Pelvic floor physical therapy for men - different types of pelvic floor contractions

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Kegels and the Male Pelvic Floor
In clinical practice, the question is rarely “Are Kegels good or bad?” but rather “Which type of pelvic floor activity is appropriate for this specific individual, at this specific time, for this specific diagnosis?” For many men, indiscriminate Kegel training can be ineffective at best and symptom worsening at worst. For others, Kegels performed correctly and at the right stage of rehabilitation can be essential.

Understanding the Male Pelvic Floor
The male pelvic floor is a complex system of muscles, nerves, and connective tissue that spans the bottom of the pelvis. It supports the bladder and bowel, contributes to sexual function, maintains continence, assists in breathing and core stability, and plays a role in posture and movement. These muscles must be able to contract, relax, and lengthen in a coordinated way. Dysfunction arises not only from weakness, but from poor timing, excessive tone, altered neural control, and impaired coordination with breathing

What Are Kegels? A traditional Kegel is a voluntary contraction of the pelvic floor muscles, typically described as squeezing the muscles that stop urine. This is a shortening or concentric action of the pelvic floor. However, this definition is incomplete.

Pelvic floor training actually includes multiple distinct motor patterns:
1. Concentric contractions (shortening and lifting)
2. Isometric holds (sustained contraction)
3. Eccentric control (controlled lengthening)
4. Active relaxation (dropping or bulging)
5. Reflexive coordination with breathing and movement

Two Broad Pelvic Floor Presentations: Underactive vs Overactive
1. Underactive and/or Weak Pelvic Floor Characteristics may include:
• Poor strength or endurance
• Delayed activation
• Difficulty maintaining continence under load
• Reduced support after surgery
In these cases, strengthening based Kegels may be appropriate, though still within a comprehensive program

2. Overactive and/or Hypertonic Pelvic Floor
Characteristics may include:
• Excessive resting tone
• Difficulty relaxing or lengthening
• Pain with sitting, ejaculation, or bowel movements
• Sensation of tightness, pressure, or incomplete emptying
In these cases, traditional Kegels often worsen symptoms, because the problem is not weakness but an inability to let go

Why Pelvic Floor Physical Therapy Matters
Pelvic floor physical therapists do far more than prescribe exercises. They assess:
• Resting tone
• Voluntary and involuntary control
• Coordination with breathing
• Symptom response
• Functional integration
• Determines if other muscles that attach to the pelvis (low back, abdominals, obliques, glutes, groin, hip flexor muscles) are involved and need strengthening or stretching

This evaluation determines whether Kegels are indicated, contraindicated, or premature