When it comes to the pelvic floor and pelvic floor exercises, we always hear about women and leave men out of the equation. With the current sedentary lifestyle of our society, we need to abandon the ‘rumor’ that pelvic floor issues are mostly seen in women. We are seeing more and more of the non-stereotyped crowd with pelvic floor dysfunction and that is due to our sedentary lifestyle more than anything else. Let’s understand the anatomy of the pelvis to better understand how the right exercises for pelvic floor dysfunction cannot only include the floor.
Anatomy of the Pelvic Floor
As in my blog, Pelvic Floor Exercises for women I explained, “The pelvic floor, unlike what most people think, is more than the area where the penis, anus, and the tissue in between is and involves the inner lining of the pelvis as well. The pelvic inlet is like a 3-piece-bowl and these muscles line the bowl.” The bladder, prostate, and intestines are inside the bowl and can get ‘squished’ or compressed by the pressure coming from above which is referred to as inter-abdominal pressure (IAP). IAP is influenced by our breathing, posture (and postural distortion), spinal abnormalities such as Scoliosis, Pectus Excavatum (pushed in chest), and Pectus Carniatum (pushed out chest) which are commonly seen in men.
The pelvis consists of 2 joints in the back forming the Sacro-iliac joints (or SI joint between Sacrum and Ilium), and in the front to form the Pubic Symphysis or the pubic bone; the alignment of these joints play a huge role in the integrity of the floor since your pelvis is the ‘house’ where pelvic floor is the ‘floor’ of.
(courtesy of https://orthoinfo.aaos.org/)
While hips are connected to the pelvis and their instability of dysfunctional movement directly impacts the pelvis and pelvic floor, you need to understand that the deepest layer of soft tissue or connective tissue can be the first layer of soft tissue ‘ malfunction’ that the problems can arise from. If the connective tissue is involved, it is fair to say that there was a major injury or that the problem has not been addressed properly for a long time.
What Are the Best Pelvic Floor Exercises for Men?
The best pelvic floor exercises for men are not different than those for women. The issue is that most recommended pelvic floor exercises are targeted toward a specific region and disregard the surrounding areas that ‘feed’ the problem. If we do address those ‘feeders’ the problem is not resolved and WILL come back.
Exercises to address pelvic floor conditions that you can do yourself should include:
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Biological Breathing
This is perhaps the most misunderstood part of pelvic floor dysfunction as most people think of ‘belly’ breathing when you should think about creating a barrel with the top of the barrel being your abdominal diaphragm at the lower rib area, the pelvic diaphragm being the bottom of the barrel. The sides are the sides of your belly, the front is the abdomen, and the back of the barrel being the middle portion of your mid-back and the whole lower back. Watch this video to understand what you are to do next.
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Lower Mid-Back Exercise
If you think of your pelvis, you can see that the spine is connected to it and the lower part of the mid-back is directly influenced by your breathing and the positioning of the lower back. Any instability in that area therefore directly impacts the positioning of the pelvis and can lead to issues related to its instability. Imagine the bowl again; if the bowl tips forward or backward, you will have issues not only related to the bowl but also what it contains. In men, this can cause pressure on the prostate and testicles and/or the feeling of fullness in the rectum or pain in the rectal area. The inner abdominal pressure is compromised and not applied evenly when the pelvis is uneven.
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Lower Back Exercise
The same is true with lower back pain only the lower back is directly connected to the pelvis and therefore the tolerance to its instability when it comes to pelvic leveling is much less. In general, I am not a fan of isolating the area to stretch or to strengthen so my go-to exercises are those of Dynamic Neuromuscular Stabilization or DNS. These are exercises that we all did as babies; we never used a gym, band, weight, or straps to work out and yet we all went from being fully helpless to the mobile toddlers. Why re-invent the wheel?
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Sacroiliac Exercise
This is the back portion of your pelvis that is under a lot of stress with the prolonged sitting activities, from sitting behind the desk to the bike seat in cycling. The muscles connected to both the sacrum and Ilium (see above).
Once again, the best exercises to address the function of this area are those of DNS.
If you are looking for something that will get your heartbeat up, you won’t find it in DNS, however, if you are looking for something that is challenging despite the easy look, you will find yourself challenged. A good start is what you did at 3 months of age, and yet as adults, getting the spine in a neutral spine while breathing correctly is much more difficult than you imagine.
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Hip Stability and Movement Exercise
I see the over-involvement of the hips in almost all pelvic floor dysfunctions and perhaps is one of the most commonly overly restricted areas. I love quite a few exercises for the hips that will allow mobility of the joint while the rest of the body learn to ‘play in the background’ just like musicians do when the spotlight is on another musician in a concert.
I suggest you visit my youtube channel to see what my go-to exercises are, not only for the hips but for the rest of the body are.
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Kegel Exercise
While Kegel exercises are over-rated when indicated, you have 2 choices: to visit a pelvic floor therapist to practice the Kegel exercises with their help or use the Emsella Chair which produces 400 Kegels a minute, more than most people do in their lifetime.
There are many exercises that focus on the pelvic floor but the most compressive approach to any pelvic floor dysfunction is those shown in my functional movement and rehab Youtube channel categorized by the area. If you are tired of your pelvic floor dysfunction and need help getting to the root of your problem, read my google reviews and contact me for an appointment.
Dr. Shakib
