What is the Pelvic Floor?
The pelvic floor is a group of muscles that forms a supportive sling in the lower pelvis. This sling, made up of 14 different muscles arranged in three layers, attaches to the pelvic bones. In a man’s body, these muscles surround the urethra, the area beneath the prostate gland, and the anus. Click here for a diagram of the male sexual anatomy. In addition to keeping the pelvic organs in place and the pelvic bones stable, these muscles are also responsible for:
1. The pleasurable muscle contractions felt during orgasm. Orgasms feel bigger and stronger when the pelvic floor muscles are strong. Some men are able to learn to separate their orgasm from ejaculation, partly by flexing their pelvic floor muscles. This allows a man to choose how long to experience sexual pleasure, rather than have his ejaculation end the experience.
2. More forceful ejaculations.
3. Keeping urine inside the bladder at moments of unexpected belly pressure (laughing, coughing, lifting, sneezing, jumping).
4. Keeping stool inside the rectum until you consciously relax your pelvic floor to allow it to pass.
Pelvic Floor Problems
A healthy pelvic floor is strong and flexible, and can contract and relax easily. Pelvic floor strength and flexibility vary from person to person. Some people go through life without problems, while others experience troublesome symptoms because their pelvic floor muscles are too weak, too tense, too inflexible, poorly coordinated, or a combination of these. Pelvic floor problems can be divided into two broad categories: Low Tone Pelvic Floor Dysfunction (weakness of the pelvic floor), and High Tone Pelvic Floor Dysfunction (painful, tense pelvic floor). There are concrete steps you can take to prevent and/or treat either type of problem.
Low Tone Pelvic Floor Dysfunction
Low Tone Pelvic Floor Dysfunction occurs when the pelvic floor muscles are weak from disuse, or stretched or damaged by surgery. When this happens, the muscles are not strong enough to sufficiently hold up the pelvic organs and hold in urine and stool. Orgasms feel weaker, and the muscles tire more easily.
Who is at Risk of Developing Low Tone Dysfunction?
• People who have had pelvic surgery, particularly with access through the perineum
• People who do not have regular orgasms, because orgasmic contractions help keep the pelvic floor strong
• People who carry a lot of body weight, which can stress the pelvic floor muscles
• Athletes who experience injury to the perineum from water-skiing, bicycling, or equestrian sports
• Men after prostate surgery
• People who have had radiation treatment to the pelvic region
What are the Symptoms of Low Tone Dysfunction?
• Weak or absent orgasms
• Stress incontinence (losing urine or stool when you sneeze, laugh, cough, lift, or exercise)
• Weak ejaculations
How can I treat or prevent Low Tone Dysfunction?
Whether you are trying to treat symptoms of a weak pelvic floor, prevent them from occurring in the future, or increase sexual pleasure, learning to do Kegel exercises will help. These exercises, named Kegel exercises after the doctor who developed them, are designed to increase the strength of the pelvic floor muscles by intentionally contracting and relaxing them in a series of repetitions.
First, Find the Muscles:
For some men, finding the correct muscles to contract and feeling them respond can be challenging. To tighten your pelvic floor muscles, think of pulling your testicles up into your body. If you’re contracting the correct muscles, your penis will rise when you tighten, and fall again when you relax your muscles. This is more noticeable when your penis is erect, but you should still be able to feel the movement when soft. You may also be able to feel the subtle lifting of muscles in your perineum–the area between the scrotum and anus–by placing a hand there and then contracting. This is easiest to do lying on your side.
If you are unsure that you are contracting the correct muscles, or are not able to make the muscles respond, contact a Pelvic Floor Therapist who can teach you how to do this correctly and effectively. There are tools available to help you do Kegel exercises. Some are also prostate massagers, but anything that is designed for anal insertion, whether or not it stimulates the prostate, can help you feel and identify your pelvic floor muscles more easily. This allows you to strengthen more effectively, especially at first. Some men choose to use a tool, others feel confident exercising without tools. One way is not better than another; as long as you’re doing the exercise as outlined below, you can do them however works best for you.
If you choose to use a tool, you’ll also need some lubricant. Use only water-based lubricants if your tool is made of silicone, but any lubricant is fine with plastic and stainless steel. Many men prefer a thicker lubricant to provide extra cushion for anal skin.
1. Lie down on your back in a comfortable place, with your knees bent. If you are using an exercise tool, coat it with lubricant, relax and gently insert it into your anus.
2. Contract your pelvic floor muscles. It will feel like you’re pulling up and in toward your belly button. Do not push out—imagine that you are pull in your testicles. If you’re using a tool, you should feel it rise a bit or, if it’s curved, nudge your prostate. Try to keep your leg, buttock, and abdominal muscles relaxed, and remember to breathe normally throughout the exercise.
3. Hold the lift for a count of 5. Again, remember to breathe!
4. Relax your muscles. You may notice your penis moving as you tighten and release your pelvic floor muscles.
5. IMPORTANT: After each Kegel, take a deep belly breath. Inhale deeply then gently blow out the air while you relax your pelvis completely. This deep relaxation is just as important as the other steps, because the deep breath relaxes the muscles that are not under your conscious control.
6. Congratulations, you have just done one Kegel.
Important Points to Remember:
• If you forget to do your exercises for a few days, don’t fret—just get back to them when you can.
• If you have any pain in your pelvis or genitals that feels worse when doing this, STOP, and contact your health care provider.
• If there’s no improvement in your symptoms after a month, contact a Pelvic Floor Therapist. It’s not uncommon to think you’re doing Kegels correctly but are actually contracting your buttock or abdominal muscles instead, or pushing out rather than pulling up. If you think this might be the case, a Pelvic Floor Therapist can help you do them correctly.
How many Kegels should I do every day?
Start out doing 2 sets of 5 twice a day, holding each for 5 seconds. Gradually increase the time until you can hold each contraction for 10 seconds. Next, increase the number you do each time until you can do 2 sets of 10, holding each for 10 seconds. It would go like this: contract and hold for 10 seconds (while breathing normally), and then relax for 10 seconds (while taking a deep belly breath). Then, repeat the sequence until you have completed 10 exercises. Next, rest for a few minutes and then do another set of 10 in the same way. Repeat this entire sequence again later in the day.
But I read I should do 100 Kegels really fast. Why do you recommend only 5-10?
The pelvic floor is made up of two kinds of muscle fibers: slow-twitch (70%) and fast-twitch (30%). Slow-twitch fibers respond best to slow, step-by-step engagement like we have described. If you only do fast ones, you are not strengthening the majority of the muscle fibers. So it’s important to learn to do the “hold” as described above.
The other 30% of muscle fibers are important too, so once you’re comfortable with the Kegel “hold”, you can learn “flicks.” To do these, tighten your pelvic floor muscles the same way as before but more quickly, then relax. The entire cycle should take about 3 seconds, and you should breathe normally and keep the rest of your body relaxed throughout. Do about 20 twice a day, and finish each set with the deep belly-breath. Doing more would just overwork the muscles, and can lead to poor technique that compromises your progress or leads to other problems.
Once I have my routine of two sets of 10 Kegel “holds” and 20 “flicks,” how should I progress from there?
If you began by using a tool, now is the time to learn to contract your pelvic floor muscles without the tool. Once you have mastered holding for 10 seconds without the tool and without involving your buttock or abdominal muscles while lying down, the next step is to do your exercises sitting up, and after that, standing. You can eventually build up to doing them while you do functional tasks like lifting, walking up stairs, jumping, etc. It’s important to make sure you’re able to contract and relax your pelvic floor muscles without involving other muscles in your body, and while breathing normally, so don’t rush the process. If you’re not sure if you’re doing them correctly, check with a Pelvic Floor Therapist.
If you want to do more advanced exercises, you can add weight (resistance) while you do your exercises. Once you have mastered doing the exercises lying down, the next step is to use a tool and hold it with your hand and pull slightly outward on it at the same time as your muscles work to hold it in. Once you can hold for 10 seconds, still using good technique (not involving other muscles, remaining relaxed, breathing normally) you may try it while standing. Or try hanging a light towel over your erect penis while doing the exercises as another way of adding resistance. The weight of the towel can be increased over time. Another method is to use weighted anal tools, such as those made by Njoy, first lying down then standing, while allowing the weight of the tool to provide resistance.
High Tone Pelvic Floor Dysfunction
High Tone Pelvic Floor Dysfunction occurs when the pelvic floor muscles are overly tense, inflexible, or in spasm. The muscles are unable to move and stretch easily with daily activities. This causes uneven stress on the bones where the muscles attach, as well as discomfort of the muscles themselves. The term “high tone” refers to the presence of high tension in the muscles. This can occur with either strong or weak pelvic floor muscles, and can cause a wide range of problems.
Who is at Risk of Developing High Tone Dysfunction?
• People who do a lot of Kegels without adequate relaxation both during and in between exercises.
• Athletes, gymnasts, and Pilates enthusiasts who work out with a focus on core strength without adequate focus on relaxation.
• People with high-stress lifestyles and/or difficulty coping with stress who carry their tension in their pelvis.
• People who have had trauma to their pelvic floor from surgery or sexual abuse.
What are the Symptoms of High Tone Dysfunction?
• Pain as sexual arousal builds
• Pain with orgasm
• Pain in the penis, testicles, or perineum
• Constipation and/or pain with bowel movements
• Painful urination and/or increased frequency of urination
• Ache in the pelvis from constant muscle stress on the lower spine and tail bone
• Incorrect diagnosis of prostatitis, or prostatitis that is resistant to medical treatment over a period of months or years
What should I do if I think I have High Tone Dysfunction?
There are many conditions that are easily confused with High Tone Dysfunction, so we recommend you start by seeing your health care provider to obtain an accurate diagnosis. Once a medical diagnosis of pelvic floor dysfunction is made, a Physical Therapist (PT) or Occupational Therapist (OT) who specializes in the pelvic floor can do a thorough assessment and determine the exact portions of the pelvic floor that need attention. The therapist can perform treatment as well as teach you a series of individualized exercises you can do at home, either alone or with the help of a partner, to help facilitate normal coordination and flexibility of pelvic floor muscles. We recommend working with a therapist rather than attempting to treat this condition on your own.