Caring for your pelvic floor is a guy thing, too.

The Citizen

23-07-2025

An expert said focused physiotherapy can play a big part in recovery.
Pelvic floor dysfunction is not just a women's health issue.
It's a guy thing, too, and for many men, it is the cause of pain, embarrassment, and an unwanted segue from normal life.
It can mean challenges in the bedroom, a surprise and unwanted bit of leakage with a sneeze and a cough or a slow, exhausting recovery after prostate surgery.
Pelvic floor physiotherapy has traditionally been an environment for or at least a treatment for women.
Dr Lisa Kaestner, a urologist at Netcare Christiaan Barnard Memorial Hospital, said that it is helpful for post-prostatectomy incontinence, sexual dysfunction, and pelvic pain in men. But it's not really at the top of any man's health-awareness chart.
'There's a lack of awareness and not enough pelvic floor physiotherapists comfortable treating men,' she said. 'And rehab like this is not well funded in most South African healthcare settings, which makes it a personal expense many cannot afford.'
This is probably why many guys say nothing, do nothing, and just suffer in silence.
Men stay silent
John De Klerk, a physiotherapist with a special interest in pelvic rehabilitation, said the entire concept has roots in women's medicine.
'Pelvic floor exercises, commonly known as Kegels, were initially developed for women by Dr Arnold Kegel,' he said.
'The research focused on women's reproductive health, especially for incontinence during and after pregnancy.'
The same principles have been found effective for men with certain pelvic dysfunctions. But that does not mean the conversation is easy.
'To speak about a problem in a sensitive and private area, it must be brought out from the darkness of ambiguity,' De Klerk said.
There is no single symptom that exclusively points to the challenge. Kaestner said it can range from incontinence to sexual issues and chronic pelvic pain.
'The back, the prostate, the pelvis, the pelvic floor are not separate entities,' she said. 'They are interrelated; even bowel function is part of the equation.'
De Klerk unpacked it more.
'Overactive pelvic floor symptoms include difficulty initiating urination or defecation and pain during sexual function,' he said.
'Underactive symptoms relate to incontinence and excess flatulence. Then there's uncoordinated pelvic floors, which involve timing and control issues.'
ALSO READ: Why Gen Z fears phones
Men recovering from prostate surgery are particularly vulnerable, Kaestner said
'Pelvic floor physiotherapy can speed up recovery to continence after radical prostatectomy,' she said.
Physiotherapy helps fix male pelvic floor issues
De Klerk said focused physiotherapy can play a big part in recovery.
'Physiotherapy aims to improve modifiable factors of recovery,' he said. 'That includes urinary control, pain management, and longer-term erectile function recovery.'
It is not just about exercise, though, he noted.
'We clear up misconceptions, explain the process, modify lifestyle factors like alcohol and caffeine use, and tailor a plan unique to each person,' he said.
'Training involves strengthening neural pathways to form new habits. In plain English, to prepare men in bracing the pelvis in times of need with better timing than Cheslin Kolbe in a World Cup kick-charge-down.'
It remains a sensitive topic, though, and a reluctance to seek help is endemic.
'Pelvic floor physiotherapy is awkward and uncomfortable because it is incredibly intrusive,' said Kaestner. 'The key is to explain why it's needed and how it helps. Many men just need someone to open the door slightly. If they want to talk, they'll take that gap.' De Klerk agreed.
'Fewer men are embarrassed as much as they are afraid of the unknown,' he said. 'We meet them where they are, reassure them, and give them control of the process. The patient is in the driver's seat. We just navigate.' It's not just about doing Kegels. 'It starts with consent and a conversation,' said De Klerk.
But don't do this at home, yourself, he warned the guys. Hypertonicity, or over-tightening, can occur.
'More men are trying to self-diagnose with apps and online videos,' he said. 'That can lead to more harm than help. Knowledge is not wisdom. A breadknife and a scalpel both cut, but one is made for the job.'
Impacts sexual health
Sexual health is, of course, a big driver for men to finally take some action. It's also a big taboo courtesy of society.
Kaestner said that she found men do want to talk about stuff, but they do not always receive a safe space wherein to do so.
As for the first step, De Klerk suggested a visit to a physio, GP or urologist.
'It is a great place to start. In the right clinical setting, pelvic rehab is a practical and evidence-based service. And don't be afraid, because there is hope, and there is no shame.'
NOW READ: Feeling fine? Think again – Why annual check-ups are a must.