The Journey

It’s not just women – MEN need to do pelvic floor exercises, too!

Every woman knows how important it is to do pelvic floor exercises after giving birth, and devices and mobile phone apps to help them do this have now become quite commonplace. What’s less well known is that men need to do these exercises, too, to prevent incontinence in later life but also to ward off problems in the bedroom. However, even if you know you need to do this, getting the practice right is another matter. That’s where a new generation of pelvic floor gadgets designed specifically for men could help.

The pelvic floor is made up of the sling-shaped muscles which run from the pubic bone to the base of the spine, supporting the bladder, bowel and uterus in women and the bladder and bowel in men. There are also 19 tiny individual muscles embedded in it, some of which are vital for sexual function. Like all muscles, the pelvic floor can weaken over time. If the muscles are too loose they don’t support the bladder or bowel and this may lead to leaking from either area, as well as erectile dysfunction or difficulty ejaculating. This is because one of the muscles in the pelvic floor, the bulbocavernosus muscle, which sits at the base of the penis, is responsible for allowing the organ to engorge with blood during an erection and contract during ejaculation. This muscle is one of the first to weaken, and if its strength isn’t maintained, it stops functioning properly. ‘A pelvic floor that’s strong will provide much better support for all of the pelvic and sexual organs,’ says Katie Mann, a specialist clinical physiotherapist based in the north-west of England.

But pelvic floor exercises, otherwise known as Kegel exercises, aren’t only important as men age. In younger men, the muscles can become too tight – known as a hypertonic pelvic floor. This is a problem which affects fit, gym-going types. ‘Regular weight-lifters often contract these muscles, and for too long, which can result in tightness,’ explains Katie Mann. If the muscles are too tight and restricted, they can pull the anus and prostate forward towards the pubic bone, along with the sacrum (a triangular bone at the base of the spine), pulling it out of alignment and causing severe pain in the rectum and genital region, and even the lower back and abdomen. Stress could also, inadvertently, cause issues. ‘When emotionally stressed, men can over-contract the pelvic muscles without realising it, which can cause permanent tightening, too,’ adds Katie Mann. Kegel exercises can help both problems, as they involve repeatedly relaxing to loosen over-tightened muscles, as well as contracting to strengthen weakened ones.

Exercising the pelvic floor can also help men with stress incontinence – a particular problem after surgical procedures on the prostate. If you’ve got problems we would recommend performing the exercises three times a day every day. Surgery inevitably damages the sphincter muscle that would normally hold urine back. Pelvic floor exercises strengthen the accessory muscles to compensate for this. ‘Up to 20 per cent of men will develop persistent stress urine leakage of varying degrees, and virtually all will have temporary leakage after a prostatectomy for prostate cancer,’ says Tamsin Greenwell, a consultant urological surgeon at University College London Hospitals. ‘Regularly performing pelvic floor exercises for three months greatly improves continence or reduces leakage after prostate surgery.’

To exercise their pelvic floor without a device, men would have to rely on the same sort of contractions women are taught to do post-natally to strengthen their pelvic floor. This involves relaxing the muscles of the thighs, bottom and abdomen (some experts recommend doing them sitting down to help with this) and squeezing the muscles around the front passage as though trying to stop urine flow, while simultaneously contracting around the back passage as though trying to stop wind. However, the pelvic floor muscles are hard to isolate and research has shown that 50 per cent of people get the technique wrong when following a pamphlet. Specialist physiotherapists can help. However, their services are often targeted predominantly at women, which Katie Mann says adds to the embarrassment men feel about seeking help. ‘A lot of the physios who treat them are called women’s health physios – and there’s nothing worse than going to the obstetrics department if you’re a bloke,’ she says.

Of the 500 or so patients who come to her clinic annually with pelvic-floor-related health problems, fewer than ten are male. If performing the exercise correctly, a man should see the base of the penis draw in and his scrotum lift up. ‘However because the muscles are tucked away inside, it’s not always possible to see the action take place – especially if the muscles are weak to begin with,’ says Katie Mann.

Using a device that provides a visual reading – and usually some kind of feedback – ‘helps a great deal,’ she adds. One such device, now in development, is the bicycle seat-shaped kGoal Boost, which men sit on. It’s placed on a normal chair, and connects to a smartphone app which reports back on the strength of the contractions.

When emotionally stressed, men can over-contract the pelvic muscles without realising it. It can also keep a record of previous workouts, and more adventurous exercisers can take part in games on the app, designed to train muscles further. Manufacturers say it will be available to buy this summer for around £78. Other devices use weights to gradually build up strength – the Private Gym Kegelmale Trainer (£79.99, privategym.co.uk) was designed by a urologist and uses weighted rings that go round the penis, the aim is to see the weight lift up and down while pelvic floor exercises are performed. Other options use electronic pulses to stimulate muscles via electrodes that stick on the skin – a bit like a Slendertone – such as the Kegel8V (£149.99, kegel8.co.uk).

Physiotherapists who treat men with pelvic floor problems typically use small internal devices inside the anal canal. These have electrodes and measure the strength of contractions. Similar devices for home use are available, such as the Anuform (£25.99, kegel8.co.uk) or the Maximum Pelvic Trainer (MPT) (£85, bestforlife.com), an internal probe with the benefit that the weight can gradually be increased.

‘If you’ve got problems we would recommend performing the exercises three times a day every day for a maximum of ten-second holds for ten repetitions,’ says Katie Mann. ‘It takes around 12 to 16 weeks to change a muscle, and, exactly like muscles in the arms and legs, if you stop training it, it will weaken again.’ Pelvic floor training could have an added benefit: a better sex life. A British study led by Dr Grace Dorey in 2004 found that as well as improving erectile dysfunction, men who did pelvic floor exercises also had more powerful orgasms. The research involved 55 men with erectile dysfunction between the ages of 22 to 78. After working at strengthening their pelvic floor muscles for three months, 22 of the participants attained normal erectile function, 19 of them had improved function, and 14 showed no improvement. The results, published in the British Journal of General Practice, was almost as good as seen in previous studies of men taking Viagra. However, as well as improved erectile function, men also reported longer, stronger orgasms. ‘It made sense once I’d thought about it: stronger muscles are more powerful,’ Dr Dorey concluded.

By Nilufer Atik For Dailymail.com

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