Pelvic Floor Exercises for Men: How to Do Kegels Correctly

Pelvic floor exercise is usually associated with women's health after childbirth. Yet men have the same muscle group supporting the bladder, the bowel and sexual function — and it is directly useful in a range of areas, from urinary control after prostate surgery to premature ejaculation. The problem is that the exercise is most often performed by contracting the wrong muscle: a programme done with poor technique is not merely useless but can make the complaint worse.

What is the pelvic floor and what does it do in men?

The pelvic floor is a layer of muscle and connective tissue stretched like a hammock between the tailbone and the pubic bone. It has three basic roles in men:

• Urinary and bowel control: the sphincter muscles surrounding the urethra are part of this layer
• Support of sexual function: it contributes to maintaining blood volume in the penis during erection and to the ejaculatory reflex
• Management of intra-abdominal pressure: it provides support during coughing or lifting

The picture changes when these muscles weaken — or conversely become excessively tense. Weakness tends to present with leakage, whereas excessive tension presents with pelvic pain, frequent urination and discomfort on ejaculation. Because this distinction determines the direction of treatment, a programme should not be started without assessment.

When is pelvic floor rehabilitation recommended?

1. Urinary incontinence after prostate cancer surgery: the area of most frequent and most evident benefit. A programme started before the operation may ease the period of regaining control afterwards.
2. Temporary control problems after surgery for prostate enlargement
3. Urge incontinence and overactive bladder: applied together with bladder training.
4. Post-micturition dribble: leakage of urine remaining in the urethra after the toilet; targeted contractions can reduce it.
5. Premature ejaculation: used as part of a behavioural programme to delay the ejaculatory reflex.
6. Support for erection quality: in patients with mild to moderate complaints it can add to the effect of other treatments.
7. Chronic pelvic pain syndrome: here the aim is not to contract but, conversely, to learn to relax.

How do I find the right muscle?

The most critical step is identifying the muscle that needs to contract. Two practical references are used: acting as though holding back urine, and tightening as though preventing the passage of wind. In a correct contraction there is a slight upward movement at the base of the penis and a slight lift of the testicles; the abdominal, buttock and thigh muscles stay still and the breath is not held.

Common mistakes are:

• Tightening the abdominal muscles — check by placing a hand on the abdomen
• Squeezing the buttocks and inner thighs, or pushing the body upwards when seated
• Holding the breath — normal breathing should continue throughout the contraction
• Practising by stopping the flow during urination — this can be tried once to identify the muscle, but is not recommended as a regular exercise method because it can impair bladder emptying

How are Kegel exercises performed in men?

A commonly used starting scheme is as follows:

1. Position: lying on the back with knees bent for the first weeks. Once the technique can also be performed seated and standing, positions are varied.
2. Contraction: hold the correct muscle for 3-5 seconds, then relax fully for at least as long as the contraction lasted. Relaxation matters as much as contraction.
3. Repetitions: a set of 8-12 repetitions; 2-3 sets a day.
4. Quick contractions: 8-10 one-second rapid contractions are added to each set — this trains the response that engages when coughing or lifting.
5. Progression: as the technique settles, the hold is extended to 8-10 seconds.
6. Functional use: the habit of contracting deliberately just before coughing, sneezing or lifting is developed.

The programme is tailored to the individual; the scheme above is a general framework and is not suitable for patients with an excessively tense pelvic floor.

When are results seen?

The pelvic floor behaves like any other muscle: the effect emerges over weeks of regular work. The first noticeable change is generally reported between 6 and 12 weeks; recovery after prostate surgery is a process lasting months and varies between individuals. Abandoning the programme after a few days is the most common reason for failure. Equally, working excessively for hours each day is not beneficial: the muscle tires, tension increases and the complaint may worsen.

What do biofeedback and electrical stimulation offer?

A significant proportion of patients cannot find the right muscle on the first attempt. Biofeedback displays the contraction visually or audibly on a screen, making it concrete which muscle is working. Electrical stimulation is used to introduce the contraction in patients who cannot feel the muscle at all. Neither replaces the home programme; their purpose is to enable the patient to work correctly on their own. Initial sessions guided by a physiotherapist are reported to make the long-term outcome more predictable than a home programme alone.

When should you see a doctor?

Before starting exercises, the cause of the complaint must be established: if there is a urinary tract infection, a bladder stone, obstruction from the prostate or a neurological condition, treating those takes priority. In the following situations the programme should be postponed and an assessment made: burning on urination, blood in the urine, fever, inability to pass urine at all, progressive pelvic pain, or sudden-onset leakage. In addition, a patient who feels no change after weeks of regular work is most likely using the wrong technique; at that point seeking guidance is more sensible than continuing alone.

Assoc. Prof. Zülfü Sertkaya practises in the field of urology and andrology in Istanbul; pelvic floor assessment and rehabilitation planning are carried out with individualised planning and full confidentiality.

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