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The male pelvic floor supports important functions like your core, urination, bowel movements, and sexual performance, but it rarely gets any attention until something feels off. Even then, many cases are misdiagnosed as prostatitis. For many men, symptoms like groin pain, urinary urgency, genital pain, post-ejaculatory pain or trouble with erections come as a surprise—and are often hard to talk about.
This guide focuses on everything you need to know about pelvic floor dysfunction in men and the treatment available.
Male Pelvic Floor Anatomy and Physiology
The male pelvic floor is a group of muscles, ligaments, and connective tissue that form a supportive sling at the base of the pelvis. These muscles stretch from the pubic bone to the tailbone and play an important role in bladder and bowel control, sexual function, and core stability. The pelvic floor works together with the deep abdominal and back muscles to support the pelvic organs, including the bladder, rectum, and prostate.
Pelvic floor dysfunction in men happens when these muscles become too tight, too weak, or lose coordination. This can lead to a range of symptoms such as urinary leakage, frequent urination, constipation, erectile dysfunction, or pain in the pelvis, genitals, or rectum. Sometimes the muscles spasm or stay contracted, which can make the symptoms worse over time.
Understanding the anatomy of the pelvic floor helps explain how dysfunction in this area can affect many different parts of daily life.
The pelvic floor muscles are innervated by the pudendal nerve, the levator ani nerve and sacral nerve roots. These muscles are under voluntary and involuntary control and are never fully at rest, making them unique and different from all of our other muscles in our body.
Diagnostic Challenges and Categories
Research shows 10% of men experience pelvic pain at some point in their lives that is caused by pelvic floor dysfunction. However, many of these individuals are misdiagnosed and mistakenly prescribed antibiotics for what they believe is prostatitis, and experts believe the prevalence is actually higher than 10%. However, the majority of men diagnosed with prostatitis do not have prostatitis. Many urologists prescribe men antibiotics without even testing. And if they do test, they tend to still prescribe antibiotics even if the cultures are negative because medical schools do not include training on pelvic floor dysfunction and, therefore, general urologists are often unaware that pelvic floor dysfunction exists.
Pelvic pain syndromes such as Chronic Pelvic Pain Syndrome/Male Pelvic Pain, Pudendal Neuralgia, Hard Flaccid Syndrome, and Interstitial Cystitis/Painful Bladder Syndrome are all associated with dysfunction in the pelvic floor, resulting in persistent discomfort and/or urinary, bowel, and sexual dysfunction.
Studies indicate that men with pelvic pain may take up to seven years to receive an accurate diagnosis. This prolonged diagnostic journey is attributed to the fact that the symptoms of male pelvic pain closely resemble those of prostate, bladder, and/or sexually transmitted infections.
Adding to the complexity, numerous pelvic floor physical therapists are primarily trained to treat women. However, at PHRC, this is not the case. In fact, there are some days where we treat more men than women.
The key to addressing this issue lies in targeted physical therapy aimed at strengthening the pelvic floor muscles rather than relying on ineffective antibiotics.
Symptoms of Male Pelvic Floor Dysfunction
Pelvic floor dysfunction in men can manifest in a range of symptoms, which generally fall into four categories: urinary, bowel, sexual dysfunction, and pelvic floor/girdle/trunk/lower extremity pain.
- 1. Urinary Symptoms
- Frequent urge to urinate with little output
- Hesitancy or difficulty starting urine stream
- Feeling incomplete bladder emptying after urinating
- Burning or pain during or after urination
- Dribbling urine after finishing urination
- 2. Bowel Symptoms
- Constipation and/or straining during bowel movements
- Incomplete bowel emptying sensation
- Pain before, during, or after bowel movements
- Urgency or frequent need to have a bowel movement
- Need for excessive toilet paper
- Leakage of stool or gas
- 3. Sexual Symptoms
- Pain during or after ejaculation
- Erectile dysfunction or difficulty maintaining an erection
- Testicular pain or aching
- Penile or perineal pain with arousal or sexual activity
- Decreased sensation or numbness during sex
- 4. Pelvic Floor, Girdle, Trunk, and Lower Extremity Pain
- Pain in the perineum or sit bones
- Lower abdominal or groin pain
- Tailbone or coccyx pain when sitting
- Hip, lower back, or sacroiliac joint pain
- Inner thigh or pelvic floor muscle tightness
Causes of Male Pelvic Floor Dysfunction
Men can develop pelvic floor dysfunction for many reasons, including the below:
- Surgical trauma (vasectomy, benign prostatic hyperplasia (BPH) interventions, prostatectomy)
- Orthopedic injuries or other traumas (spine, hip, knee, and/or ankle injuries/pathology, accidents)
- Biomechanical or structural dysfunction (hip dysfunction, piriformis syndrome, scoliosis, leg length discrepancy)
- Excessive exercise or changes to exercise routine
- Excessive sitting or sitting changes involving car changes, office changes
- Chronic constipation and straining
- Jelqing and/or attempts at genital enhancement or foreskin regeneration
- In rare cases, bladder, prostate, or sexually transmitted infections after successful resolution of infection
Many men who experience pelvic pain, with or without issues related to urination or digestion, often have pelvic floor dysfunction.
Learn more about Pelvic Floor Dysfunction
Treatment for Male Pelvic Floor Dysfunction
Pelvic floor dysfunction in men is treated through a combination of in-person physical therapy sessions and a personalized home exercise program. Treatment focuses on addressing muscle tension, weakness, or coordination issues that contribute to symptoms like pelvic pain, urinary problems, and sexual dysfunction. Techniques might include manual therapy, targeted exercises, relaxation strategies, and education on posture and movement patterns, often combined with collaboration from other healthcare providers to support your recovery.
Why PHRC and What To Expect at Your First Appointment
When you arrive for your first appointment at PHRC, the primary goal is to understand your pelvic health concerns in detail. During this initial consultation, your therapist will ask about your medical history, including any past pelvic surgeries, chronic conditions, or injuries that might contribute to symptoms like urinary issues, bowel dysfunction, sexual pain, or lower extremity pain. This conversation helps guide the best approach for your care.
A physical assessment will follow, where your physical therapist evaluates the muscles, tissues, and nerves in your pelvic region. This exam may include checking for muscle tightness, weakness, or imbalances that could be affecting your pelvic floor function. Your therapist also looks at how well your muscles coordinate during movement, which plays a role in bladder and bowel control, sexual function, and core stability.
Once the assessment is complete, your physical therapist will create a personalized treatment plan based on your specific symptoms. This plan might include exercises to relax or strengthen your pelvic floor muscles, manual therapy to release tension, or other techniques designed to target your needs. For example, if you’re dealing with urinary leakage, your therapist might focus on muscle coordination and bladder retraining. If bowel issues are present, strategies to improve control and relaxation will be part of your care.
Your treatment plan will also include a home exercise program to support your recovery between sessions. These exercises, along with regular appointments, help you regain control of your pelvic floor function and reduce pain or discomfort.
We make sure you feel supported throughout your recovery and coordinate care with any other healthcare providers involved in your treatment.
Find Relief from PHRC
At PHRC, our goal is to provide compassionate and comprehensive care to help you manage and overcome pain from pelvic floor dysfunction. By understanding the underlying causes and providing targeted treatments, our goal is to improve your quality of life and restore your health.
We also recognize the challenges some people might face in accessing in-person care, which is why we offer virtual sessions through telehealth after your initial consultation. These sessions allow for continuity of care and accessibility for those unable to travel to one of our clinics.