Pelvic Floor Dysfunction

What Is Pelvic Floor Dysfunction?

Your pelvic floor is a lot like plumbing in your home: you never really think about it unless something goes wrong. Even though we don’t pay much attention to our pelvic floor muscles, they are essential to everyday bodily functions. 

Much like the pipes in your home, your pelvic floor muscles are hidden but critical. They support your pelvic organs — such as your intestines, reproductive organs, and bladder — and ensure those organs are properly positioned in order for them to work properly.

Pelvic floor dysfunction in men may contribute to issues like erectile dysfunction (ED), premature ejaculation, delayed orgasm , incontinence, and pelvic pain, among other conditions. 

So, while you won’t be flexing your pelvic floor at the gym, being aware of these muscles is crucial. Let’s explore your pelvic floor muscles, the symptoms of pelvic floor dysfunction, and how to get these muscles back to top condition if they aren’t functioning the right way. 

Why Is the Pelvic Floor Important?

Your pelvic floor muscles form a hammock-like structure that spans your pelvis and keeps your pelvic organs in the right place. They help to control urination and ejaculation, and also contribute to achieving and maintaining erections. 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, as well as your bowel movements.

Pelvic floor dysfunction — or PFD — is a term for a variety of disorders that affect the muscles and connective tissue in your pelvic floor. If your pelvic floor weakens over time, gets injured during surgery, or becomes overactive, it can lead to pelvic pain or pelvic floor problems like incontinence or trouble defecating.

The pelvic floor also contributes to sexual health, meaning pelvic floor dysfunction may contribute to sexual dysfunctions like erectile dysfunction or ejaculatory disorders like premature ejaculation, delayed orgasm, or painful ejaculation.

Now that you know pelvic floor health is an important part of men’s health, it’s important to keep an eye out for the signs of pelvic floor dysfunction. Sometimes these issues can be signs of other more serious medical conditions, so be sure to seek medical evaluation and treatment if you’re experiencing any of the following symptoms. 

Symptoms of Pelvic Floor Dysfunction

Common pelvic floor dysfunction symptoms in men include:

• Pain in the pelvis, abdomen, or genitals

• Pain during or after ejaculation

• Urinary problems, such as frequent urination, urgency, or pain during urination

• Bowel problems, such as constipation, straining, or pain during bowel movements

• Sexual dysfunction, including erectile dysfunction, premature ejaculation, and painful intercourse

• Muscle tenderness or spasm in the pelvic floor, psoas, or adductors

• Abnormal muscle tone, which can be either too high or too low

• Poor awareness or control of the pelvic floor muscles

Sexual Dysfunction and the Pelvic Floor

Male pelvic floor dysfunction may also contribute to sexual dysfunction, including erectile dysfunction or different types of ejaculatory dysfunction, such as:

• Delayed ejaculation

• Premature ejaculation 

• Retrograde ejaculation, where semen flows into the bladder rather than exiting through the urethra

Not all men with pelvic floor dysfunction experience sexual problems. Some may primarily struggle with pelvic pain or urinary symptoms, while others may have issues with bowel movements. Regardless, pelvic floor problems can significantly impact your quality of life, making it essential to consult a healthcare professional if you notice any symptoms.

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Causes of Pelvic Floor Dysfunction in Men

The exact causes of pelvic floor dysfunction are not well understood in most cases. 

However, experts know that weakened pelvic muscles and connective tissue, along with pelvic injuries, can contribute to the condition. 

Some potential triggers for pelvic floor dysfunctions include:

• Advanced age

• Pelvic trauma

• Surgery

• Prostate issues

• Overweight/obesity

• Diabetes

• Hypertension

• Cardiovascular disease

 Because symptoms of pelvic floor dysfunction often overlap with urological and colorectal disorders, identifying an exact cause can be challenging.

Risk Factors for Pelvic Floor Dysfunction

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

• Obesity 

• Certain types of surgery, such as prostate surgery

• Smoking 

• Regular heavy lifting, such as powerlifting

Women are more likely to develop pelvic health issues than men, primarily due to pregnancy and childbirth — women who give birth at least once have a nearly 60 percent chance of developing pelvic floor dysfunction — but pelvic floor issues still affect many men.

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Common Tests for Pelvic Floor Dysfunction

So, how is pelvic floor dysfunction diagnosed?

Start by consulting a healthcare provider, such as a colorectal specialist, a urologist, primary care physician, or specialized physical therapist. Some healthcare providers, though, may be unfamiliar with the diagnosis and management of pelvic floor dysfunction. So it is important to do research and find an expert who has experience treating patients with pelvic floor problems. 

They will likely ask about your symptoms and medical history, followed by a series of tests to assess your pelvic floor function.

Tests for pelvic floor dysfunction depend on the specific types of symptoms that you have and may include:

• A physical exam to check for muscle contractions, bulging, weakness, or tenderness in the pelvic floor

• A cystoscopy, which is a visual inspection of the bladder and urethra using a fiberoptic scope

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

• Anorectal manometry, a noninvasive procedure that measures the strength of the rectum and sphincter muscles

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

Additional tests may be ordered to confirm your diagnosis or rule out other causes, such as:

• Endoscopy (colonoscopy, sigmoidoscopy, or anoscopy) to examine parts of your lower digestive tract

• MRI or CT scans, such as a defecography, to capture detailed images of the pelvic region

If needed, you might be referred to a physical therapist specializing in pelvic floor dysfunction, for an more in depth assessment of pelvic floor muscular function and pain.

How to Treat Pelvic Floor Dysfunction

Pelvic floor dysfunction can disrupt your quality of life, but several treatment options can help.

Treatments include:

• Pelvic floor exercises

• Physical therapy

• Habits and lifestyle changes 

• Medications

Pelvic Floor Exercises

Despite the common misconception that pelvic floor exercises are only for women, men can benefit from pelvic floor physical therapy to improve muscle function.

Also called pelvic floor muscle training, these exercises may: 

• Improve urinary incontinence

• Reduce erectile dysfunction 

• Provide relief from pelvic pain

• Increase time to ejaculation in people with lifelong premature ejaculation

Even a few minutes per day can make a difference. A common pelvic floor exercise is the Kegel. Here’s how to do this exercise:

1. Empty your bladder and locate the muscles of the pelvic floor (the same muscles used to stop urinating) 

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

3. Relax the muscles completely. 

4. Repeat this process 10 to 20 times, three to four times per day. 

Biofeedback is often used alongside pelvic floor exercises. 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 for improving pelvic floor issues.

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

Physical Therapy

Specialized physical therapy is among the most effective treatments for pelvic floor dysfunction in men. It uses techniques such as neuromuscular reeducation, manual therapy, and biofeedback to improve muscle function, reduce pain, and restore normal bowel and bladder function. It can also be an effective treatment for erectile dysfunction. 

Habits and Lifestyle Changes

A number of lifestyle changes can prevent and treat pelvic floor dysfunction or reduce symptoms in affected men. If you have pelvic floor difficulties, try these healthy habits to 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. This can improve digestion and make bowel movements easier. Fiber-rich foods include whole grains, vegetables, fruits, beans, and lentils.

• Keep exercising. Exercise benefits many aspects of your health, including your 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.

• Take warm baths. Taking warm baths can help relax the muscles of the pelvic floor and increase blood flow.

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, physical therapy or medication.

Medications

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

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

For overactive bladder symptoms, a healthcare provider may prescribe:

• Anticholinergic medications, which target the neurotransmitters that control urination

• Beta-3 agonists, or muscle relaxers for your bladder, which help reduce the urge to urinate

• Botox® injections to keep your bladder muscles from spasming

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

• Medication for treating diarrhea and improving bowel control

• Medications containing diphenoxylate and atropine.

• Fiber laxatives to reduce constipation

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

• Viagra Connect® (sildenafil) 

• Cialis Together® (tadalafil) 

• Stendra® (avanafil)

• Vardenafil (sold under the brand names Levitra® and Staxyn®

If you’re looking for something a little more discrete, try chewable ED meds like Hard Mints, which contain the same 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 dapoxetine and tadalafil.

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Pelvic Floor Dysfunction Prevention Tips

Many of the same habits that can ease pelvic floor dysfunction symptoms may help prevent them altogether.

To prevent pelvic floor dysfunction, you can:

• Practice Kegels regularly

• Stop smoking

• Maintain a healthy weight

• Practice good posture

• Drink plenty of water

• Increase fiber intake

• Avoid straining when defecating

• Try not to lift heavy objects

A Final Word on Pelvic Floor Dysfunction

Although your 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 can affect your bowel, urinary and sexual function. In fact, pelvic floor dysfunction is associated with erectile dysfunction and disorders of ejaculation conditions.

• 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. If you are experiencing persistent and bothersome symptoms, consult with specialized physical therapists and/or other healthcare providers to make sure that nothing else is wrong, and to get started with the right treatment plan.

• There is no medication that cures pelvic floor problems, but they can help. Certain medications can help with the symptoms of pelvic floor dysfunction. For example, a healthcare practitioner might prescribe medications for overactive bladder or erectile dysfunction medications if necessary.