Signs of a Weak Pelvic Floor in Men
Men have pelvic floor muscles too, and when these muscles are not functioning well, they can affect bladder control, bowel health, sexual function, and pelvic pain. Pelvic floor issues and pelvic floor dysfunction in men are often misunderstood and are not always caused by weakness alone. This article explains the role of the male pelvic floor, common signs of weakness, tension, or poor coordination, and why symptoms like leakage, erectile dysfunction, constipation, or pelvic pain may occur. Understanding how the pelvic floor works is the first step toward effective, evidence-based treatment and improved pelvic health. Pelvic floor therapy specifically for men is always available at our offices, and we’d love to help you.
Let's talk about weak pelvic floor muscles and men's pelvic floor health in more detail.
Did you know that some men (and women) are shocked to know that men have pelvic floors also? While pelvic health conditions in women have been in the spotlight now for several years (featured on the TODAY show, in Cosmopolitan magazine, Women’s Health Magazine and more!), pelvic health conditions in men continues to take a backseat. Several years ago, I was featured in an article by Men’s Health Magazine, and it was amazing to help spread knowledge on the connection between pelvic floor problems and pelvic pain. So, today, we’re talking about something a little bit different– pelvic floor muscle weakness.
First, what are the pelvic floor muscles?
The pelvic floor muscles are a group of muscles that sit inside the pelvis and run from the pubic bone in the front, all the way back to the tailbone.
They have 3 layers.
In men, the superficial muscles run around the penis, attaching into the erectile tissue of the penis. They also support the perineal body (that part between the testicles and the anus).
They also run around the anal canal.
The middle layer includes a sphincter muscle (the external urethral sphincter) that helps to hold back urine.
The deeper layers of muscles support the organs in the pelvis– the bladder, prostate and rectum– and they provide stability to the sacrum, tailbone, and spine.
The pelvic floor muscles have very important jobs for us. They offer:
Support: for organs in the pelvis
Stability: for the spine, hips, and pelvis
Sexual wellness: assisting in erection, and suporting ejaculation
Sphincteric control: opening to allow for emptying of the bowels and bladder, and contracting to hold back urine and stool.
They also help to pump lymphatic fluid and blood in and out of the pelvis, coordinate with breathing, and respond to stress/perceived threat. So clearly, these are pretty darn important muscles.
Now, how would a man know if his pelvic floor muscles aren’t functioning well?
Just like other muscles in the body, we want the pelvic floor muscles to be strong, flexible and well coordinated. Let’s look at what problems in the pelvic floor muscles and symptoms of pelvic floor dysfunction can look like in men.
Pelvic floor muscle weakness can happen for a variety of reasons.
The most common time we see this is when a man has had prostate challenges– specifically with prostate cancer.
Prostate removal (Prostatectomy) is a common surgical intervention for prostate cancer.
When the prostate is removed, part of the sphincteric control is lost–so the external urethral sphincter (part of the pelvic floor muscles) becomes even more important. Often times, strengthening these muscles can help a lot with bladder leakage and other problems that happen after prostate removal.
Other signs of pelvic floor muscle weakness can include:
Urinary or bowel leakage
Difficulties with erection (erectile dysfunction)
Premature ejaculation.
Many people assume pelvic floor weakness is the major problem people deal with– however– more often, we find that the pelvic floor muscles are tense and overactive or may not be coordinating properly.
Tension in the pelvic floor muscles can feel like:
A golf ball in the rectum
Pain in the perineum, penis or around the pelvis
Pain in the lower abdomen
Increased bladder urgency and frequency
Constipation, straining, or difficulty emptying the bowels
Tailbone pain
Erectile difficulties or challenges with ejaculation
Additionally, coordination problems can present in a variety of ways.
If someone has difficulty lengthening and relaxing their pelvic floor muscles, they might have challenges emptying well when they have a bowel movement.
They could also have difficulties with voiding, or challenges with their sexual health.
Where to find pelvic therapy for men in Marietta and Atlanta
If you read this article and what you read sounds like you (or your friend, partner, husband)-- know that you aren’t alone! Pelvic floor problems are common in men, and help is available!
We offer men’s pelvic health at our pelvic therapy offices in Marietta and Atlanta and would love to help. Feel free to reach out by clicking the button below and requesting an appointment.
Written by Dr. Jessica Reale
Dr. Jessica Reale, PT, DPT, WCS, is a board-certified pelvic health physical therapist and founder who specializes in treating pelvic floor conditions across the lifespan and gender spectrum, including pediatrics, adolescents, and adults. Her clinical work focuses on bowel, bladder, and pelvic pain conditions, with particular expertise in complex and often misunderstood pelvic health diagnoses.
Dr. Reale is a nationally recognized educator in pelvic rehabilitation and has taught thousands of clinicians through advanced pelvic health coursework. She is board-certified as a Women’s Health Clinical Specialist (WCS) and remains deeply committed to evidence-based, compassionate care that supports both patients and providers within the pelvic health community.