The pelvic floor is critical for men’s health too—here’s how
New research is highlighting how men are affected by a weak or overtightened pelvic floor, bringing awareness to an issue that was previously focused on women.
If you’ve ever fought the urge to pee, stood tall without strain, or maintained a satisfying sex life, you have your pelvic floor to thank. This network of muscles and connective tissue is central to urinary continence, bowel movements, posture, and sexual function.
Despite such importance, pelvic floor strength is usually framed as a women’s health issue—primarily because a weak pelvic floor is commonly linked to childbirth, menstruation, and menopause. “But it’s also important for men to understand that the pelvic floor is a vital part of their bodies, as it ties together so many different bodily functions,” says Peter Bajic, a urologist and director of men’s health at Cleveland Clinic in Ohio. About one in five men over the age of 65 experience pelvic floor-related urinary incontinence, and as many as 16 percent live with chronic pelvic pain.
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Fortunately, recent research and new clinical attention are improving awareness and putting men’s pelvic health in the spotlight.
What is the pelvic floor?
The pelvic floor, or pelvic diaphragm, is a layered group of muscles, connective tissue, and nerves. “Think of it as a hammock-like sling connecting your sit bones and the bones at the base of your spine with your pubic bone,” says Loren Fishman, a professor of physical medicine and rehabilitation at Columbia University.
That sling does more than support pelvic organs, though. It also works in tandem with the bladder, rectum, and reproductive system, contracting and relaxing to regulate abdominal and pelvic pressure while also aiding lymphatic drainage, supporting core stability, and improving sexual function, continence, and digestion, says Jennifer Kinder, a physical therapist and clinical specialist at the University of California, San Francisco.
Though the pelvic floor usually holds strong “once a person is potty trained,” says Karen Brandon, president of the International Pelvic Pain Society, it can weaken over time due to aging, genetics, chronic stress, and other circumstances. When it falters, symptoms may include pelvic pain, organ prolapse, frequent urges to urinate, incontinence, or diminished sexual function in men.
And problems aren’t only caused by weakness. Men can also suffer from overly tight pelvic floor muscles due to chronic stress, poor posture, excessive exercise, or from overcompensating for back or hip pain, notes Bajic. This can trigger discomfort and issues in the testicles, penis, prostate, or bladder.
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How the pelvic floor serves men—and where issues begin
While the pelvic floor serves foundational functions for both men and women, some roles are unique to each.
For men, the pelvic floor plays especially direct roles in sexual and urinary function. Its muscles contract during erection and ejaculation, helping maintain rigidity, control ejaculation, and enhance pleasure. They also stabilize the bladder and urethra—reducing risks of leakage or overactive bladder.
This matters because research shows that nearly 5 percent of men ages 19 to 44 experience daily incontinence—a figure that more than quadruples in men 65 and older, albeit less so in men who are physically active.
Pelvic floor dysfunction most often surfaces for men after prostate removal surgery (typically for cancer), but obesity, chronic straining or coughing, genetics, athletic injuries, chronic stress and anxiety, and poor posture are also factors. Research shows that even sitting on the toilet for too long can weaken one’s pelvic floor—and extended toilet sitting could be twice as common among men than women.
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Aging is another factor, as “the integrity of one’s connective tissue can change as one gets older,” says Emi Bretschneider, chief of urogynecology and reconstructive pelvic surgery at Northwestern Memorial Hospital.
New studies shifting the focus
For decades, pelvic floor research focused almost exclusively on women, primarily due to the way menstruation, menopause, pregnancy, and labor can weaken the area. But in the past several years, men’s pelvic health has also been influencing how clinicians think about prevention and treatment.
A 2021 observational cohort study, for instance, links pelvic floor muscle strength directly with erectile dysfunction. A 2022 randomized control trial shows targeted pelvic floor training reducing urinary incontinence after prostate surgery. And a 2025 narrative review concluded that physical therapy should be a first-line treatment for many male disorders ranging from premature ejaculation to chronic pelvic pain.
Emerging approaches also include biofeedback, electrical stimulation, and even app-based training programs. “Research is finally proving what many of us have seen in practice—that the pelvic floor is just as central to men’s health as it is to women’s,” says Bajic.
How to strengthen the pelvic floor
For strengthening your main pelvic floor muscles, "Kegel exercises are the most proven option," says Fishman. Created in 1948 by American gynecologist Arnold Kegel, the exercise is remarkably simple.
Brandon explains that it begins by locating the right muscles. “Imagine trying to stop the flow of urine or holding back gas,” she advises. Once identified, contract them for five to 10 seconds, then relax. Repeat for about 15 reps daily. “It can become part of your routine, like brushing your teeth,” she says.
But Kegels aren’t the only option. “Any kind of core strengthening—Pilates, yoga, barre, squats—can help,” says Amy Park, section head of urogynecology and pelvic reconstructive surgery at Cleveland Clinic. “These muscles are all intertwined and work in concert, and functional exercises like these can absolutely improve pelvic floor strength.”
Because tight pelvic floor muscles can impair bladder and bowel control, relaxing and lengthening these muscles through stretching can also be helpful.
Prescription medications are another option, and surgery is sometimes recommended when addressing an overlapping issue such as prolapse or urinary or bowel dysfunction. And while research is limited, Kinder adds that breathing techniques are important too: inhale to expand the belly, exhale while gently contracting the pelvic floor muscle.
Still, not all pelvic floor issues benefit from strengthening. “Strengthening an already tight pelvic floor can actually make symptoms worse,” warns Bajic. Men recovering from prostate surgery may need specialized programs, while others may require relaxation strategies such as targeted stretches, mobility work, and exercises known as “reverse Kegels” instead of contraction-based training.
A doctor or physical therapist can tailor the right approach and address individual concerns, Kinder says. “One of my biggest joys is seeing the empowered change in a patient from their first appointment to their last—the confidence they have upon leaving is so gratifying.”
