When should Men do Kegels?

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By Stephanie Prendergast

When should men do Kegels? As pelvic floor PTs who treat men, this is a question we often address in our clinics. Recently, the question of men and Kegels has hit the mainstream with both the New York Times  and Dr. Oz tackling the topic, among others. So I thought it a perfect time to address the question here on our blog.

Just as in women, the male pelvic floor extends like a hammock from the tailbone to the pubic bone. And as is the case with the female pelvic floor, the male pelvic floor plays a role in bladder, bowel, and sexual function as well as helping to maintain urinary and fecal continence. So then it’s not surprising that Kegels are not just for women, and that there are situations where they are appropriate for men.

One Size does not Fit All

I’d first like to take a look at the mainstream hoopla currently surrounding men and Kegels. Unfortunately, it’s the same one that is consistently directed at women: one-size-fits-all.

“People do cardio exercises for their heart, and they do strength training and work on their six-pack, but the pelvic floor is neglected,” said Dr. Andrew Siegel, a urologist from the above-mentioned Times article.

As the article points out, Dr. Siegel is also the co-founder of Private Gym, a company marketing what a Men’s Health article calls “a workout for your penis.” Dr. Siegel’s system includes an instructional DVD as well as small, ultralight weights on a silicone band that fits around the penis, intended for “men who want to add a bit of resistance training to their routines.”

Dr. Siegel’s product goes beyond the repetitive contractions done in regular Kegels by adding resistance to the exercise with weights. As an experienced pelvic floor PT, I do not believe that using resistance will improve functional outcomes in men.

The reason is that the pelvic floor muscles are one of the only muscle groups in the body that are always active, and for good reason. Without them constantly working to provide pelvic tone, we would be completely incontinent. As a result, these muscles are already working harder than any other muscle in the body, and their optimal physiological function is based on appropriate length, strength, and motor control of, not just the pelvic floor muscles, but also the surrounding pelvic girdle muscles.

So it’s not just about building strength when it comes to the pelvic floor.

Another problem I have with the one-size-fits-all approach to men doing Kegels, is that Kegels are simply not appropriate for every man.

Here’s why: Pelvic floor PTs regularly make the distinction between low-tone (weak or “short”) and high-tone (too tight) pelvic floor muscles when evaluating patients. They then prescribe individualized treatment plans to eradicate and reduce a patient’s symptoms based on the PTs objective findings. While Kegels may be just the thing for a weak pelvic floor, a man with a tight pelvic floor should not do Kegels. (Complicating things is that high-tone, tight pelvic floor muscles can (and often do) come across as weak.) So at the end of the day, short, tight, and apparently weak muscles need to be lengthened, not tightened.

If you’re someone who has not dealt with the symptoms of a tight pelvic floor, you might wonder why a tight muscle is a bad thing. Well, when it comes to the pelvic floor, too tight muscles can cause dysfunction and symptoms, such as genital pain, urinary urgency and frequency, and constipation, among others.

So when are Kegels Appropriate for Men?

Prostate surgery

Studies show that 80% of men experience urinary incontinence following a prostatectomy. The good news is that research also shows that Kegels can hasten recovery from prostate surgery. As a result, surgeons now routinely recommend patients start Kegels before, or shortly after the surgery.

Erectile Dysfunction (Sometimes)

While some Kegel enthusiasts believe Kegels can enhance erections and orgasms, there’s little evidence to support the claim. That said, research has shown that they can be helpful for men with one of the most common sexual disorders, premature ejaculation. In addition, some research also suggests that they might help in cases of erectile dysfunction. (Erectile dysfunction may affect up to 60% of men by the age of 50.)

In fact, in one study titled “Pelvic Floor Exercise for Erectile Dysfunction,” 55 men with erectile dysfunction underwent a randomized controlled study. The findings will interest you.

The first group received pelvic floor muscle training by a PT for three months. The second group received lifestyle modification instructions for three months (diet, increased cardiovascular exercise, decreased alcohol consumption). At the end of the three months, the men receiving pelvic floor muscle training were significantly improved: 40% of the men regained normal erectile function, and 35% were improved.

For its part, the control group who only received counseling on lifestyle improvement showed no change.

This group was then given the same pelvic floor training that the first group received with similar results: a significant improvement in their quality of erection.

What did the above-mentioned pelvic floor muscle training consist of, specifically?

*Maximum pelvic floor contractions (Kegels): three while lying, sitting, and standing, two times per day

*Submaximal pelvic floor contractions (Kegels) while walking

*Tightening the muscles strongly after voiding (Kegel), using the bulbocavernosus muscle to eliminate urine from the glands

Based on these impressive statistics, I do NOT think the penis weights featured in the Private Gym product line are necessary, but they are probably not harmful.

Despite research of its benefits, most urologists do not suggest pelvic floor PT for men with incontinence or erectile dysfunction, so they are often left on their own, frustrated and embarrassed. Many turn to the Internet and products, such as Dr. Siegel’s.

In an ideal world, men would be referred to a pelvic floor PT as a first-line treatment for urinary and sexual impairments. Unfortunately, that’s not the world we live in. Many men simply do not have access to this type of care for a number of reasons. This being the case, the Private Gym (minus the penis weights) and other self-treatment products, such as the book, Use it or Lose It and the video, Health Issues: Erectile Dysfunction and Post-micturition Dribble may be helpful.

If you have any questions/comments about men and Kegeling, please do not hesitate to leave them in the comment section below!

All my best,

Stephanie


10 thoughts on “When should Men do Kegels?

  1. Hi Stephanie,
    Great article! Wanted to say Hi and I miss you here in the Bay Area.
    Hope you’re loving LA. I’m sure there’s many thankful patients to have there as you are the best! I’m sure glad I had the opportunity to have you work on me.

  2. Thanks for the info.I have set an appt with a local PT group to try and address my CPPS. I hope they know what they are doing.All I could find in Memphis for treatment of pelvic pain were services structured for women. I know you don’t like Kegel exercises in general but they have helped me not wet myself when I cough,sneeze or get startled. I have had horrible prostate and urinary issues since my late twenties and this is the only thing that has really worked. I just hope the Kegel exercises aren’t causing more problems in my pelvic area which from reading your posts i know can happen.I will keep you informed of my progress if you wish .Thanks.

  3. Went to the appointment today.Turns out they started a year ago and only did women but now also do men.They are going to advertise that fact soon.My Therapist says there are seven of them all qualified to do pelvic work and it is there specialty. They are all PTs.She really put me at rest and I was not nervous at all.She did both external and internal exams and did treatments in both areas.Apparently,I have quite a few issues as almost all of the areas had spasms when manipulated. I will be going twice a week for treatments. She asked me to discontinue my Kegel exercises for now.If you would like their address and phone number for possible addition to your list of places in the Deep south to go to just ask and I will send it to you. You were a big help in getting me to do something about my CPPS and I thank you from the bottom of my heart.Hopefully we can manage the pain I have and give me a better quality of life.

    • That is such great news Wilburn! Please keep us posted on your progress! Yes, we would love the information of the PTs to add to our list.

      All my best,
      Stephanie

  4. Results Physiotherapy,7796 Wolf Trail Cove. Suite 102. Germantown Tn. 38138. Phone # 901-624-5020. Fax#901-624-5021.www.resultsphysiotherapy.com. Cameron Pikula PT,DPT,COMT. This should get you in contact with them. Cameron is the one who did my assessment and first treatment. She was great and put me at ease. A great person.

  5. I will get back with you guys after I have had a few treatments and let you know how it goes. Hopefully this will help with a lot of my ED and prostate/urinary issues. 55 is too young to be miserable like I have been. Once again ,thanks for leading me into this direction. Bill Rivenbark.

  6. I am a MALE , and i have been in unbearable pain 14 years since i had a Proctectomy. Crohn’s Disease 39 years , colon and rectum removed in 2001. I have not been able to sit, stand ,and can only lie on my left side. This has mostly destroyed my life, and due to other complications (same surgery) in my Urinary Tract, I have had to start dialysis 16 months ago. Is there a DR. that can help me, and would be willing to speak with me about my problem? Please contact through my email if you have any information or suggestion about this. Thank You.

  7. Pingback:Guest blogger: Stephanie Prendergast, Physical Therapist | sue croft physiotherapist blog

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