- Men can develop a hypertonic pelvic floor — over-activation of muscles for peeing and sex.
- Sometimes it's a response to too much stress or anxiety but there are other causes too.
- Strength training, stretching, breath work, and no more than 10 minutes on the toilet all help.
If you're a woman, you probably already know what a kegel exercise is, and have been told to work on strengthening your pelvic floor.
But an increasing number of men are discovering they have the opposite problem: a pelvic floor that is hyper tense and over-flexed nearly all the time.
All of us, regardless of gender, are sitting on a hammock of muscles that control how well we can urinate, perform a bowel movement, and have sex. This is the pelvic floor.
When operating properly, it sits largely unnoticed, helping thanklessly to facilitate these bodily functions throughout the course of each day. But, if the pelvic floor muscles become too tight or too loose, chaos can ensue.
That's what happened to Adam Gvili when he was in his early 20s.
"I went like 20 times a day," Gvili, now a physical therapist treating pelvic floor issues, told Business Insider, referring to his frequent urge to pee — one of the most common symptoms of hypertonic pelvic floor.
According to the US National Institutes of Health's Pelvic Floor Disorders Network, up to one in five women will have surgery for a pelvic floor disorder at some point in her lifetime, and even more women — about 32% — will have some sort of diagnosed pelvic floor disorder. The number of men with chronic pelvic pain is estimated to be about half that, around 16%.
Pelvic floor experts told BI these men are often suffering in the shadows. Almost no one is talking about the male pelvic floor, due to a mix of shame, a lack of awareness, and the fact that getting a diagnosis typically involves a long process of elimination with specialists.
Many patients quietly find PTs like Gvili on Reddit or through frantic Google searching, he said. Others might hear him on a podcast, or are referred from a urologist.
"Because they have this urge and frequency to go, it's like, 'Do I have to go? Should I go? Wait, I'm not sure. I already went like 20 minutes ago. Does that mean I really have to go?' And that's just for urination," Gvili said. "So imagine how much in your head you can get."
Symptoms of an overactive pelvic floor in men
Beyond needing to pee often, common tell-tale signs of a pelvic floor in panic mode include:
- Shooting pain in the rectum
- Erectile dysfunction (ED)
- Premature ejaculation
- Constipation
- Groin pain
- Testicular pain
"It's not like the muscle pops up and says, 'Hey, I'm the problem,'" physical therapist Karen Brandon, president of the International Pelvic Pain Society, told BI.
"What is more common is that men will experience symptoms of urgency and difficulty urinating and some random strange pains in their penis or their scrotum."
Stress is not the only reason men can develop an over-toned pelvic floor
There are myriad reasons that a pelvic floor can become tight and overengaged. Sometimes, it's stress.
"For some people, they tense their pelvic floor when that [stress] happens" Gvili, the founder of Pelvis NYC, said. Tensing and tightening those muscles can also be a response to anxiety, or sexual trauma.
Not all of the cases he sees are linked to stress, though. He says there are a fair number of "type B guys here that are way chill and have this" for other reasons. Older men can develop a hypertonic pelvic floor after a prostatectomy, for example.
"It could be, for a lot of men, masturbating too many times, it could be after squatting or deadlifting, I mean, there's many reasons."
Male pelvic floor issues can also be spurred by an infection or injury to the area, even a "really bad bowel movement," Brandon said.
"What happens is your pelvic floor muscle then starts to guard and get protective."
Lift heavy weights, stretch, and spend less time on the toilet
Ultimately, Gvili said, there's not a ton that men can do to prevent the pelvic floor from going into overdrive. Of course, maintaining a good exercise routine, staying flexible, breathing through stress, and time for relaxation, those all help.
His work endeavors to help people pay less attention to their pelvic floor, and let "your body's natural mechanism" operate automatically again.
"My goal is to decrease your awareness to a certain area of the body," Gvili said. "It's not as simple as 'just do some kegels.'"
Instead, it's the engagement and then release of the pelvic floor throughout the day that will help keep it healthy.
Brandon imagines the pelvic floor like a set of saloon doors that can swing both ways: lifting and pulling in, much like you would for a kegel, but also doing the opposite, by dropping and releasing, telescoping the anus to push towards the floor, almost like you're about to pass gas.
One of the best things Gvili recommends for maintaining a healthy pelvic floor is strength training.
"Lift heavy," he said. "Squats, dead lifts."
But you have to be careful. Brandon stresses that maintaining "good form" for your strength training is essential, to ensure you're not "biasing a certain muscle and overusing the one that's connected to the pelvic floor."
Men with really tight hips who never take time to stretch after they work out are prime candidates for a hypertonic pelvic floor.
"Don't be shy or afraid of being flexible," she said. "The majority of the male issues I see are that."
Poses like frog can help release the pelvic floor, when done correctly. The goal is to be able to both contract and relax this silent set of muscles, in proper balance.
"For a lot of men that are tight, we help them use those muscles, but also tone down their nervous system to know that there's no reason to tighten them up," Gvili said.
Gvili and Brandon both had the same parting piece of advice for maintaining a healthy pelvic floor: Don't spend too much time on the toilet.
Invest in a squatty potty if you are often constipated, it will help relax the muscles so your bowels can flow without pushing.
"I get the whole scrolling on the phone thing," Gvili said.
If you need some alone time in the bathroom, that's fine, just don't spend too long with your cheeks spread across the bowl. If you're constipated, try leaning forward or backwards without pushing, breathing deeply, and if you're ultimately unsuccessful, get off and try again later.
"I tell people five to 10 minutes, no longer," he said.
