By Stephanie Prendergast
When should men do Kegels? As pelvic floor PTs who treat men, this is a question we often address in our clinics. Recently, the question of men and Kegels has hit the mainstream with both the New York Times and Dr. Oz tackling the topic, among others. So I thought it a perfect time to address the question here on our blog.
Just as in women, the male pelvic floor extends like a hammock from the tailbone to the pubic bone. And as is the case with the female pelvic floor, the male pelvic floor plays a role in bladder, bowel, and sexual function as well as helping to maintain urinary and fecal continence. So then it’s not surprising that Kegels are not just for women, and that there are situations where they are appropriate for men.
One Size does not Fit All
I’d first like to take a look at the mainstream hoopla currently surrounding men and Kegels. Unfortunately, it’s the same one that is consistently directed at women: one-size-fits-all.
“People do cardio exercises for their heart, and they do strength training and work on their six-pack, but the pelvic floor is neglected,” said Dr. Andrew Siegel, a urologist from the above-mentioned Times article.
As the article points out, Dr. Siegel is also the co-founder of Private Gym, a company marketing what a Men’s Health article calls “a workout for your penis.” Dr. Siegel’s system includes an instructional DVD as well as small, ultralight weights on a silicone band that fits around the penis, intended for “men who want to add a bit of resistance training to their routines.”
Dr. Siegel’s product goes beyond the repetitive contractions done in regular Kegels by adding resistance to the exercise with weights. As an experienced pelvic floor PT, I do not believe that using resistance will improve functional outcomes in men.
The reason is that the pelvic floor muscles are one of the only muscle groups in the body that are always active, and for good reason. Without them constantly working to provide pelvic tone, we would be completely incontinent. As a result, these muscles are already working harder than any other muscle in the body, and their optimal physiological function is based on appropriate length, strength, and motor control of, not just the pelvic floor muscles, but also the surrounding pelvic girdle muscles.
So it’s not just about building strength when it comes to the pelvic floor.
Another problem I have with the one-size-fits-all approach to men doing Kegels, is that Kegels are simply not appropriate for every man.
Here’s why: Pelvic floor PTs regularly make the distinction between low-tone (weak or “short”) and high-tone (too tight) pelvic floor muscles when evaluating patients. They then prescribe individualized treatment plans to eradicate and reduce a patient’s symptoms based on the PTs objective findings. While Kegels may be just the thing for a weak pelvic floor, a man with a tight pelvic floor should not do Kegels. (Complicating things is that high-tone, tight pelvic floor muscles can (and often do) come across as weak.) So at the end of the day, short, tight, and apparently weak muscles need to be lengthened, not tightened.
If you’re someone who has not dealt with the symptoms of a tight pelvic floor, you might wonder why a tight muscle is a bad thing. Well, when it comes to the pelvic floor, too tight muscles can cause dysfunction and symptoms, such as genital pain, urinary urgency and frequency, and constipation, among others.
So when are Kegels Appropriate for Men?
Studies show that 80% of men experience urinary incontinence following a prostatectomy. The good news is that research also shows that Kegels can hasten recovery from prostate surgery. As a result, surgeons now routinely recommend patients start Kegels before, or shortly after the surgery.
Erectile Dysfunction (Sometimes)
While some Kegel enthusiasts believe Kegels can enhance erections and orgasms, there’s little evidence to support the claim. That said, research has shown that they can be helpful for men with one of the most common sexual disorders, premature ejaculation. In addition, some research also suggests that they might help in cases of erectile dysfunction. (Erectile dysfunction may affect up to 60% of men by the age of 50.)
In fact, in one study titled “Pelvic Floor Exercise for Erectile Dysfunction,” 55 men with erectile dysfunction underwent a randomized controlled study. The findings will interest you.
The first group received pelvic floor muscle training by a PT for three months. The second group received lifestyle modification instructions for three months (diet, increased cardiovascular exercise, decreased alcohol consumption). At the end of the three months, the men receiving pelvic floor muscle training were significantly improved: 40% of the men regained normal erectile function, and 35% were improved.
For its part, the control group who only received counseling on lifestyle improvement showed no change.
This group was then given the same pelvic floor training that the first group received with similar results: a significant improvement in their quality of erection.
What did the above-mentioned pelvic floor muscle training consist of, specifically?
*Maximum pelvic floor contractions (Kegels): three while lying, sitting, and standing, two times per day
*Submaximal pelvic floor contractions (Kegels) while walking
*Tightening the muscles strongly after voiding (Kegel), using the bulbocavernosus muscle to eliminate urine from the glands
Based on these impressive statistics, I do NOT think the penis weights featured in the Private Gym product line are necessary, but they are probably not harmful.
Despite research of its benefits, most urologists do not suggest pelvic floor PT for men with incontinence or erectile dysfunction, so they are often left on their own, frustrated and embarrassed. Many turn to the Internet and products, such as Dr. Siegel’s.
In an ideal world, men would be referred to a pelvic floor PT as a first-line treatment for urinary and sexual impairments. Unfortunately, that’s not the world we live in. Many men simply do not have access to this type of care for a number of reasons. This being the case, the Private Gym (minus the penis weights) and other self-treatment products, such as the book, Use it or Lose It and the video, Health Issues: Erectile Dysfunction and Post-micturition Dribble may be helpful.
If you have any questions/comments about men and Kegeling, please do not hesitate to leave them in the comment section below!
All my best,