl craftsman. Look out for these major symptoms to ask a specialist about:

  • Urinary incontinence 
  • Fecal or gas incontinence
  • Constipation
  • Consistent and persistent bothersome post urination dribble
  • Bothersome urinary urgency and frequency (average voiding intervals are between 2-4 hours)
  • Urinary retention 
  • Bladder pain and/or bladder spasms
  • Changes in urine stream (i.e, start/stop urination, hesitancy initiating stream, weak urine flow)
  • Straining to urinate or defecate
  • Feeling bladder fullness after urinating 
  • Nocturia (waking up > 1x night to urinate at night)
  • Pain during or after urination 
  • Pain during or after a bowel movement
  • Frequent hemorrhoids or pain with sitting
  • Sexual pain (pain with erection, pain during or after ejaculation, and pain during or after intercourse and/or masturbation)
  • Penile pain, testicular pain, or scrotal pain (or any changes in penile appearance or function)
  • Sensory changes like numbness, tingling, burning, prickling sensations anywhere in the pelvic region including sex organs
  • Lower back pain (there’s a high correlation of low back pain and pelvic floor dysfunction)

It’s time to see a pelvic floor therapist when you think more about your concerns than anything else. 

The sooner you can see a pelvic floor therapist, the better! Pelvic therapy is an integral part of the healthcare team and educates you on your pelvic and sexual health: knowledge is power! The more you understand how your body functions, the more empowered you will be to optimize your health, know how to recognize future red flags, and feel more confident and comfortable in your body. Pelvic therapists also connect men to more resources, specialists, and health approaches that work with your values and goals.

You’re well on your way to taking charge of your pelvic health and urinary incontinence by learning how the pelvic floor and urinary incontinence is interconnected, recognizing red flags that need attention and specialized care, and starting to chart out treatment options you’d like to explore with your pelvic health team.


About the Author

Specializing in men’s pelvic and sexual health, Susie Gronski, PT, DPT is a licensed doctor of physical therapy, certified pelvic rehabilitation practitioner, Michigan trained sex counselor and educator, international teacher, and author of Pelvic Pain The Ultimate Cock Block: A no-bullshit guide for men navigating through pelvic pain. Learn more at www.drsusieg.com


Information provided on the Aeroflow Urology blog is not intended as a substitute to medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.


References

  • Dorey, G. (2006). Pelvic dysfunction in men: diagnosis and treatment of male incontinence and erectile dysfunction. John Wiley & Sons.
  • Haag, S. (2019). Understanding and treating Incontinence: what causes urinary incontinence and how to regain bladder control. OPTP.
  • Medications that contribute to incontinence/voiding dysfunction. (2021, May 15). Retrieved from https://www.nafc.org/glossary
  • Park, H.J., Park, C.H., Chang, Y., & Ryu, S. (2018). Sitting time, physical activity and the risk of lower urinary tract symptoms: a cohort study. BJU International, 122, 293-299. doi: 10.1111/bju.14147
  • Shields, K.M., Fox, K.L., & Liebrecht, C. (2018). Health professionals drug guide. Pearson.
  • Wyman, J.F., Burgio, K.L., & Newman, D.K. (2009). Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence. International Journal of Clinical Practice, 63(8), 1177-1191. Doi: 10.1111/j.1742-1241.2009.02078.x

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