Pelvic health is widely assumed to be a women's speciality. It is not. Men have the same pelvic floor muscles, performing the same jobs — bladder and bowel control, support of the pelvic organs, and a role in sexual function — and those muscles develop the same problems.
The difference is recognition. Male pelvic floor dysfunction is under-diagnosed, under-referred and rarely discussed, so men typically arrive having been through repeated courses of antibiotics for "prostatitis" without infection, or having been told that leaking after prostate surgery is simply something to accept.
It is usually neither. Male pelvic floor conditions respond to the same assessment and rehabilitation principles that work in women, and often respond well.
What we treat
Urinary incontinence
Leaking with effort, urgency, and the very common post-void dribbling. See male incontinence physiotherapy.
After prostate surgery
Continence rehabilitation before and after prostatectomy — the single most effective use of pelvic floor training in men. See prostate surgery rehabilitation.
Chronic pelvic pain
Persistent pain in the perineum, testicles, penis, lower abdomen or rectum, frequently labelled chronic prostatitis. See chronic prostatitis and CPPS.
Overactive bladder
Urgency, frequency and night-time waking. Responds to the same bladder retraining used in women. See overactive bladder.
Bowel dysfunction
Faecal urgency, difficulty controlling wind, incomplete emptying and constipation. See bowel incontinence.
Erectile and sexual difficulties
The pelvic floor contributes to erectile function and ejaculatory control. Pelvic floor training has an evidence base in erectile dysfunction, particularly where muscles are weak or overactive.
Post-surgical rehabilitation
After hernia repair, prostate surgery or other pelvic and abdominal operations — scar work, core rehabilitation and graded return to activity.
Coccyx and pelvic pain
Tailbone pain and pain on sitting, which frequently involves pelvic floor overactivity. See coccyx pain.
Weak or overactive — the distinction that matters most
Men are usually told to "do pelvic floor exercises" without anyone establishing whether their pelvic floor is weak or overactive. Those require opposite treatments, and getting it wrong reliably makes things worse.
Weakness typically presents as leaking — after prostate surgery, with effort, or as post-void dribbling. Treatment is strengthening.
Overactivity typically presents as pain: perineal ache, testicular or penile pain, pain on sitting, urinary hesitancy or a stop-start stream, incomplete emptying, and pain after ejaculation. Treatment is release and downtraining — and strengthening exercises in this group commonly worsen symptoms considerably.
This is why so many men with pelvic pain report that Kegels made them worse. They were not doing them wrong; they were doing the wrong exercise for their condition.
If pelvic floor exercises have increased your pain or urinary symptoms, that is a strong indicator of overactivity rather than weakness — and a reason to stop and be assessed.
What assessment involves
History
Your symptoms and their pattern, urinary and bowel habits, sexual function where relevant, previous surgery and investigations, pain behaviour, and what you want to get back to. Sexual function is asked about because it is clinically relevant, and you can decline any question.
Movement and posture
Assessed fully clothed — how you breathe, how you sit, hip and back function, and how pressure moves through your abdomen with effort. Prolonged sitting patterns are frequently relevant in male pelvic pain.
External assessment
Abdominal wall, hip rotators, adductors and gluteals, all of which commonly harbour trigger points that refer pain into the pelvis and genitals.
Internal assessment — optional
A rectal examination is the most accurate way to assess male pelvic floor tone, strength, coordination and trigger points. It is entirely optional, explained fully beforehand, and can be stopped at any point. Many men begin with external assessment and biofeedback instead.
Biofeedback
Particularly useful in men, who often have poor awareness of these muscles and cannot tell whether they are contracting correctly. See biofeedback therapy.
Your plan
A written, individualised programme — whether that is strengthening, downtraining, bladder retraining, or a combination — with clear progression criteria.
On seeing a female physiotherapist
This comes up often enough to address directly. Pelvic health physiotherapy is a clinical speciality, and the assessment and treatment of male pelvic floor dysfunction is routine work carried out many times a week. Whatever your symptom is, it will not be new.
You can request a chaperone, bring someone with you, and decline any part of the assessment. Internal examination is never a condition of treatment, and a great deal can be achieved with external assessment, biofeedback and education alone.
If you would prefer to be treated by a male clinician, that is a perfectly reasonable preference and the Association of Pelvic Obstetric and Gynaecological Physiotherapists maintains a directory that can help you find one.
See your GP before physiotherapy for: blood in urine or semen, a new testicular lump or swelling, unexplained weight loss, fever with pelvic pain, or difficulty passing urine that is new or severe. These need medical assessment first.
Frequently Asked Questions
Do men have a pelvic floor?
Yes. Men have the same pelvic floor muscle group as women, performing the same functions — bladder and bowel control, support of the pelvic organs, and a role in erectile and ejaculatory function. Male pelvic floor dysfunction is common but under-recognised, largely because pelvic health is widely assumed to be a women's speciality.
Why did pelvic floor exercises make my symptoms worse?
Most likely because your pelvic floor is overactive rather than weak. Men with pelvic pain, urinary hesitancy, a stop-start stream or incomplete emptying typically have muscles held in sustained contraction, and strengthening exercises add tension to a muscle that already cannot relax. Treatment for that presentation focuses on release and downtraining, which is the opposite approach.
Will I need an internal examination?
Not necessarily. A rectal examination gives the most accurate assessment of male pelvic floor tone, strength, coordination and trigger points, which is why it is offered — but it is entirely optional, explained fully first, and can be stopped at any moment. Many men are assessed and treated effectively using external assessment and biofeedback alone.
Can physiotherapy help erectile dysfunction?
It can contribute, particularly where pelvic floor weakness or overactivity is a factor. Pelvic floor muscle training has an evidence base in erectile dysfunction and in ejaculatory control. It is not a treatment for all causes — vascular, hormonal, medication-related and psychological factors need addressing through your GP or a specialist — so assessment establishes whether the pelvic floor is a relevant contributor in your case.
Is post-void dribbling normal?
It is very common but it is not something you have to accept. Dribbling shortly after finishing usually reflects urine remaining in the bulbar urethra that is not being cleared, often related to pelvic floor function. It typically responds well to a specific technique — urethral milking combined with pelvic floor contraction after voiding — which takes minutes to learn.
Do I need a GP referral?
No, you can self-refer. However, some symptoms need medical assessment first — blood in urine or semen, a new testicular lump, unexplained weight loss, fever with pelvic pain, or new difficulty passing urine. If you have any of those, see your GP before booking physiotherapy.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
These Problems Are Treatable
Male pelvic floor dysfunction is common, under-recognised, and responds well to proper assessment and rehabilitation.
Book Your ConsultationOr contact us directly: 07999 996926 | info@zylohphysio.com