Pelvic floor physical therapy for men - Should you do kegels?

Описание: Please visit www.philippeschafer.com or call Philippe at 240-626-6454 or email at [email protected] for any questions or to set up an appointment

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

Pelvic Pain Syndrome: Why Kegels are often not a good idea
Chronic pelvic pain syndrome (CPPS), prostatitis like symptoms, perineal pain, testicular pain, penile pain, or pain with sitting are frequently associated with pelvic floor overactivity.
In these men, the pelvic floor muscles are often:
• Shortened
• Neurologically sensitized
• Unable to fully relax
Adding repeated contractions through Kegels can:
Increase muscle tone, heighten nerve irritation, and reinforce maladaptive motor patterns.
Patients often report worsening pain or new symptoms after attempting Kegels on their own.
What Helps Instead:
• Diaphragmatic breathing
• Pelvic floor lengthening (reverse Kegels)
• Manual therapy
• Nervous system regulation
• Focus on strengthening/stretching other muscles that attach to the pelvis: low back, obliques, hip flexors, hip adductors, or glutes.

Constipation: Men with constipation or incomplete bowel emptying often have paradoxical pelvic floor contraction during defecation. Instead of relaxing and lengthening, the pelvic floor tightens. In these cases, traditional Kegels can be counterproductive because they reinforce contraction patterns and/or increase straining behavior

Pelvic Floor Lengthening Is Essential
Effective bowel movements require the pelvic floor to lengthen and descend.
Therapy focuses on:
• Coordinated relaxation
• Breath pelvic floor coupling
• Proper toileting mechanics
Strengthening may play a later role, but only after normal mechanics are restored

Post Prostate Surgery:
After a radical prostatectomy, many men experience urinary incontinence due to sphincteric weakness and disrupted neuromuscular control. Kegels are often appropriate and necessary, but they must be taught correctly, properly timed, integrated with breathing and movement
Common Mistakes
• Performing excessive repetitions
• Ignoring compensatory muscle use
Even post surgically, overactivity can develop if strengthening is not balanced with relaxation

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