Men’s Pelvic Health

Support for bladder, bowel and pelvic floor function

Pelvic floor problems can affect men at different stages of life and may cause symptoms involving bladder control, bowel function, pelvic pain and everyday physical activity.

Symptoms may develop following prostate surgery, other pelvic procedures, changes in bladder or bowel function, or problems with the way the pelvic floor muscles contract and relax.

Men’s pelvic health physiotherapy focuses on understanding how the pelvic floor is functioning and developing treatment around your individual symptoms. For some men this involves strengthening weak muscles, while others may need help learning to relax an overactive pelvic floor.

What is the male pelvic floor?

The pelvic floor is a group of muscles at the base of the pelvis.

These muscles contribute to:

• Bladder control
• Bowel control
• Supporting the pelvic organs
• Sexual function
• Managing pressure during coughing and lifting
• Stability during movement

The pelvic floor needs to be able to contract when additional support is required and relax when passing urine, opening the bowels and during normal movement.

Problems can occur when the muscles are weak, overactive, poorly coordinated or affected by surgery.

When men’s pelvic health physiotherapy may help

An assessment may be useful if you are experiencing:

• Urinary leakage
• Leakage after prostate surgery
• Leakage when coughing, sneezing or exercising
• Post-void dribbling
• Urinary urgency
• Frequent urination
• Difficulty controlling the bladder
• Bowel leakage
• Difficulty controlling wind
• Pelvic pain
• Perineal discomfort
• Difficulty relaxing the pelvic floor
• Symptoms associated with prolonged sitting
• Pelvic floor weakness before or after prostate surgery
• Difficulty returning to exercise after pelvic surgery
• Uncertainty about performing pelvic floor exercises correctly

Symptoms involving urination, bowel function or pelvic pain can have several causes, so physiotherapy assessment does not replace appropriate medical investigation.

What happens during your first appointment?

The first appointment begins with a private discussion about your symptoms and how they affect everyday life.

The physiotherapist may ask about:

• Bladder symptoms
• Urinary leakage
• Urinary frequency
• Urgency
• Post-void dribbling
• Bowel function
• Pelvic pain
• Previous prostate or pelvic surgery
• Other medical conditions
• Medication
• Current exercise
• Work
• Lifting and physical activity
• Fluid intake
• Toilet habits
• What you would like to improve

Depending on your symptoms, the physical assessment may consider:

• Breathing
• Abdominal movement
• Hip and pelvic movement
• General strength
• Functional movement
• Pelvic floor muscle control

In some situations, a rectal pelvic floor examination may provide useful information about muscle strength, coordination and the ability to relax.

An internal examination should only be carried out when clinically appropriate, after it has been fully explained and with your informed consent. You can decline or stop the examination at any point.

What treatment may include

Treatment depends on what is identified during your assessment.

Pelvic floor strengthening

If the pelvic floor muscles are weak, rehabilitation may include exercises designed to improve strength and endurance.

This may involve practising:

• Short contractions
• Longer controlled holds
• Relaxation between contractions
• Pelvic floor activation during movement

The exercise programme should reflect your current ability rather than using the same number of repetitions for everyone.

Correct technique is important.

Pelvic floor relaxation

Not every male pelvic floor problem is caused by weakness.

Some men have pelvic floor muscles that remain tense or do not relax properly.

In this situation, repeatedly strengthening the muscles may increase symptoms.

Treatment may instead focus on:

• Relaxed breathing
• Pelvic floor awareness
• Learning to release the muscles
• Comfortable mobility
• Reducing unnecessary muscle tension
• Gradually returning to normal activity

Strengthening can be introduced later if required.

Bladder training

Where urgency or frequent urination is a problem, rehabilitation may include bladder-management strategies.

This may involve:

• Reviewing toilet frequency
• Managing urgency
• Gradually changing bladder habits where appropriate
• Reviewing fluid intake
• Reducing unnecessary precautionary toilet visits

The approach depends on the cause and pattern of your symptoms.

Breathing and pressure management

The pelvic floor works alongside the abdominal muscles and breathing system.

Treatment may include learning how to coordinate breathing and pelvic floor activity during:

• Lifting
• Coughing
• Standing from a chair
• Strength training
• Household activities
• Work-related movements

The pelvic floor does not need to remain tightened throughout the day. It needs to respond when required and relax normally afterwards.

General strengthening and movement

Pelvic health rehabilitation may also include:

• Hip strengthening
• Abdominal exercises
• Gluteal strengthening
• Mobility exercises
• General conditioning

Treatment should consider the whole body rather than focusing entirely on isolated pelvic floor contractions.

Home exercise programme

You may receive exercises and management strategies to continue between appointments.

The programme can be reviewed and progressed as your symptoms and pelvic floor control change.

Pelvic floor rehabilitation before prostate surgery

Pelvic floor physiotherapy may begin before some types of prostate surgery.

This allows time to:

• Identify the correct pelvic floor muscles
• Practise the exercises
• Understand when to contract and relax
• Become familiar with the programme before surgery

Learning the technique beforehand can make it easier to restart the exercises during recovery when medically appropriate.

Your surgical team will provide guidance on when exercises should begin or resume.

Pelvic floor rehabilitation after prostate surgery

Urinary leakage can occur following prostate surgery, particularly after procedures involving removal of the prostate.

The amount of leakage varies considerably.

Some men experience relatively mild symptoms, while others require a longer period for bladder control to improve.

Rehabilitation may focus on:

• Pelvic floor strength
• Muscle endurance
• Timing of contractions
• Relaxation between contractions
• Using the pelvic floor during coughing and movement
• Gradually returning to normal physical activity

Supervised pelvic floor muscle training is recommended for men experiencing stress urinary incontinence after prostatectomy.

Urinary leakage

Urinary leakage may occur during activities that increase pressure through the abdomen.

This can include:

• Coughing
• Sneezing
• Standing from a chair
• Lifting
• Walking quickly
• Exercise
• Changing position

Pelvic floor rehabilitation may improve the strength and timing needed to manage these situations.

Treatment gradually moves from isolated contractions towards using the muscles during normal everyday movement.

Leakage during exercise

Some men notice leakage during more physically demanding activities such as:

• Gym training
• Running
• Lifting
• Sport
• Heavy work

This does not necessarily mean these activities need to be avoided permanently.

Rehabilitation may work on:

• Pelvic floor strength
• Breathing
• Pressure management
• General strength
• Gradual return to loading

The goal is to develop enough capacity for the activities you want to return to.

Post-void dribbling

Post-void dribbling is leakage of a small amount of urine shortly after finishing urination.

It may occur when urine remains within the urethra after the bladder has emptied.

Pelvic floor exercises and practical emptying strategies may help some men manage this problem. Male pelvic floor exercises are also used for post-void dribbling.

Persistent or changing urinary symptoms should be discussed with an appropriate healthcare professional.

Urinary urgency

Urgency is a sudden and difficult-to-delay need to pass urine.

You may find yourself:

• Rushing to the toilet
• Going more frequently
• Planning activities around toilet access
• Experiencing leakage before reaching the toilet

Treatment may include bladder training alongside pelvic floor strategies.

The aim is to improve control without simply encouraging you to hold urine for increasingly long periods regardless of symptoms.

Frequent urination

Frequent urination can occur for several reasons.

An assessment may consider:

• Fluid intake
• Caffeine
• Bladder habits
• Urgency
• Medication
• Other urinary symptoms

Physiotherapy may help where bladder habits or pelvic floor function are contributing.

However, a significant or unexplained change in urinary frequency may require medical assessment.

Difficulty emptying the bladder

Some men experience difficulty starting urine flow or feel that the bladder has not emptied completely.

These symptoms should not automatically be treated with pelvic floor strengthening.

The pelvic floor needs to relax during urination.

Difficulty emptying may also be related to prostate enlargement or other urinary conditions, so appropriate medical assessment is important.

Bowel-control problems

The pelvic floor also contributes to bowel control.

Men may seek physiotherapy because of:

• Difficulty controlling wind
• Bowel leakage
• Urgency
• Reduced confidence leaving the house

Assessment may consider pelvic floor muscle strength, coordination and bowel habits.

Rehabilitation may include strengthening or coordination exercises depending on the findings.

New or significant changes in bowel control should also receive appropriate medical assessment.

Constipation and difficulty emptying

Some pelvic floor problems involve difficulty relaxing the muscles during bowel movements.

Repeated straining may then become part of the problem.

Treatment may include:

• Toilet positioning
• Relaxed breathing
• Pelvic floor relaxation
• Reducing unnecessary straining
• Movement and activity advice

Persistent constipation can have several causes and may require medical or dietary assessment alongside physiotherapy.

Male pelvic pain

Pelvic pain can affect areas such as:

• The perineum
• Lower abdomen
• Groin
• Around the rectum
• Genital area
• Lower back or hips

Symptoms may be constant or triggered by activities such as sitting, exercise, bowel movements or sexual activity.

Pelvic pain is not automatically caused by weak muscles.

In some men, the pelvic floor muscles may be overactive or sensitive.

Overactive pelvic floor muscles

An overactive pelvic floor has difficulty relaxing fully.

Symptoms can sometimes include:

• Pelvic aching
• Perineal discomfort
• Pain with sitting
• Difficulty starting urination
• Discomfort around bowel movements
• A feeling of pelvic tension

If the muscles are already excessively tense, repeatedly performing strengthening exercises may not be appropriate.

Treatment may instead focus on relaxation, breathing and restoring comfortable movement.

Pelvic pain and prolonged sitting

Some men notice that pelvic symptoms become more noticeable after sitting for longer periods.

This can affect:

• Desk work
• Driving
• Travel
• Cycling

Rehabilitation may consider:

• Sitting duration
• Position changes
• Hip mobility
• Breathing
• Pelvic floor relaxation
• General physical activity

Rather than searching for one perfect sitting posture, regularly changing position may be more useful.

Pelvic floor and breathing

The pelvic floor moves in coordination with breathing.

Continually holding the abdomen tight or frequently holding your breath during physical tasks may alter this coordination.

Breathing exercises may therefore be included when the goal is to improve pelvic floor relaxation or pressure management.

The aim is not to make breathing complicated but to allow the pelvic floor and surrounding muscles to work more naturally.

Pelvic floor and abdominal strength

Pelvic floor rehabilitation does not require avoiding abdominal exercise.

The abdominal and pelvic floor muscles normally work together during movement.

Depending on your symptoms, rehabilitation may gradually include:

• Abdominal strengthening
• Squats
• Lunges
• Carrying
• Resistance training
• Functional exercise

The programme can become progressively more demanding as control improves.

Returning to lifting

Lifting increases pressure through the abdomen and pelvis.

Men recovering after pelvic or prostate surgery may initially need restrictions according to surgical guidance.

Once healing allows, rehabilitation can gradually rebuild lifting capacity.

This may involve:

• General strengthening
• Breathing
• Pelvic floor coordination
• Squatting
• Carrying
• Progressive resistance

The goal is to return to normal physical demands rather than permanently avoiding lifting.

Returning to the gym

Pelvic floor symptoms can make gym training feel uncertain, particularly after prostate surgery.

Returning to exercise may initially involve:

• Reducing resistance
• Shortening sessions
• Using controlled movements
• Building general strength gradually
• Monitoring urinary symptoms

You may then progress towards:

• Squats
• Deadlift variations
• Pressing
• Pulling
• Resistance machines
• Cardiovascular exercise

The programme should follow any surgical restrictions that remain.

Returning to running

Running places repeated demand through the trunk and pelvic floor.

If running causes urinary leakage or pelvic symptoms, rehabilitation may first address:

• Pelvic floor strength
• General leg strength
• Trunk control
• Physical fitness
• Impact tolerance

A gradual programme can then progress from walking to short periods of running.

Symptoms can help determine how quickly the programme should progress.

Returning to sport

Returning to sport may require greater pelvic floor and whole-body capacity than normal everyday activity.

Depending on the sport, rehabilitation may eventually include:

• Running
• Jumping
• Lifting
• Changes of direction
• Repeated high-effort movements

The later stages of rehabilitation should reflect the actual demands of the activity you want to return to.

Pelvic floor health and sexual function

The pelvic floor contributes to normal sexual function in men.

Symptoms involving erections, ejaculation or pain during sexual activity can have several possible causes and should not automatically be attributed to pelvic floor weakness.

Where pelvic floor dysfunction appears to be contributing, rehabilitation may form one part of management.

Other medical assessment or treatment may also be required depending on the symptoms.

Sexual function after prostate surgery

Changes in sexual function may occur after prostate surgery.

Recovery depends on several factors and may involve care from the surgical or urology team.

Pelvic health physiotherapy primarily focuses on pelvic floor muscle function, continence and physical rehabilitation.

If erectile difficulties or other sexual symptoms remain a concern, these should also be discussed with the appropriate urology or medical professional.

Pain during or after sexual activity

Pelvic floor muscle tension can sometimes contribute to discomfort associated with sexual activity.

Where appropriate, rehabilitation may involve:

• Pelvic floor relaxation
• Breathing
• Mobility
• Reducing muscle guarding
• Gradual return to comfortable activity

Persistent genital or pelvic pain should receive appropriate medical assessment to exclude other causes.

Returning to everyday activities after surgery

Following prostate or other pelvic surgery, everyday activities may initially feel more demanding.

Rehabilitation can gradually work towards:

• Walking
• Stairs
• Household activities
• Driving
• Lifting
• Work
• Exercise
• Sport

The programme should respect healing and any restrictions provided by your surgical team.

Walking after pelvic surgery

Walking is often an important part of general recovery.

You may begin with relatively short distances and gradually increase according to:

• Energy
• Comfort
• Continence
• Surgical recovery
• General strength

If urinary leakage increases during longer walks, pelvic floor rehabilitation can be adjusted alongside the walking programme.

Pelvic floor fatigue

Like other muscles, the pelvic floor can fatigue.

Some men notice that bladder control is better earlier in the day and becomes more difficult later or after prolonged physical activity.

This may indicate that muscle endurance needs to improve.

Your programme may therefore include both stronger contractions and longer controlled holds where appropriate.

More exercise is not always better. The pelvic floor also needs adequate relaxation between contractions.

Doing pelvic floor exercises correctly

A pelvic floor contraction should feel like a tightening and lifting around the back passage and urinary passage.

You should generally avoid:

• Holding your breath
• Excessively tightening the buttocks
• Strongly squeezing the legs together
• Continually holding the pelvic floor tight

The muscles should relax fully between contractions.

If you are unsure whether you are using the correct muscles, an assessment can help check technique.

Should I stop urine flow to test the muscles?

Trying to interrupt urine flow may sometimes help someone recognise which muscles are involved, but repeatedly stopping and starting urine as a regular exercise is not recommended.

Pelvic floor exercises should usually be practised away from the toilet.

This allows you to train contraction and relaxation without interfering with normal bladder emptying.

Bladder habits

Pelvic health treatment may include looking at bladder habits alongside muscle function.

This may involve discussing:

• Fluid intake
• Caffeine
• Toilet frequency
• Urgency
• Going to the toilet before leaving home
• Night-time urination

Advice should be individual.

Not every urinary symptom can be corrected through changing fluid intake or performing pelvic floor exercises.

Returning to work

Pelvic floor symptoms can affect different jobs in different ways.

A desk-based role may involve prolonged sitting, while a physical role may require:

• Lifting
• Carrying
• Walking
• Climbing
• Repeated heavy activity

Rehabilitation can gradually prepare you for these demands.

After surgery, return to work should also follow the advice provided by your surgical team.

Confidence after prostate surgery

Urinary leakage can affect confidence with everyday activities.

You may become reluctant to:

• Exercise
• Travel
• Socialise
• Return to work
• Walk longer distances

Rehabilitation aims to improve physical control while helping you gradually return to these activities.

Recovery varies from person to person, so progress should be judged according to your own symptoms rather than comparisons with someone else’s recovery.

Pelvic floor rehabilitation is not only for older men

Men’s pelvic health problems can occur at different ages.

Younger men may seek physiotherapy because of:

• Pelvic pain
• Bowel symptoms
• Difficulty relaxing the pelvic floor
• Symptoms associated with exercise or prolonged sitting

The assessment and treatment are based on the symptoms rather than age.

Working with other healthcare professionals

Pelvic health symptoms may require input from several healthcare professionals.

Depending on your needs, this may include:

• GPs
• Urologists
• Colorectal specialists
• Pelvic health physiotherapists
• Continence services
• Pain specialists
• Other relevant healthcare professionals

Physiotherapy focuses on pelvic floor function, movement and rehabilitation.

Medical conditions affecting the prostate, bladder, bowel or reproductive system may require additional investigation and treatment.

When further medical assessment may be needed

Some bladder, bowel or pelvic symptoms require medical investigation rather than physiotherapy alone.

Seek appropriate medical advice if you experience:

• Blood in the urine
• Blood in the stool
• Difficulty or inability to pass urine
• Repeated urinary infections
• New or severe pelvic pain
• Significant testicular pain or swelling
• Unexplained weight loss
• A significant or rapidly changing urinary problem
• New bowel-control problems
• New numbness around the saddle or genital area

New loss of bladder or bowel control combined with significant back pain, leg weakness or numbness around the saddle area requires urgent medical assessment.

Treatment based on your goals

Men’s pelvic health rehabilitation should relate to the symptoms and activities that matter to you.

Your goals may include:

• Improving bladder control
• Reducing leakage after prostate surgery
• Managing urinary urgency
• Reducing post-void dribbling
• Improving bowel control
• Reducing pelvic tension
• Managing pelvic pain
• Returning to work
• Returning to the gym
• Running again
• Lifting comfortably
• Returning to sport
• Feeling more confident with everyday activity

Your rehabilitation programme can be developed around these priorities.

How long does men’s pelvic health rehabilitation take?

There is no single timeline.

Recovery depends on:

• The underlying problem
• Whether surgery was involved
• Current pelvic floor strength
• Ability to relax the muscles
• Bladder or bowel symptoms
• General health
• Exercise and activity goals

Some men may need a relatively short period of assessment and exercise guidance.

Others may require rehabilitation over several months, particularly following prostate surgery or where symptoms have been present for a long time.

The programme can be reviewed and progressed as muscle control and symptoms change.