Use it or lose it: the role of pelvic floor muscles

With supervised pelvic floor exercise programs, men can regain their erectile function, writes Rachel Heerey.

Women are very aware of the importance of pelvic floor muscles, but most men are blissfully ignorant. Pelvic floor muscles are not just for preventing incontinence, however; they can be an effective treatment for erectile dysfunction. The superficial pelvic floor muscles play an important role in gaining and maintaining erections, and the firmness of erections.

The superficial pelvic floor muscles
The male pelvic floor is made up of two layers: the deep pelvic floor muscles and the superficial pelvic floor muscles. It is the superficial pelvic floor muscles – ischiocavernosus and bulbocavernosus – that play an important role in erectile function.
The bulbocavernosus muscle encircles the base of the penis and has two key functions in erectile function: it prevents blood from escaping from the erect penis by exerting pressure on the deep dorsal vein, and it contracts during ejaculation. The ischiocavernosus muscle attaches from the ischial tuberosity to the pubic ramus, and its contraction leads to an increase in intracavernous pressure and penile rigidity.

Pelvic floor muscles and erectile dysfunction
Research shows that men with stronger pelvic floor muscles have better erectile function. The pelvic floor muscles can weaken due to ageing, constipation and strain, heavy lifting or low back pain. Research also shows that strengthening the pelvic floor muscles can improve a man’s erectile function.
In a randomised controlled trial (Dorey et al, 2004), it was discovered that a supervised pelvic floor muscle training program was more effective than lifestyle advice in treating erectile dysfunction. After a six-month supervised pelvic floor muscle training program, 40 percent of men regained normal erectile function, while 35 percent improved. Their cohort excluded individuals with neurological deficits or previous pelvic surgery.

Erectile dysfunction after radical prostatectomy
Erectile dysfunction is extremely common after surgery for prostate cancer, affecting between 19 and 74 percent of men after nerve-sparing radical prostatectomy. Fortunately, recent research also shows that pelvic floor exercises can help these individuals.
In another randomised controlled trial (Geraerts et al, 2013) pelvic floor exercises were found to be effective in reducing erectile dysfunction after radical prostatectomy. They studied the efficacy of a three-month supervised pelvic floor muscle training program commenced at 12 months post-radical prostatectomy, and found statistically and clinically significant benefit in the pelvic floor exercise group, with results maintained at long-term follow-up. Also, they found that pelvic floor exercises had a beneficial effect on climacturia (incontinence with orgasm).

Targeted pelvic floor muscle training is the key
Pelvic floor exercises should be considered as a first-line treatment option for men seeking long-lasting resolution of erectile dysfunction of a non-neurological or surgical origin. Additionally, for men already undertaking other forms of therapy for erectile dysfunction, pelvic floor exercises may further enhance the efficacy of these treatments.
For pelvic floor exercises to be effective, a sufficient training program must be completed. Best results will be achieved when men complete an intensive, individualised training program under the guidance of a pelvic floor physiotherapist. Optimal strength gains will be achieved after four to six months.
Pelvic floor exercises have no side effects, are easy to do and cost-effective, and have other benefits, such as preventing or treating urinary incontinence or bowel dysfunction.

Rachel Heerey
APA women’s, men’s and pelvic health physiotherapist
APCR Prostate Cancer Centre and Women’s and Men’s Health Physiotherapy

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