Pelvic floor exercises for male patients

What are pelvic floor exercises? 

The pelvic floor muscles stretch from the pubic bone at the front of your body to the bottom of your spine, below the bladder and bowel. They act as a sling, supporting the bladder and bowel and helping to control when you urinate (pee) or empty your bowels. Pelvic floor muscle exercises help to strengthen these muscles. 

Strong pelvic floor muscles may help with some urinary problems, including: 

• leaking urine – this could be just a few drops, or a steady flow throughout the day.  

• leaking urine when you sit down or stand up, cough, sneeze, or bend forwards.  

• a sudden urge to urinate and sometimes leaking before you get to the toilet. 

• needing to urinate more often than usual including several times at night. 

• dribbling urine after you finish urinating.  

• leaking a little urine when you get sexually aroused.  

Why are pre-radiotherapy pelvic floor exercises important?  

Having strong pelvic floor muscles before the radiotherapy treatment starts can significantly improve your ability to keep a full bladder. It is important that you can hold a full bladder during each of your radiotherapy treatments. This can become progressively more difficult as treatment progresses due to radiotherapy side effects.  

When should I start pelvic floor exercises? 

The exercises should be started as soon as possible and continued until you have completed your course of radiotherapy treatment as it will take several weeks to improve your pelvic floor muscles.  

Some patients may wish to continue these exercises after they have completed their course of treatment to assist with associated symptoms and side effects of the radiotherapy.  

These exercises may also help with bowel problems, such as needing to rush to the toilet, leakage of faecal matter (poo) or passing a lot of wind, as well as some aspects of sexual function such as maintaining an erection and reducing bladder and bowel leakage during intercourse. 

How do I find my pelvic floor muscles? 

To find your pelvic floor muscles: 

• Sit, stand, or lie down, whichever you find most comfortable, and relax your thighs and buttocks. 

• Tighten the ring of muscle around the opening to your back passage (anus) as if you’re trying to control wind. Then relax. Try not to squeeze your buttocks together or tighten your thigh or stomach muscles.  

• Try not to hold your breath and keep breathing normally. 

• At the same time as tightening your muscle, imagine you are urinating and tighten your muscles as if you’re trying to stop mid-flow, then relax. You can try this once or twice while you’re urinating if this helps you to find the right muscles. Do not do this all the time as it could cause problems emptying your bladder. 

• If you’re tightening the right muscles, you should feel a dip at the base of your penis and feel your scrotum (the skin around the testicles) move up a little. You might find it helpful to do the exercises in front of a mirror to begin with, so you can see the base of your penis and your scrotum move. 

• You can also check if you’re using the right muscles by touching the skin just behind the scrotum. You should feel the muscles lift up and away from your fingers when you tighten them. If you feel the muscles pushing down, start these steps again until you feel the muscle lift.  

Pelvic floor exercises 

Once you have identified your pelvic floor muscles and know how it should feel when you tighten them, you should begin the exercises. 

There are two sets of exercises, slow and fast. You can do them while sitting, standing, or lying down. 

Slow pelvic floor muscle exercises 

1. Slowly tighten the muscles as hard as you can so you feel a lifting sensation.

2. Try to hold this lift for 10 seconds. Keep breathing normally. 

3. Slowly relax the muscles and rest for 10 seconds. 

Aim to repeat these steps up to 10 times. 

You might find that you can’t hold the lift for 10 seconds to start with. Hold it for as long as you can and try to build up to 10 seconds. It’s more important to do the exercises properly than to rush to get to 10 seconds. 

Fast pelvic floor muscle exercises 

1. Repeat the same actions as with the slow exercises, but this time try tightening the muscles as quickly as possible. 

2. Hold the lift for one second and then let go. 

3. Try to do up to 10 of these short, fast lifts. 

How often should I do the exercises? 

There’s no fixed advice on how often you should do pelvic floor muscle exercises. You may want to try doing a set of slow and fast exercises three to six times a day. Try to make them part of your daily routine. Pelvic floor muscles are like any other muscles, they can get tired if you do too many exercises.  

You might notice that you leak more urine towards the end of the day, as your muscles get tired. This should get better with time as the muscles get stronger. It might help to tighten the pelvic floor muscles at certain times such as: 

When you leak urine 

Tighten the muscles strongly before and during activities that cause you to leak urine. For example, when getting up from a chair, lifting, bending, coughing, or sneezing. Tighten the muscles for as long as you can, over time this might help to prevent urine leaking. 

After urinating 

Tightening your pelvic floor muscles strongly after you urinate should help to get rid of any urine that’s left in the urethra (the tube you urinate through) and avoid any dribbling afterwards. You may see a small improvement each week, but it can take up to several weeks before you notice a real difference. The exercises might not work for some men, if this is the case for you, please speak to your medical team to get further support.