Men Have Pelvic Floors Too: Signs Something Is Off
Yes, men have a pelvic floor, and it can stop working well just as it can in women. It is a group of muscles at the base of the pelvis that helps control the bladder and bowel and plays a part in sexual function. Common signs that it is too tight or out of sync include a slow or hesitant stream, a deep ache between the legs, pain with or after ejaculation, and straining on the toilet. Many men do not connect these signs to a muscle at all.
Learn moreHow Dr. Gordon treats pelvic floor dysfunctionWhat the pelvic floor does in men
The pelvic floor is a bowl of muscles and connective tissue at the base of the pelvis. In men, the prostate sits inside a sling of these muscles.
It has several jobs. It supports the bladder and bowel. It holds urine and stool in, then relaxes so they can pass. It works with your diaphragm and deep abdominal muscles to steady your trunk. It also takes part in sexual function, and the Sexual Medicine Society of North America notes that the pelvic floor plays a role in ejaculation.
Trouble starts when these muscles stop letting go, or when their timing slips.
Signs it may be too tight
When the pelvic floor holds too much tension, it rarely shows up as an obvious muscle problem. It tends to look like this:
- A deep ache in the perineum, the area between the scrotum and the anus, sometimes like sitting on a ball.
- Aching in the groin, testicles or inner thigh with no clear cause.
- Pain during or after ejaculation.
- Needing to urinate often or in a hurry.
- Discomfort that builds the longer you sit.
- Low back or hip tightness that flares along with the pelvic symptoms.
When pelvic pain like this lasts three months or more and no infection or disease explains it, it is often called chronic pelvic pain syndrome.
Signs it may not be coordinating
A healthy pelvic floor relaxes when you empty and tightens when you hold. When the timing is off, the muscles tighten just when they should let go. You might notice:
- Standing at the toilet, waiting for the stream to start.
- A weak or stop and start stream, or a feeling that you have not fully emptied.
- Straining for a bowel movement even when the stool is soft.
- A feeling of blockage when you try to go.
- Holding your breath and bearing down to get things moving.
When this happens with bowel movements, it is called pelvic floor dyssynergia. A similar pattern can affect urination.
Everyday habits that load it
Long hours of sitting at a desk or behind the wheel, cycling, and heavy lifting with your breath held all feed the pattern. Stress tightens the pelvic floor in many men. Breath holding and bracing your stomach out of habit also change how these muscles behave.
Squeezing harder is not always the answer, either. Kegel exercises can help a weak pelvic floor, but they can make a tight one worse. Knowing which pattern you have comes first.
When to have it checked
If these signs keep coming back, it is worth having the muscles checked. If you have already had tests that came back normal, I explain why that happens in Why Pelvic Floor Pain Gets Missed, and What a Muscle Exam Can Find.
The first visit runs 60 to 75 minutes. I examine the pelvic floor from the outside, with no internal exam. With you draped for comfort, gentle pressure around the perineum, sit bones, tailbone and inner thighs shows me tone, tenderness and trigger points.
When the muscles are too tight, dry needling releases them and their trigger points. The needles go in through the skin of the buttock, perineum or inner thigh, never through the rectum. Alongside dry needling, I use neuro-functional acupuncture, built on neuroscience and evidence-based practice. Unlike regular electroacupuncture, the needles and gentle electrical stimulation are mapped to the specific nerves involved, such as the sacral and pudendal nerves. It works in three ways. It neurorehabilitates, helping irritated tissues and nerve receptors recover. It neuromodulates, shifting the body's own pain-relieving chemistry. It neuroregulates, calming the nerve signals and circuits that keep pelvic floor symptoms going. I completed the ASE Seminars Pelvic Floor Certification and was trained by Dr. Jamie Hampton. Results vary from person to person.
See a doctor first if you have fever or chills with pelvic or urinary symptoms; inability to urinate; visible blood in the urine or stool; sudden, severe pelvic or abdominal pain; unexplained weight loss; or new numbness in the saddle area or loss of bladder or bowel control. If you have any of these, contact your doctor or go to the nearest emergency department.
If you are not sure what is causing your pain, try the My Symptoms tool.
Questions people ask
Can I tell on my own whether my pelvic floor is too tight or too weak?
Not reliably. The signs overlap, and tight muscles can also test weak because they never fully relax and reset. That is why I examine the muscles before suggesting any exercise.
Can the pelvic floor affect erections?
It can be part of the picture. The Sexual Medicine Society of North America notes that these muscles can become too tight or too loose, which can contribute to sexual health problems. Erection changes can also have medical causes, so start with your doctor.
Is this just an enlarged prostate?
It might be, and your doctor should check. An enlarged prostate can cause trouble starting, a weak stream, dribbling at the end and getting up at night, and it becomes more common with age. A tight pelvic floor can cause some of the same signs at any age, and some men have both.
References
- Sexual Medicine Society of North America. Pelvic Floor Physical Therapy for Male Sexual Dysfunctions. smsna.org. 2022.
- National Institute of Diabetes and Digestive and Kidney Diseases. Enlarged Prostate (Benign Prostatic Hyperplasia). niddk.nih.gov.
