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Amanda Lee is a Women’s Health and Musculoskeletal Physiotherapist and Pilates instructor who has been working at my physiotherapy practice and pelvic floor exercise studio, Studio194, since August 2015. She was asked to write an article on Men’s Health for a popular men’s magazine Men’s Muscle and Health and she did a fabulous job and it got printed in full with beautiful images. Well done to this young men’s mainstream magazine for embracing such a topic and well done Amanda for a great article! The article is below in italics.
Do you work on your abdominal strength at the gym? How about your pelvic floor? Before you think “I’m a dude, we don’t have those!” – think again. Your pelvic floor is an important part of your central strength. If you imagine your trunk as a cylinder, your diaphragm makes up the ‘lid’, your deep abdominal and back muscles make up the front and back, and your pelvic floor is the base. Now the chances are that unless something has gone wrong ‘down there’, you probably haven’t given your pelvic floor much of a thought (or even knew that it existed). However, having a basic understanding of the anatomy and the function of the ‘levator ani’ (the technical term for the pelvic floor) is key to maintaining health in the nether regions. Not only this, but your pelvic floor health can have immediate implications on your sex life (hello stronger erections and improved ejaculation control). So have I got your attention now?
To understand what is normal function and anatomy and how to gain optimal pelvic health, let’s talk about the things that can go wrong. This can include urinary symptoms, rectal symptoms, pain on sexual activity, abdominal and/or pelvic pain. Any of these symptoms can affect men of all ages, ethnicities and populations. Furthermore, as part of the ageing process, the prostate (walnut sized gland responsible for semen production situated between the bladder and the scrotum) can enlarge and cause urinary problems of increased urinary frequency and reduced urinary flow. Pelvic symptoms can also arise with long distance cyclists, due to compression of the pudendal nerve, the main nerve in the pelvis responsible for sensation, motor control and bladder and bowel function. Those who work in physically strenuous jobs or lift heavy weights repetitively at the gym can also be susceptible to pelvic floor weakness, hernias, haemorrhoids or rectal prolapse (when the lining of the rectum can relax and even protrude – yep, not pleasant). But enough of the stuff that can go wrong – what can you do to prevent these things happening? To be able to do this, we need to learn more about the pelvic floor.
So what exactly is the pelvic floor?
Stein-Illustration3 drawing of the male pelvic floor
Copied with permission from Amy Stein’s site
Your pelvic floor is a group of muscles attached to the base of your pelvis. Here it sits like a sling or hammock, supporting your pelvic organs (the bladder and bowels).   Along with the sphincter muscles of the front and back passages, the pelvic floor is responsible for maintaining urinary and faecal continence. They are like your arm or leg muscles, meaning you can actually switch them ‘on’ and ‘off’ at will and they respond to strength training. What makes it harder to know whether you are contracting them correctly is the fact that we can’t really see them when they work, which is where physiotherapists specializing in the pelvic floor can be of assistance.
How to ‘find’ your pelvic floor
Found yourself stuck in a lift full of people, with a sudden irrepressible urge to pass wind? The anal sphincter is part of the pelvic floor muscles and you will be familiar with using them in the above scenario or similar. Now how about engaging the pelvic floor muscles that are situated more at the front? This involves more of a visual assessment. Standing in front of a mirror (pants and underwear off), visualize stopping the flow of urine. Did you see your penis retracting and the scrotum lifting? University studies have shown that the most effective way of getting a good pelvic floor contraction is if men think of ‘shortening the penis’ and ‘lifting the testes’. (1) Another analogy which can be useful is ‘nuts to guts’ – which you find may happen automatically say, when you’ve run into freezing cold water at the beach!
Great, you’ve found it! So now what do you do with this newfound skill?
Having a strong pelvic floor helps with urinary leakage which can occur after prostate surgery for cancer, increased urinary frequency and/or urgency issues and with lower back pain. Research also shows that it contributes to stronger erections and more control with premature ejaculation.
Ok then, how do I strengthen the pelvic floor?
To strengthen your pelvic floor try doing a contraction at about 70-80% of a maximal voluntary contraction (MVC) and holding this for 10 seconds. Don’t worry if the contraction drops off before 10 seconds, but you can work towards getting stronger and practising to eventually hold for this long. Keep breathing while contracting and make sure you fully relax the abdominal and pelvic floor muscles between attempts. Aim for 10 repetitions of these, three times a day. The fibres that work to keep things from leaking when you cough, laugh, sneeze or lift something heavy are called the fast twitch ones. To train these, try doing 10 quick pulse contractions at 100%MVC a few times a day as well.
Don’t forget to relax
Importantly, you must balance all the tightening with some relaxation. Lots of pelvic pain problems (such as anal fissures and pudendal neuralgia) can be exacerbated by overly strengthening your abs and never letting your pelvic floor muscles relax. An overly tight pelvic floor can cause pain and tightness in the muscles and connective tissue (fascia) all around the pelvis in an ‘overflow’ effect, so exercises to stretch the gluteals, hip flexors, hamstrings, quadriceps and back muscles can relieve the tightness that may be exacerbating pain.
Healthy Bladder and Bowel tips every man should know:

  • Aim to drink about 2 litres of non-caffeinated fluid a day – this includes water, juices, soups etc. Caffeine, and alcohol especially, have a diuretic effect and can irritate the lining of the bladder, making you need to go to the toilet more.
  • Limit caffeine to about 3 cups a day, if no overactive bladder symptoms – Otherwise go completely decaf if you do have an overactive bladder.
  • Sitting position for emptying the bowels – Straining to pass a bowel motion or having stools stuck in the colon or rectum can cause painful anal and rectal conditions. Effective emptying of your bowels is improved by using some elevation under your feet (this recreates the ‘squat’ position which actually helps to open up the rectum). This can be as simple as using toilet rolls or a low footstool. Sit with the feet flat; lean forwards, elbows resting on knees, maintain a straight back, while looking forwards.
  • Abdominal muscle coordination to empty the bowels – To avoid straining (which puts too much stress on the pelvic floor and pelvic organs), let your abdominals relax, then gently bulge your tummy further out.
  • Maintain healthy looking stools – Yes, look at the finished product. Stools which should be formed and soft but easy to evacuate are achieved by maintaining a healthy diet, including plenty of vegetables and fruit, and a good fluid intake.

Male toilet position
(1) Neurol Urodyn 2016 Apr;35(4):457-63. doi: 10.1002/nau.22745. Epub 2015 Mar 1. Pattern of activation of pelvic floor muscles in men differs with verbal instructions. Stafford R et al
Amanda Lee is a Brisbane-based pelvic floor physiotherapist who sees patients for pelvic floor dysfunction, as well as other musculoskeletal injuries and conditions at Sue Croft Physiotherapy in Highgate Hill, Brisbane. She also runs pelvic floor safe Pilates classes at Studio194 at Highgate Hill. Being actively involved in various sports has led Amanda to be passionate about helping her patients’ return to function, and improve their quality of life.
Men's magazine cover amandas article men's health mag image2 men's health mag image 3
Fantastic work Amanda! And great find by my PR girl Rebecca who sourced the lead. Amanda is heading off to Bali to marry the love of her life Damien at the end of May and all of the staff at Sue Croft Physiotherapy wish them lots of laughter and happiness for many years to come and we are all praying the volcano stays sleeping for the next six weeks. xx
amanda and damien