What Happens at Pelvic Floor Physical Therapy for Men? What to Expect at Your First Visit
If you’ve been referred to pelvic floor physical therapy, you might have a few questions.
What exactly are we going to do? Is there an internal exam? Do I have to talk about my sex life? Am I just going to be told to do Kegels?
These are completely reasonable questions—especially because pelvic floor physical therapy is still often talked about as something primarily for women.
But men have pelvic floors, too. These muscles play an important role in bladder and bowel control, sexual function, core stability, and pelvic comfort. Problems with the pelvic floor can contribute to urinary leakage, frequent urination, constipation, erectile or ejaculatory concerns, and pain in the pelvis, penis, testicles, perineum, hips, or lower back.
So, what actually happens when you come to pelvic floor physical therapy for men?
First, We Talk About What’s Going On
Your first pelvic floor physical therapy appointment starts much like any other physical therapy evaluation: with a conversation.
Your physical therapist wants to understand what brought you in, how long your symptoms have been happening, and how they’re affecting your life.
Depending on your concerns, we may ask about:
Bladder habits, including urgency, frequency, or urinary leakage
Bowel movements and constipation
Pelvic, testicular, penile, or perineal pain
Erectile function, ejaculation, or pain with sexual activity
Previous injuries or surgeries
Prostate surgery or prostate cancer treatment
Exercise and physical activity
Hip, back, abdominal, or groin symptoms
Your goals for treatment
Some of these questions can feel personal, but there’s a clinical reason we ask them. The pelvic floor is involved in urination, bowel movements, and sexual function, so understanding the full picture helps us figure out what may be contributing to your symptoms.
You also don't have to have the “right” words for what you're experiencing. Describing what you've noticed is enough.
We Look at More Than Your Pelvic Floor
Pelvic floor therapy isn't just about examining the muscles directly underneath your pelvis.
Your pelvic floor works together with your hips, abdominal muscles, diaphragm, back, and the rest of your movement system. That's why an evaluation may include looking at your posture, breathing, mobility, strength, flexibility, and movement patterns.
For example, your therapist might have you perform movements such as a squat or assess how your hips and lower back move. We may also look at how you breathe and whether you can coordinate your breath with your abdominal and pelvic floor muscles.
The goal is to figure out why you're having symptoms, not simply give you a generic list of exercises.
Does Pelvic Floor PT for Men Include an Internal Exam?
This is often the biggest question, so let's talk about it.
For men, an internal pelvic floor assessment may be performed rectally. It allows a specially trained pelvic floor physical therapist to assess things like muscle tension, tenderness, strength, coordination, and your ability to contract and relax the pelvic floor. Internal rectal assessment is an established examination technique used in male pelvic health physical therapy.
But here's the important part:
An internal examination is optional.
Your therapist should explain what they're recommending, why they think it could be useful, and what it would involve before anything happens. You can ask questions, decline an internal exam, or change your mind.
Pelvic floor physical therapy can still include valuable assessment and treatment without an internal examination. The American Physical Therapy Association's pelvic health guidance specifically notes that although a detailed pelvic floor assessment can be helpful, an internal assessment isn't necessary when a patient isn't comfortable with it.
Your comfort and consent are part of your care, not an obstacle to it.
No, Pelvic Floor Therapy Isn't Just Kegels
One of the biggest misconceptions about pelvic floor PT is that everyone needs to strengthen their pelvic floor.
Sometimes strengthening is appropriate. Other times, the problem is that the pelvic floor muscles are too tight, overactive, painful, or having difficulty relaxing and coordinating.
A hypertonic—or overly tight—pelvic floor can contribute to urinary difficulty, constipation, pelvic pain, painful ejaculation, and erectile dysfunction.
In those situations, repeatedly squeezing the pelvic floor may not address the actual problem.
Your treatment might instead include breathing exercises, mobility work, relaxation and coordination training, manual therapy, stretching, posture or movement changes, and strategies for managing bladder or bowel symptoms. Biofeedback may also be used to help you better understand when your pelvic floor muscles are contracting or relaxing.
Your home program should be based on what your body needs.
What Can Pelvic Floor Physical Therapy Help Men With?
Men come to pelvic floor PT for many different reasons, including:
Urinary leakage, including after prostate surgery
Urinary urgency or frequency
Difficulty starting or maintaining a urine stream
Pelvic or perineal pain
Testicular or penile pain
Chronic pelvic pain or prostatitis-like symptoms
Constipation or difficulty emptying the bowels
Erectile dysfunction
Pain with erections or ejaculation
Hip, groin, tailbone, or lower abdominal pain associated with pelvic floor dysfunction
Some of these symptoms can have causes outside the pelvic floor, so pelvic floor PT isn't automatically the answer to every urinary, sexual, or pelvic symptom. Appropriate medical evaluation may also be important.
When the pelvic floor is involved, however, physical therapy can help address the muscle and movement factors contributing to your symptoms.
Pelvic Floor PT Doesn't Have to Be Awkward
We know talking about bladder leakage, erections, bowel movements, testicular pain, or what happens during sex isn't exactly everyone's idea of casual conversation.
For us, though, these are health concerns.
At Bonneville Pelvic Health, our goal is to create an environment where you can ask questions, understand what we're doing and why, and have a say in your treatment every step of the way.
If you've been dealing with pelvic pain, urinary symptoms, bowel problems, sexual dysfunction, or changes following prostate surgery, you don't have to keep guessing about what's happening.
Ready to learn whether pelvic floor PT could help? Contact Bonneville Pelvic Health to schedule an evaluation or ask about a free phone consultation.
Written By:
Pelvic Floor Physical Therapist
Dedicated to continuous clinical education and supporting individuals across all pelvic health phases through evidence-based, compassionate care. I am actively pursuing my CAPP-Pelvic (Certificate of Advanced Practice in Pelvic Physical Therapy) to further enhance patient outcomes.
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