Doctor Answers: What is Male Pelvic Floor Dysfunction?

If you’re a man experiencing symptoms like twitching in the pelvic area, chronic constipation, or trouble urinating, you might be dealing with male pelvic floor dysfunction. This condition is more common than most realize and can significantly impact your quality of life if left untreated. 

We sat down with Dr. Houman, a medical expert with deep experience in pelvic health, to break down everything you need to know about pelvic floor dysfunction in men. Dr. Houman walks us through the symptoms, causes, diagnosis, and the most effective treatments for this condition. 

He also shares statistics and evidence-based information to help clarify this complex topic. Every detail provided here has been reviewed for medical accuracy.

Q: What is pelvic floor dysfunction?

Dr. Houman answers: Pelvic floor dysfunction refers to the inability to properly relax and coordinate the muscles in your pelvic floor. This group of muscles acts like a sling, supporting important organs like the bladder, bowel, and, in women, the uterus. In men, this sling supports the bladder and bowel. When these muscles don’t work correctly, they contract instead of relaxing, making it difficult to have a bowel movement.

Though more commonly discussed in women, men also experience pelvic floor dysfunction. It’s often tied to other male-specific health conditions such as urinary dysfunction, erectile dysfunction, and prostatitis.

Q: What are the symptoms of pelvic floor dysfunction?

Dr. Houman answers: Men with pelvic floor dysfunction often present a mix of urologic, colorectal, and sometimes sexual symptoms. The most frequent signs include:

• The most common signs and symptoms of this condition include:
• A bulge in the lower back area
• Bowel strain or chronic constipation
• Discomfort during sexual intercourse (for women)
• Involuntary leakage of stool
• Lower back pain
• Muscle spasms in the pelvis
• Pressure in the pelvic area or rectum
• Stress urinary incontinence, i.e., a small amount of urine leaking from the body due to an activity such as coughing or sneezing, exercising, laughing, etc.
• Urinary symptoms such as painful urination, incomplete urination, and urge incontinence

Interestingly, an overactive bladder can also be linked to male pelvic floor dysfunction.In women, pelvic floor muscle dysfunction can affect reproductive health. This is especially the case after pregnancy and childbirth due to diastasis recti (a separation in abdominal muscles that weakens the pelvic region). The condition can also contribute to sexual dysfunction in women. It manifests itself in the form of painful sex.

Q: What are the different types of pelvic floor dysfunction?

Dr. Houman answers: Not all cases of pelvic floor dysfunction are the same. Types of this condition include:

• Coccygodynia – Pain in the tailbone that worsens after a bowel movement.
  
• Cystocele – Bladder dropping and pushing into the vagina.
  
• Enterocele – Small intestine descending and pushing into the vagina.
  
• Levator syndrome – Spasming of pelvic floor muscles after a bowel movement.
  
• Obstructed defecation – Stool enters the rectum, but the body is unable to fully evacuate the bowels.
  
• Paradoxical puborectalis contraction – A pelvic floor muscle that contracts, making it difficult to pass the stool.
  
• Pelvic organ prolapse – Pelvic floor stretching and the pelvic organs protruding. Pelvic prolapse can happen due to childbirth, age, and collagen disorder.
  
• Proctalgia fugax – Painful spasms of the rectum and pelvic floor muscles.
  
• Pudendal neuralgia – Irritation or damage of pudendal nerves, which support the function of the pelvis.
  
• Rectocele – Tissue from the rectum protruding into the vagina. The stool can get caught in this “pocket” and form a bulge in the vagina.
  
• Urethrocele – Urethra passing into the vagina.
  
• Uterine prolapse – Uterus descending and pushing into the vagina.
  

If left unmanaged, pelvic floor issues can lead to complications such as discomfort, infection, and long-term colon damage.

Q: What causes male pelvic floor dysfunction?

Dr. Houman answers: The exact cause isn’t always clear, but many contributing factors exist. It might result from poor evacuation habits, poor posture, pelvic trauma, or even skeletal imbalances. Other causes include:

• Pregnancy and childbirth (for women)
  
• Nerve damage
  
• Pelvic surgery
  
• Obesity
  
• Aging
  
• Overuse of pelvic muscles, especially straining during bowel movements
  
• Systemic diseases
  

Pelvic floor dysfunction can run in families. The potential genetic cause of pelvic floor disorders requires further research.

Various factors can contribute to or aggravate pain in pelvic floor disorders. They include:

• Irritable bowel syndrome
• Endometriosis (happens when the lining of the uterus grows outside of the uterus)
• Interstitial cystitis (a common bladder condition that produces pain in the bladder and pelvis)

Q: How is pelvic floor dysfunction diagnosed?

Dr. Houman answers: It starts with a thorough review of your symptoms and medical history. A physical exam is conducted to identify muscle spasms or weakness. We may use a perineometer inserted into the rectum to assess control or apply surface electrodes externally.

Other diagnostic tools include:

• Anorectal manometry: Measures pressure and coordination
  
• Defecating proctogram: Uses an enema visible by X-ray to watch muscle movement
  
• Uroflow test: Assesses how well the bladder empties

Self-diagnosis isn’t advised. A professional evaluation is crucial.

Q: How is pelvic floor dysfunction diagnosed?

 Dr. Houman answers: Symptoms of pelvic floor dysfunction are uncomfortable and have a major impact on a person’s quality of life. That’s why you shouldn’t ignore them. If you experience the above-mentioned symptoms, you need to schedule an appointment to see your doctor. While it’s easy to look up symptoms online, you should not self-diagnose.

The doctor will review your medical history and ask questions about your symptoms. During the appointment, the doctor will also perform a physical examination to check for muscle spasms or knots. The physical evaluation also serves to check for muscle weakness.

The doctor may perform an internal exam to check for pelvic muscle control and pelvic muscle contractions. To perform this exam, the doctor needs to insert a perineometer into a rectum or vagina. Perineometer is a small sensing device.

There’s also a less invasive method to perform this exam – surface electrodes. It includes placing electrodes on the perineum to determine if a patient can contract and relax pelvic muscles. The perineum is an area between the scrotum and anus in men and between the vagina and anus in women.

In order to check how anal sphincters are working, the doctor will perform anorectal manometry. This painless test checks pressure, muscle strength, and coordination.

Other tests may include:

• Defecating proctogram – the patient gets an enema of a thick liquid that can be seen with an X-ray. The doctor uses a video X-ray to record the movement of the muscles as a patient attempts to push the liquid out of the rectum. The test shows whether a patient can pass a bowel movement or any other causes for pelvic floor dysfunction.
• Uroflow test – shows how well a patient can empty the bladder. Weak urine flow and stop-and-start urination point to pelvic floor dysfunction.
  

Q: What treatment options are available?

Dr. Houman answers: Thankfully, the condition is treatable, and many options are available. A combination of approaches often works best:

• Biofeedback: This is the gold standard. It helps you retrain your muscles with visual/audio feedback. It’s painless and effective in about 75% of patients.
  
• Medications: Stool softeners like MiraLAX or Senna may be recommended. In some cases, muscle relaxants are prescribed to prevent contractions.
  
• Pelvic floor physical therapy: Often combined with biofeedback, it helps identify tight muscles and retrains them.
  
• Pessary (for women): A type of device that helps treat numerous symptoms of pelvic floor dysfunction. It is available for women, and doctor or nurse inserts pessary into the vagina to support prolapsed organs. It is often a non-surgical treatment approach, but it is also performed on a patient while awaiting surgery.
  
• Relaxation techniques: Meditation, yoga, and acupuncture aid stress relief and muscle relaxation.

Women have a 50% risk of developing pelvic organ prolapse in their lifetime. About 11% to 19% of women have a lifetime risk of undergoing surgery for prolapse or incontinence. The U.S. surgeons perform about 200,000 surgical procedures for prolapse every year.

Q: Are surgical treatments ever needed?

Dr. Houman answers: Surgery is typically a last resort and only considered when non-invasive methods don’t work. Depending on the issue, different procedures may be suggested:

• Bladder sling: Supports bladder and treats incontinence
  
• Sacral colpopexy: Repositions the vagina using mesh support
  
• Sacrospinous ligament suspension: Reattaches the vagina to supportive ligaments
  
• Sacral nerve stimulation: Like a pacemaker for bowel control
  
• Stoma: Redirects waste when other treatments fail
  
• Uterosacral suspension: Used for uterine or bladder prolapse
  

Surgery is also necessary when pelvic floor dysfunction results from a rectal prolapse or rectocele. 

Minimally invasive techniques like laparoscopy or robotic surgery are preferred for faster recovery and fewer complications.

Q: Is there any role for Kegels in treating male pelvic floor dysfunction?

Dr. Houman answers: Kegel exercises can help strengthen the pelvic area, but they’re not a standalone solution for this condition. In fact, if done incorrectly or without a full treatment plan, they might worsen symptoms. That’s why guided therapy under a specialist is key.

Q: What is the long-term outlook?

Dr. Houman answers: With timely diagnosis and treatment, most men can effectively manage pelvic floor dysfunction. Don’t ignore symptoms or hope they’ll resolve on their own. Early treatment improves quality of life and prevents complications. Surgery is rare and only necessary in persistent or severe cases.

Key FAQs on Male Pelvic Floor Dysfunction 

Q: Can cycling regularly lead to pelvic floor dysfunction in men?

Dr. Houman answers: Yes, cycling regularly can contribute to pelvic floor dysfunction in men, but it depends on how you ride, how often, and what kind of saddle you use.

As a urologist, I often see avid cyclists who develop issues like perineal numbness, erectile dysfunction, or chronic pelvic pain. These symptoms are sometimes linked to prolonged pressure on the pudendal nerve and blood vessels that supply the penis and pelvic floor.

The culprit is often a narrow, hard, or poorly fitted bike saddle, which compresses the perineum. Over time, this pressure can reduce blood flow and irritate the nerve pathways critical for sensation and sexual function.

Pelvic floor dysfunction may include:

• Urinary urgency or frequency
• Pelvic or perineal pain
• Erectile or ejaculatory problems
• Constipation or incomplete evacuation

Cycling itself isn’t bad, but poor bike ergonomics and excessive time in the saddle without proper recovery can lead to pelvic floor dysfunction in some men. If you’re noticing any symptoms, don’t ignore them. Early intervention can make a big difference.

Q: Does testosterone deficiency play a role in male pelvic floor weakness?

Dr. Houman answers: Yes, testosterone deficiency can play a role in male pelvic floor weakness, though it’s often under-appreciated. Testosterone is an essential hormone for maintaining not just libido and energy levels, but also muscle mass and strength, including the muscles of the pelvic floor.

The pelvic floor is a group of muscles that support the bladder, rectum, and sexual organs, and these muscles are rich in androgen receptors, meaning they respond to testosterone. When testosterone levels decline, especially with age or certain medical conditions, men may experience decreased muscle tone and endurance in this area. That can contribute to issues like urinary leakage, erectile dysfunction, and even pelvic pain.

That being said, testosterone deficiency isn’t usually the sole cause. Pelvic floor dysfunction is multifactorial, it can also stem from chronic straining, surgery, nerve injury, or poor posture. But in men with confirmed low testosterone and pelvic floor symptoms, restoring testosterone to healthy levels can help improve muscle function and support pelvic floor rehab efforts.

For optimal outcomes, I often combine testosterone optimization with pelvic floor physical therapy.

Q: Are there specific exercises to avoid if you have pelvic floor dysfunction?

Dr. Houman answers: Absolutely. I can tell you that certain exercises can worsen pelvic floor dysfunction, especially if they increase intra-abdominal pressure or overly strain the pelvic floor muscles.

Exercises to avoid include:

• Heavy weightlifting, particularly with poor form or without proper pelvic floor engagement. Think of deadlifts, squats, or leg presses with very heavy loads.
• High-impact activities, such as running, jumping, or plyometrics, which can place repetitive stress on the pelvic floor.
• Intense core exercises, like sit-ups, crunches, or double leg lifts, which can increase pressure on a weakened or overly tight pelvic floor.
• Kegels, if improperly prescribed. Many assume that all pelvic floor issues require strengthening, but in cases of a hypertonic (too tight) pelvic floor, Kegels can actually worsen symptoms.

It’s critical to first identify whether the dysfunction is due to weakness, tension, or coordination issues. That’s why I always recommend a thorough evaluation, ideally by a pelvic floor physical therapist or a urologist familiar with functional pelvic floor assessments, before jumping into any exercise regimen. A personalized program can make all the difference.

Q: How is male pelvic floor dysfunction different from female pelvic floor disorders?

Dr. Houman answers: In men, pelvic floor dysfunction often centers around urinary and sexual function. It may present as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), urinary urgency or frequency, post-void dribbling, pain during or after ejaculation, or erectile dysfunction. 

Unlike women, men don’t typically experience pelvic organ prolapse because of the absence of a vaginal canal and different support structures.

In contrast, female pelvic floor disorders are more commonly associated with prolapse, urinary incontinence, and postpartum changes. The female pelvic floor is more susceptible to stretching and injury due to pregnancy and childbirth, leading to structural issues like uterine or bladder prolapse.

Another key difference is in diagnosis and referral patterns. Female pelvic floor issues are often more easily identified and referred to gynecologists or urogynecologists. Male pelvic floor dysfunction, however, is frequently misdiagnosed as prostatitis or dismissed altogether, leading to delays in appropriate pelvic floor physical therapy or multidisciplinary care.

Ultimately, while both men and women benefit from pelvic floor rehabilitation, the clinical presentation, underlying causes, and management strategies require a tailored, gender-specific approach.

Q: Can chronic constipation cause pelvic floor issues in men?

Dr. Houman answers:I frequently see men who don’t initially realize that their bowel habits can directly affect urinary, sexual, and pelvic health. Chronic straining from constipation places significant pressure on the pelvic floor muscles. Over time, this can cause pelvic floor dysfunction, where the muscles become either too tight (hypertonic) or weak and uncoordinated.

In men, this can manifest as:

• Urinary symptoms like hesitancy, weak stream, or feeling of incomplete emptying
• Pelvic pain or discomfort, often described as a dull ache or pressure in the perineum, rectum, or lower abdomen
• Erectile or ejaculatory dysfunction, due to nerve and muscle tension in the pelvic floor
• Rectal pressure or pain, especially during or after bowel movements

Treating the root cause, like improving bowel regularity through diet, hydration, and sometimes pelvic floor physical therapy, can significantly relieve symptoms. For men with persistent or complex symptoms, a multidisciplinary approach involving a urologist, pelvic floor specialist, and sometimes a GI doctor is ideal.

Q: What role does anxiety or mental health play in pelvic floor dysfunction?

Dr. Houman answers: I can tell you that anxiety and mental health play a significant and often underappreciated role in pelvic floor dysfunction. The pelvic floor muscles are highly sensitive to the body’s stress response. When someone is dealing with chronic anxiety, their body is often in a state of hypervigilance, this can lead to subconscious clenching or overactivation of the pelvic floor muscles, especially in men.

Over time, this persistent tension can result in a range of symptoms: pelvic pain, urinary urgency or frequency, erectile dysfunction, pain with ejaculation, and even bowel dysfunction. It’s not uncommon for patients to undergo extensive testing for infections or structural issues, only to find that the root cause is functional and driven by stress-related muscle overactivity.

Additionally, men often carry stress differently than women, internalizing it physically, and the pelvic floor becomes a common site for that tension to manifest. That’s why a comprehensive approach to treatment is essential. In many cases, we combine pelvic floor physical therapy with stress reduction strategies, such as cognitive behavioral therapy (CBT), mindfulness, or even medications to treat underlying anxiety or depression.

Q: Can epididymitis develop after a vasectomy, and if so, how common is it?

Dr. Houman answers: Yes, epididymitis can develop after a vasectomy, and while it’s not extremely common, it’s a well-recognized potential complication. I typically tell patients that post-vasectomy epididymitis occurs in approximately 1% to 6% of cases.

What happens is that after the vas deferens is cut and sealed, sperm production continues, but there’s nowhere for the sperm to go. This buildup of pressure in the epididymis, where sperm mature and are stored, can lead to inflammation, known as congestive epididymitis. In some cases, it can also be due to a mild infection, though infectious causes are less frequent in this context.

Fortunately, this type of epididymitis is usually self-limited and responds well to anti-inflammatories, rest, scrotal support, and occasionally antibiotics. It’s important for patients to know that while this condition can be uncomfortable, it does not indicate that the vasectomy failed.

Q: What role does immune system suppression (e.g., from steroids or HIV) play in chronic epididymitis?

Dr. Houman answers:

Immune suppression from conditions like HIV or steroid use can make patients more susceptible to chronic epididymitis by impairing their ability to clear infections, especially from atypical organisms like Ureaplasma or Mycobacterium. It also disrupts normal inflammation resolution, leading to prolonged pain, swelling, and sometimes non-infectious, autoimmune-like inflammation. These cases are harder to diagnose and often require a broader workup and tailored treatment beyond standard antibiotics.

Q: Are there long-term risks of epididymitis impacting testosterone production?

Dr. Houman answers: I can say that in most cases, epididymitis does not have a long-term impact on testosterone production. Testosterone is primarily produced by the Leydig cells in the testicles, whereas epididymitis is an inflammation of the epididymis, which is responsible for sperm transport and storage, not hormone production.

However, in severe or recurrent cases, particularly those that cause extensive scarring or involve bilateral testicular inflammation (epididymo-orchitis), there is a theoretical risk of testicular damage. This could potentially affect both spermatogenesis and Leydig cell function, leading to decreased testosterone levels, but these instances are rare.

While testosterone production is typically preserved, chronic or complicated infections may warrant follow-up hormonal testing if there are symptoms suggestive of hypogonadism, like fatigue, low libido, or poor concentration. Early diagnosis and appropriate antibiotic treatment remain key to avoiding long-term complications.

Q: Can epididymitis symptoms flare up during sexual activity or ejaculation?

Dr. Houman answers: Yes, epididymitis symptoms can definitely flare up during sexual activity or ejaculation. I often see men who report increased pain, discomfort, or a dragging sensation in the scrotum during or after ejaculation when they’re dealing with epididymitis. 

This happens because the epididymis plays a key role in transporting and storing sperm, so any inflammation in that area gets mechanically aggravated by sexual activity. It’s especially common in cases where the inflammation hasn’t fully resolved or if there’s an ongoing infection. If you’re noticing persistent or recurrent pain tied to ejaculation, it’s important to get a thorough evaluation, sometimes chronic epididymitis or underlying infections like prostatitis may be at play, and these require targeted treatment.

Q: How can you tell the difference between testicular torsion and epididymitis at home?

Dr. Houman answers: Testicular torsion and epididymitis can feel similar but have key differences, and torsion is a surgical emergency. Torsion usually causes sudden, severe pain, a high-riding or sideways testicle, and may come with nausea or vomiting. It often doesn’t improve with scrotal elevation. Epididymitis tends to come on more gradually, may improve when the scrotum is lifted, and can include urinary symptoms or fever. That said, there’s no reliable way to tell for sure at home. If you have sudden testicular pain, go to the ER immediately, every hour counts to save the testicle.

Q: Is there any dietary or probiotic support that helps during or after treatment?

Dr. Houman answers: Yes, there are supportive strategies I often recommend during and after treatment. A nutrient-dense, anti-inflammatory diet, rich in leafy greens, berries, healthy fats, and plenty of water, can help reduce inflammation, support healing, and optimize hormone balance.

Probiotics are also important, especially after antibiotics or in cases of chronic inflammation. Strains like Lactobacillus rhamnosus, Lactobacillus reuteri, and Bifidobacterium longum support gut health, reduce inflammation, and may even improve testosterone levels and fertility outcomes. Together, diet and targeted probiotics can play a meaningful role in recovery and long-term urologic health.

Conclusion

Male pelvic floor dysfunction can be distressing, but it is a manageable condition with the right care. Whether you’re dealing with weak pelvic floor symptoms, twitching in the pelvic area, or chronic constipation, help is available. 

Make an appointment, get evaluated, and follow the treatment plan. Small lifestyle changes can make a big difference.

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