What causes pelvic floor dysfunction in men and what can be done about it?

Irish Times

22-07-2025

In his early 30s, Chad Woodard spent hours cycling around New York City training for an Ironman triathlon. Around the same time, he began to experience pelvic pain and erectile dysfunction. He never suspected his workouts could be the cause.
Dr Woodard, now an assistant professor of physical therapy at Hunter College, had been in practice for several years, but it was only when a urologist asked him if he treated men with pelvic floor dysfunction that he began to educate himself about the pelvic floor, an umbrella term for the sling of muscles, ligaments and nerves at the base of the torso that supports the bladder, bowels and reproductive organs.
When the pelvic floor becomes either overly lax or overly tight in men, it can cause incontinence, sexual dysfunction and pain in the scrotum, rectum or groin.
Dr Woodard had heard passing mentions of the pelvic floor during his training, but he had no idea what pelvic floor physical therapy was. He sought out continuing education coursework in pelvic care and discovered that he was suffering from pelvic floor dysfunction.
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After he successfully treated his conditions using the exercises he was learning, he dedicated his practice to helping other men. After treatment, 'they can live their life again,' he said, now more than a decade later.
Overlooked source of suffering
In recent years, women's pelvic floor health has received an uptick in attention, thanks to women's health advocates, social media activism and the rise of a cottage industry of telehealth companies and products to treat pelvic floor issues.
But men's pelvic floor health is often still overlooked by medical providers (According to some estimates, one in 10 men in Ireland may suffer from a pelvic floor disorder).
This is in part because pelvic floor issues, such as incontinence, erectile dysfunction and chronic pain, 'can masquerade as so many other conditions,' including prostate infections, sexually transmitted infections and even cancer, said Dr Amin Herati, an assistant professor of urology at Johns Hopkins Medicine.
What causes pelvic floor dysfunction in men?
Pelvic floor disorders typically arise when the muscles of the pelvis become too tight or too loose. Generally speaking, men are more likely to experience issues from overly tight pelvic floors, in which the muscles are in a near permanent state of contraction, said Kimberlee Sullivan, the head of clinics for pelvic health provider Origin. This limits the muscles' range of motion and mobility, which ultimately weakens them, making it difficult to control the flow of urine and faeces and to support erections and ejaculation.
One of the most common causes of tight pelvic floors is stress, which can lead to over-clenching of the pelvic muscles. Other common causes include constipation, holding in urine for long periods of time and excessive sitting. Cycling or heavy lifting can also lead to tightness, experts said.
When men have overly lax pelvic floors, the cause is most often surgery to treat prostate cancer. This cohort is especially likely to experience incontinence and erectile dysfunction, since surgery can weaken the muscles and ligaments of the pelvic floor.
Pelvic floor disorders can also be caused by damage to the pudendal nerve, which runs through the pelvic floor, as a result of injury from activities such as kick-boxing, cycling or squatting.
How is pelvic floor dysfunction treated in men?
If you're suffering from bladder or bowel incontinence, erectile dysfunction or pelvic pain, first see a doctor to rule out infection or disease.
For many issues, physical therapy may be the solution – with a treatment programme that combines massage to release tight muscle and fascia, and stretching or strengthening exercises. Diaphragmatic breathing may also be recommended.
How can you keep your pelvic floor healthy?
If you don't suffer from any pelvic floor issues, there are a few simple steps you can take to avoid dysfunction down the road.
Practice deep breathing:
Diaphragmatic breathing, in which your abdomen fills with oxygen as your inhale, can help to keep the pelvic floor both appropriately relaxed and strong. Deep breathing is like 'a stretch from the inside out,' said Alicia Ferriere, a pelvic floor physical therapist.
Stretch regularly:
Stretching your hip and groin muscles, quads, glutes and hamstrings can keep the muscles of your pelvic floor mobile. This can be especially valuable after powerlifting and cycling, both of which can tighten the pelvic floor's muscles and tissues, Ferriere said.
Avoid Kegels, in most cases:
Unless you have been diagnosed with an overly lax pelvic floor, avoid Kegels, or intentionally contracting your pelvic floor muscles. Most people don't do Kegels correctly, experts said, which can exacerbate a tight pelvic floor.
Don't suffer in silence:
If you suspect you might be developing a pelvic floor issue, don't try to tough it out. Just as you would seek treatment for a pulled or cramped muscle in your shoulder or calf, Sullivan said, the sooner you start addressing symptoms in your pelvic floor muscles, the better.
– This article originally appeared in the
New York Times