Men experience a variety of problems with their urinary system, leading to unwanted leakage of urine. Some also have difficulty controlling wind or leakage from the bowels. Often this is due to a weakness of the muscles of the pelvic floor, which have an important function in preventing these troublesome conditions. In particular, pelvic floor exercises have been shown to be effective following surgery on the prostate and when men experience a dribble after passing water.

The floor of the pelvis is made up of layers of muscle and other tissues stretching from side to side like a hammock and attached to your tail bone (coccyx) at the back and to the pubic bone in front. The urethra (bladder outlet) and the rectum (back passage) pass through the pelvic floor muscles. The hammock of muscle supports the bladder and the bowel and plays an important role in bladder and bowel control.

Why the Pelvic Floor Muscles get Weak

The pelvic floor muscles can be weakened by:

-  some operations for an enlarged prostate gland
-  continual straining to empty your bowels, usually due to constipation
-  a chronic cough, such as smoker’s cough or chronic bronchitis or asthma
-  being overweight.

Although there is no research evidence, it is thought by many that lack of general fitness and persistent heavy lifting tend to result in weakening of the pelvic floor.

Neurological damage (e.g., after a stroke or spinal injury, or resulting from multiple sclerosis or other conditions) can also produce poor pelvic muscle function.  People in this group need to seek advice from a healthcare professional.

Pelvic Floor Exercises

You can improve control of your bladder and bowel by doing exercises to strengthen your pelvic floor muscles. These exercises may also be useful in conjunction with a bladder retraining programme aimed at improving bladder control in people who experience the urgent need to pass urine frequently and may not always "make it in time".

How to Identify your Pelvic Floor Muscles

The first thing to do is to identify correctly the muscles that need to be exercised.

1.  Sit or lie comfortably with muscles of your thighs, buttocks and abdomen relaxed.

2.  Tighten the ring of muscle around the back passage as if you are trying to control diarrhoea or wind. Relax it. Practice this movement several times until you are sure you are exercising the correct muscle. Try not to squeeze your buttocks or tighten your thighs or tummy muscles.

3.  Imagine you are passing urine, trying to stop the flow mid-stream, then restarting it.  (You can do this "for real" if you wish, but do so only to learn which muscles are the correct ones to use: do not make a practice of it or it may interfere with normal bladder emptying.)  If your technique is correct, each time that you tighten your pelvic floor muscles you may feel the base of your penis move up slightly towards your abdomen.

If you are unable to feel a definite squeeze and lift action of your pelvic floor muscles (or are unable to even slow the stream of urine as described in point 3), you should seek professional help to get your pelvic floor muscles working correctly. Even men with very weak pelvic floor muscles can be taught these exercises by a physiotherapist or continence advisor with expertise in this area. See "Seeking Help" below.

Doing Your Pelvic Floor Exercises

Now that you can feel the muscles working, you can start to exercise them:

1.  Tighten and draw in strongly the muscles around the anus and the urethra all at once. Lift them up inside. Try and hold this contraction strongly as you count to five, then release slowly and relax for a few seconds. You should have a definite feeling of "letting go".

2.  Repeat ("squeeze and lift") and relax. It is important to rest in between each contraction. If you find it easy to hold the contraction for a count of five, try to hold for longer - up to ten seconds.

3.  Repeat this as many times as you are able up to a maximum of 8-10 squeezes. Make each tightening a strong, slow and controlled contraction.

4.  Now do five to ten short, fast, but strong contractions, pulling up and immediately letting go.

5.  Do this whole exercise routine at least 4-5 times every day. You can do it in a variety of positions - lying, sitting, standing, walking.

While doing the exercises:

     DO NOT hold your breath.
     DO NOT push down instead of squeezing and lifting up.
     DO NOT tighten your tummy, buttocks or thighs.

Do your exercises well. The quality is important. Fewer good exercises will be more beneficial than many half-hearted ones.

Make the Exercises a Daily Routine

Once you have learnt how to do these exercises, they should be done regularly, giving each set your full attention. It might be helpful to have at least five regular times during the day for doing the exercises - for example, after going to the toilet, when having a drink, when lying in bed. You will wish to tighten your pelvic floor muscles also while you are getting up from a chair, coughing or lifting. Some men find that by tightening before they undertake such activities they assist themselves in regaining control.

Good results take time. In order to build up your pelvic floor muscles to their maximum strength you will need to work hard at these exercises. You will probably not notice an improvement for several weeks and you will not reach your maximum performance for a few months.

When you have recovered control of your bladder or bowel you should continue doing the exercises twice a day for life.

Other Tips to Help Your Pelvic Floor

•  Avoid constipation and prevent any straining during a bowel movement.
•  Seek medical advice for hay-fever, asthma or bronchitis to reduce sneezing and coughing.
•  Keep your weight within the right range for your height and age.
•  Share the lifting of heavy loads.

Seeking Help

To achieve your best results or if your problems persist despite doing the exercises, you may need to seek help professional help from your GP, a physiotherapist or a specialist continence nurse - you can obtain details of your local NHS specialist continence service from the Continence Foundation Helpline. You may be advised to use some additional technique, such as biofeedback or electrical stimulation.

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This is usually used as an adjunct to pelvic floor exercises for symptoms of stress and /or urge incontinence, although there has been no clear research to prove its effectiveness in men.  It requires the use of mechanical or electronic equipment to provide you with visual feedback about how your muscles are working - and hopefully improving. Biofeedback needs to be used in conjunction with a specialised practitioner, usually a specialist physiotherapist or specialist nurse.

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Electrical stimulation is used in the treatment of both stress and urge incontinence, but not usually as a first line of treatment (and again there is not yet any clear research evidence of its effectiveness in men). It may be administered in a clinic (either by a specialist physiotherapist or by a specialist nurse) or with the use of a small portable stimulator at home. (However, it is recommended that home treatment is supervised by a specialised health professional). It involves using a small battery-powered unit which applies an electric current to the muscles around the bladder. This current is usually passed via a small anal probe in close contact with the pelvic floor muscles or via surface electrodes placed on the perineum (the area between the front and back passages).

It is hard to describe what electrical stimulation feels like. Most individuals will describe it as a tingling sensation - a bit like pins and needles - sometimes with a involuntary tightening of the pelvic floor muscles. It will not be painful.

People are usually advised to use the unit for between 20 minutes and an hour a day for about 20 days. Some people find this treatment very effective.

The unit is available on loan from some local continence services and from some physiotherapy services. Details of your local continence service can be obtained from the Continence Foundation Helpline.

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[Revised 24 February 2001]