Pelvic floor exercises for men: how to do them right (and check that you are)

Most people hear "pelvic floor" and picture a women's health problem. Pregnancy, birth, menopause, a shelf of products at the chemist and an app to go with them. Men have the same sheet of muscle doing the same jobs, and hardly anyone explains it to them until something has already gone wrong.

Continence Health Australia (formerly the Continence Foundation of Australia) puts around 2.4 million Australian men and boys as experiencing incontinence. Roughly 2 in 10 men against 4 in 10 women. Half the rate women have, which still leaves a very large number of men. And across everyone affected, only about 4 in 10 have seen an allied health professional about it (Deloitte Access Economics for Continence Health Australia, 2024).

The male pelvic floor does exactly the same work. It just gets explained far less often, and plenty of men meet it for the first time in a pre-admission clinic three weeks out from prostate surgery, holding an A5 leaflet somebody handed over on the way out the door.

Which of the three jobs is your pelvic floor failing at?

The pelvic floor has to be strong, it has to switch on at the right moment, and it has to let go again afterwards. Those are three separate abilities and they fail separately. Work out which one is yours before you train anything, because squeezing harder only fixes the first of the three.

When the job is strength

You leak when you cough, sneeze, laugh, lift something or stand up from a chair. You leak during sport. You have had prostate surgery and you are wetting pads, which has a recovery timeline of its own after prostatectomy. Or there is the after-dribble: you finish, you zip up, you walk away, and thirty seconds later there is a patch. Different triggers, same problem underneath: a muscle that can't generate or hold enough force for what is being asked of it. Strengthening was built for this group, and so is most of what follows.

When the job is coordination and timing

You can squeeze when you think about it, sitting on the couch. The problem is that the cough beats you to it. Or the key goes in the front door and you suddenly can't hold on, even though the same bladder was quiet for the whole drive home, which is the overactive bladder pattern in miniature. Or you brace, hold your breath and clench your buttocks instead of lifting, so the effort goes everywhere except the muscle you meant to use.

That is timing and control, and it trains differently: switching on before the cough rather than after it, holding the contraction while you breathe normally, and using the pelvic floor deliberately to settle an urge instead of sprinting for the toilet, which is the skill at the centre of a proper bladder retraining program. In a 2024 trial in men with an enlarged prostate and an overactive bladder, what beat medication alone was pelvic floor training with urgency-suppression technique added. Repetition count was never the thing that moved.

When the job is relaxation

This is the group that gets missed, and the one most likely to be set back by well-meant advice to do more squeezes. The picture is pain rather than leaking: a deep ache behind the scrotum or in the perineum, pain that gets worse the longer you sit, pain with or after ejaculation, a heavy dragging feeling in the pelvis. Often it has been called prostatitis somewhere along the way, and often the antibiotics did nothing.

In the NIH Chronic Prostatitis Cohort Study, 51 per cent of men with chronic prostatitis or chronic pelvic pain syndrome had tenderness in the abdominal or pelvic muscles, against 7 per cent of men without symptoms, and that tenderness did not track with infection or inflammation in the prostatic fluid (Shoskes and colleagues, The Journal of Urology, 2008). The muscle is the problem, and the problem is that it won't let go.

The 2025 American Urological Association guideline on male chronic pelvic pain is built around that. It recommends individualised manual therapy and biofeedback aimed at lowering resting tone and improving relaxation time, and makes no recommendation for strengthening in this group at all. If this section describes you, get assessed before you start a squeezing program, and read pelvic wands for men for what treatment of a tight pelvic floor actually looks like.

Plenty of men sit in more than one of the three. Someone six weeks out from a prostatectomy can be weak and badly coordinated at the same time. A man with pelvic pain can leak as well. Sorting that out is most of what an assessment is for, but knowing which one is loudest tells you whether the rest of this article is your plan or somebody else's.

What and where the male pelvic floor actually is

Continence Health Australia (formerly the Continence Foundation of Australia) describes the male pelvic floor as running from the pubic bone at the front to the tailbone at the back, and across to the sitting bones. It surrounds the urethra, the tube you wee through, and the anus, the back passage. It supports the bladder, bowel and prostate, and contributes to sexual sensation and function including erection and ejaculation.

If you want the names, the main sheet is the levator ani: coccygeus, iliococcygeus, pubococcygeus and puborectalis (StatPearls, Anatomy, Abdomen and Pelvis: Pelvic Floor, updated May 2026). Two lower muscles matter for sex. Ischiocavernosus compresses the roots of the corpora cavernosa, briefly pushing pressure inside the erect penis above the pressure in your arteries, and bulbospongiosus engorges the head of the penis and expels the contents of the urethra during ejaculation (Cohen, Gonzalez and Goldstein, Sexual Medicine Reviews, 2016).

The instruction you're given changes whether you contract at all

Here's the finding that should be on the front of every leaflet and almost never is. Thirty-five healthy young men were asked to contract their pelvic floor using different verbal cues while researchers watched the bladder base on transabdominal ultrasound. A correct contraction lifts it upwards. The cues were not equally good.

Ben Ami, Feldman and Dar, Verbal Instruction for Pelvic Floor Muscle Contraction among Healthy Young Males, 2022.

Read that bottom row again. "Draw in" is one of the most commonly handed-out instructions in men's continence care, and three quarters of the men given it didn't contract correctly.

Those were 35 male physiotherapy students, though. Young, healthy, and far more anatomically literate than a 65-year-old six weeks out from prostate surgery, so I wouldn't bank the exact percentages for an older population. The ranking is the part that transfers. Specific cues work far more reliably than vague ones.

You may also have seen a statistic claiming a set percentage of men do kegels wrong. There isn't a good figure for men. The most-quoted number comes from a 1991 study of 47 women. What the research in men shows is that the instruction changes the result dramatically, with some common cues working less than a third as often as others.

So use the specific ones. Continence Health Australia teaches three components together in its correct technique guidance: gently squeeze the front urinary passage as if stopping the flow of urine, gently squeeze the back bowel passage as if to stop wind, and think of drawing the penis in and lifting the testes. Its memory aid is "lifting the nuts to the guts", which is not mine, is genuinely published, and sticks.

How do I know if I'm doing kegels right? Use a mirror

This is the step most men skip, and it settles the question in about four seconds. Stand undressed in front of a mirror and tighten and lift. Pelvic Floor First, the Australian continence resource run by Continence Health Australia, puts the test plainly: "If you are tightening the right muscles, you should see the base of the penis draw in and scrotum lift up." Continence Health Australia describes the same movement, the penis pulling in slightly toward your tummy and the testicles lifting.

If nothing moves, you haven't found it yet, and repetition won't fix that. Change the cue rather than the effort. Most men who see nothing on "draw in" see movement immediately on "squeeze your anus as if stopping wind, and shorten the penis". If the penis pushes out or down instead, stop: that's a bearing-down pattern, the opposite of what you're after.

In clinic I have men find it lying down first, then sitting, then standing. Standing is where you need it, so that's where the training has to end up.

Should I stop the flow of urine to do kegels?

Once. Maybe twice. Then never again. Both Australian peak bodies say this in nearly the same words, so here they are verbatim. Continence Health Australia: "If you use stopping your urine (wee) flow midstream to help you find the right muscles, only try it once or twice. Doing it regularly can interrupt your bladder's natural rhythm."

Pelvic Floor First is blunter: "Do not do this repetitively. This is not an exercise."

Stopping the flow locates a muscle. It isn't training, and doing it daily teaches your bladder a confusing lesson about when it's allowed to empty. Confirm once, then train away from the toilet.

The mistakes that quietly cancel out the work

Physiotherapists assessing male pelvic floor function watch specifically for auxiliary muscle use, breath-holding and bearing-down manoeuvres (Nahon, Waddington, Adams and Dorey, 2012). Those three account for most of the wasted effort I see.

• Holding your breath. If you can't talk while you hold, you're bracing, not contracting. Pelvic Floor First: "Try to keep everything above the belly button relaxed, and breathe normally."
• Bracing the abdomen. Continence Health Australia asks you to "gently relax the belly and buttock muscles to avoid holding any tension". A hard belly means the effort has migrated upwards.
• Clenching the buttocks and thighs. Easy to spot, because your whole pelvis shifts on the chair.
• Bearing down. Pushing rather than lifting. The mirror catches this instantly.
• Never letting go. A contraction you don't release isn't a repetition. Pelvic Floor First again: "After a contraction it is important to relax the muscles." That half gets dropped constantly, and for some men it matters more than the squeeze.

How many pelvic floor exercises should men do a day?

Start with the Australian prescription, and know that Continence Health Australia's own pages aren't perfectly consistent on hold times.

Three pages, three slightly different hold times. Rather than pretend they agree, take what they converge on: three sets a day, holds built gradually toward around 10 seconds, and an equal rest between contractions. Start at the hold you can manage without losing the contraction, the breath or the belly.

Why a number off a website isn't a program

Those figures are a sensible place to start and not much more than that. Being handed a hold time and a rep count is the pelvic floor version of being told to do three sets of ten at the gym. Nobody has asked what you are training for, and nobody has looked at what you can already do.

Get assessed by a pelvic health physiotherapist and the numbers come off your muscle instead. In clinic we can see and feel what it is actually doing, either with real-time ultrasound or by examination, and set the reps, the sets, the hold times and the rest periods to match. A strength coach does the same thing after a testing session.

Strength is only one of the qualities worth training. There is strength endurance, meaning how long you can hold before the muscle quietly gives up. Relaxation matters just as much, letting go fully and quickly rather than sitting at half-tension all day. Then there is control, which is switching on at the right moment instead of a second after you needed it, and coordination, getting the pelvic floor working with your breath and your abdominals rather than against them. Those qualities train differently. A generic set of numbers will only ever hit one of them, and not necessarily the one you are short on.

What pelvic floor exercises for men are actually for

After-dribble

The most Australian piece of evidence here. A Flinders team randomised 49 men aged 36 to 83 with post-micturition dribble to pelvic floor exercises, urethral milking, or counselling alone over 12 weeks. Adjusted for baseline, mean improvement at 13 weeks was 4.7 g of urine loss for pelvic floor exercises, 2.9 g for urethral milking, and none for counselling. The authors concluded that "both pelvic floor exercises and urethral milking are effective treatments for post-micturition dribble compared with counselling alone. Pelvic floor exercises were more effective in reducing urine loss than urethral milking in this study" (Paterson, Pinnock and Marshall, British Journal of Urology, 1997).

Small, and nearly 30 years old. Still the most-cited trial on this symptom, and if after-dribble is your main complaint, this is where the evidence is most encouraging.

Continence after prostate surgery

The 2023 Cochrane review covered 25 studies and 3,079 men and concluded that "the value of conservative interventions for urinary incontinence following prostate surgery alone, or in combination, remains uncertain" (Johnson and colleagues, Cochrane Database of Systematic Reviews, April 2023). The largest trial, MAPS, randomised 411 men after radical prostatectomy and found 75.5% still incontinent at 12 months in the treatment arm versus 77.4% in the control arm. Its conclusion: one-to-one conservative physical therapy after prostate surgery "is unlikely to be effective or cost-effective compared with standard care" (Glazener and colleagues, NIHR Health Technology Assessment, 2011).

Look at what MAPS actually tested, though. It recruited men who were already incontinent at six weeks after surgery and gave them four therapist sessions across three months. That is late, low-dose, off-the-shelf training. It says nothing about starting early, with supervision, on a program built for the individual, and it is no reason to do nothing. The American Urological Association guideline on incontinence after prostate treatment still says clinicians should offer pelvic floor muscle training in the immediate post-operative period, and may offer it before surgery. What I won't tell you is that kegels guarantee dry pants at twelve months.

One safety point for anyone with a surgery date: Continence Health Australia advises waiting until your surgeon has checked your healing before starting pelvic floor exercises after prostate surgery. Containment in those first weeks is a separate question, and whether a penile clamp suits you is worth working through with your physiotherapist.

Urgency and overactive bladder

Over 12 weeks, adding supervised pelvic floor muscle training with urgency suppression to the medication silodosin beat silodosin alone in men with an enlarged prostate and overactive bladder: voids per 24 hours 8.4 versus 9.4, and urgency intensity 1.2 versus 2.4 (both p<0.01) (Hagovska and colleagues, World Journal of Urology, 2024; endpoint values from the ICS 2023 conference abstract). The training was 30 minutes a day, five days a week, with weekly physiotherapy supervision, so read it as an add-on to medical care rather than a replacement. If it's mostly getting up overnight to wee, that has its own workup.

Know which pattern you have first, because urgency and stress leakage are not the same problem, and the training that settles one does very little for the other.

Erections

There is a physical mechanism behind this one. Ischiocavernosus compression helps maintain rigidity, and pelvic floor rehabilitation has been proposed as a treatment component for erectile dysfunction, particularly in mild-to-moderate veno-occlusive dysfunction (Cohen and colleagues, 2016). As for trials, 55 men with erectile dysfunction, median age 59, were randomised to pelvic floor muscle exercises with manometric biofeedback or control, and at three months the exercise group improved on the erectile function domain of the IIEF by 6.74 points more than control (p=0.004) (Dorey and colleagues, British Journal of General Practice, 2004). One positive trial, and a review of 10 trials concluding that training "appears effective in treating ED and PE; however, no optimal training protocol has been identified" (Myers and Smith, Physiotherapy, 2019). If your erectile dysfunction dates from prostate surgery, erectile rehabilitation after prostatectomy is a separate conversation again.

Premature ejaculation

The number from this next study gets quoted everywhere, usually stripped of the two things that explain it. In 40 men with lifelong premature ejaculation, a 12-week pelvic floor rehabilitation program raised mean intravaginal ejaculatory latency time from 31.7 seconds to 146.2 seconds, and 33 of the 40 gained control of the ejaculatory reflex (Pastore and colleagues, Therapeutic Advances in Urology, 2014).

Read the method and the picture changes. The study was prospective but not randomised and it had no control group, so there is nothing to hold that improvement up against. And the men in it were doing three 60-minute clinic sessions a week for 12 weeks, each one 20 minutes of physiotherapy, 20 minutes of electrostimulation and 20 minutes of biofeedback. Around 36 supervised clinic hours with machines attached. That is a long way from kegels on the couch.

Who needs an assessment before starting a squeezing program

Some men reading this have the opposite problem, and for them a strengthening program aims at the wrong target. In the NIH Chronic Prostatitis Cohort Study, 384 men with chronic prostatitis or chronic pelvic pain syndrome were compared with 121 men without symptoms. Abdominal or pelvic muscle tenderness was found in 51% of the symptomatic men and 7% of controls, and it did not correlate with infection or inflammation in prostatic fluid (Chronic Prostatitis Collaborative Research Network, Journal of Urology, 2008). Half of those men had a muscle problem, not a bug problem.

The 2025 AUA guideline on male chronic pelvic pain responds by recommending individualised manual physical therapy, including myofascial release, and biofeedback aimed at improving resting tone and relaxation time. It makes no recommendation for strengthening or kegel-type contractions in this group. The target is a floor that lets go, not one that grips harder.

I should be straight about how strong that position is. No trial has shown that kegels actively worsen pelvic pain in men, so this is clinical reasoning rather than proven harm. But if your symptoms include perineal discomfort, pain with or after ejaculation, or a dragging sense of pelvic heaviness, get assessed before you start a strengthening program rather than after three frustrating months of one. A floor already holding too much tension doesn't need more tone.

That's also where internal pelvic floor massage tools come up. Intimate Rose pelvic wands are internal pelvic floor massage tools used by people who've been shown how by a physiotherapist, and our guide to pelvic wands for men covers rectal technique and who it suits. Tools like these belong to the relaxation conversation, not the strengthening one.

How long before anything changes

Continence Health Australia's answer is that many men see results within weeks, with a review point earlier than most expect: seek professional support if symptoms haven't started to improve after three weeks or are getting worse, or if you have pain, can't contract or relax the muscles, or can't stop your urine flow mid-stream.

Three weeks is a checkpoint, not a deadline for being fixed. If nothing has shifted by then, the problem is usually not effort. Either you are contracting the wrong thing, or strengthening was the wrong goal in the first place. After prostate surgery the timeline is longer, with maximum improvement typically reached by twelve months.

When to see a pelvic health physiotherapist

In Australia you don't need a GP referral to see a physiotherapist privately; you can book a men's pelvic health appointment directly. If you have an eligible chronic condition, your GP can set up a GP Chronic Condition Management Plan, which allows five allied health services per calendar year. That plan replaced GP Management Plans and Team Care Arrangements from 1 July 2025, with older plans running until 30 June 2027. Rebates cover part of the fee, not all of it, so check the gap with your clinic.

That pathway is narrower than most people assume, which may be part of why only about 4 in 10 Australians with incontinence have consulted an allied health professional, according to Deloitte Access Economics research for Continence Health Australia in 2024. Around 2 in 10 Australian men experience incontinence, and most manage it alone.

Book if you have surgery coming up, if three weeks of honest effort has changed nothing, if you have pain, or if you want someone to confirm in ninety seconds that the thing you're squeezing is the right thing. That feedback is often the difference between a program that works and a wasted year.

If you want to see the products men most often ask about alongside a rehab program, browse the men's pelvic health range.