Understanding The Tight Male Pelvic Floor

Not only do men have a pelvic floor, as was discussed in an earlier blog, they can also experience a tight male pelvic floor!

What happens with a tight male pelvic floor?

Pelvic floor muscles are like other muscles in the body in that they can become tight. Most people either know people with low back pain or have experienced their own bout of low back pain. These same people are often found to have tight muscles around their hips. The pelvic floor muscles are no different in that they can become tight and cause pain in areas such as the rectum, the testicles or scrotum, the low back or hips. Besides pain, a tight pelvic floor can cause symptoms such as urinary frequency/urgency, pain during ejaculation and muscle spasm in the buttocks region.

How does it happen?

Although everyone is different, some possible reasons that may lead to an overly tight pelvic floor are:

Posture

Men often stand with their feet pointed slightly outwards, or externally rotated. This keeps the external rotators, the glute muscles, overactive leading to eventual tightness. These muscles tend to press the buttock cheeks in towards each other and one of the muscles involved in this presentation is the piriformis. The piriformis muscle plays a role in the health of the pelvic floor and if this muscle is tight, so too is the rest of the pelvic floor.

Sports

Men who played a lot of hockey through their lifetimes. This sport does encourage that externally rotated position again with the hips, contributing towards the tight pelvic floor muscles

Butt Clencher

Though not specific just for men, clenching the buttock muscles throughout the day is a common strategy used by many people. This keeps the buttock muscles in a contracted position all day leading to the overly tight pelvic floor

Should I do Kegels?

Absolutely not! Strengthening a tight pelvic floor is not the answer! We would never strengthen other muscles in the body that are too tight because in order to have great strength, muscles have to be coming from a fully lengthened position. Release work is the first line of defence.

Treatment options for a tight male pelvic floor

Dry needling the external muscles; glutes and associated hip muscles. I have had great success with using a dry needling approach to help release trigger points in tight muscles such as the gluteus maximus, gluteus medius, gluteus minims, tensor fascia latae, etc. These muscles all work around the hip so releasing them will help the ‘inside’ muscles settle down as well.

Release Work

Using stretches along with breathing into the pelvic floor helps release these muscles

Breathing

Breathing deeply and sending your inhale down into your pelvic floor will help soften these muscles so they can let go. When we inhale, our pelvic floors should lower, so focussing our inhales down into our pelvic floor muscles will help those muscles lower and release their tension.

Posture

It matters a lot less about the time we lay down to try and release our pelvic floor muscles if we aren’t addressing why they are the way they are. Posture can play a role and overly clenching the buttock muscles is common. So remind yourself as often as possible throughout your day to notice whether you are clenching and if so, let it go. If you are having a tough time remembering to do this through your busy day, try something like

setting an alarm on your phone to go off every 20 minutes

pick some coloured little dot stickers from the dollar store and put them in places you will see them throughout your day. Every time you see one, you check in with yourself and make sure your butt is relax

Bladder/Brain Changes

If your tight pelvic floor muscles are causing you to have an overactive bladder, then addressing this is just as important as the physical release techniques. The way to do this is to “give the brain a different message”. If you just went to the bathroom 20 minutes ago and already feel like you have to go again, give your brain something else to process. With tight pelvic floor muscles, the best remedy is the deep breathing:

You feel like you have to go again, even though you just went 20 minutes ago

  • Relax, sit or lean against something if possible
  • Take 3-5 deep breaths
  • When the urge has subsided, continue with what you were doing

*** even if you put off going again by 5 or 10 minutes, this is still positive, as the change happens bit by bit ***

For more ideas, refer to my youtube channel at:  https://www.youtube.com/channel/UCJqDcZOOLoNKdBwxmY_wawA

85 thoughts on “Understanding The Tight Male Pelvic Floor”

  1. Hi.
    For about a year I have been suffering with urgency and when I drink one more glass of water 1/2 hour later I need to run to toilet. Also when I lie down my bladder fills very quickly. The other day after 4 hours outside I went to toilet,produced something like 200 ml and then 25 min later I had to go again and produced 300 ml. Is that actually possible ? My body producing urine so quickly ???

    Reply
    • Hi Ludovit. Its possible you are never fully emptying…so there is always more to come out…sometimes more, sometimes less. Tight muscles can do this because when we pee, our pelvic floor muscles need to be relaxed so our bladder can do all the work of squeezing the urine out. If the pelvic floor muscles are too tight and unable to relax, the bladder won’t fully empty. To know if this is happening, your Dr. would order a post void residual test where they will ultrasound your bladder so they know how much is in there, have you empty and ultrasound again to see if you are fully emptying or not.

      Reply
      • I had 3 ultrasounds after peeing and was told my bladder was completely empty ??

        Reply
        • Well, thats good news at least. I wonder, if when tested you are able to fully empty, but when you aren’t thinking about it; going throughout your day, you don’t? The so called norms are: 5-8 pees per day based on 2 litres of water per day. The length of pee is 8-12 seconds; which only works if the stream is normal; no hesitating/stop and start, etc. Otherwise measuring is better…sounds like you are already doing that. Personally, I haven’t heard of someone generating that much fluid in such a short period of time on a consistent basis; especially if that person is fully emptying. I have had clients who drink 5, 6, 7, plus litres of water per day, thinking that is a good thing, and they pee all the time; obviously generating a lot of fluid quickly, but that is understandable. Diuretics may play a role, if you are on those? Or any other medications that have side effects of making someone want to pee more often; lots of coffee? If you aren’t generating that much fluid on a consistent basis, have you tried using the ‘urge’ techniques to quiet your bladder?

          Reply
    • Hello Cathy.Can a tight pelvic floor cause ED in men? I can feel pressure between my sit bones.Feel a lot of pressure under area of scotum as well.All standard tests by my Dr. have been negative.Thank You

      Reply
  2. Ok. Thanks.
    Have to do it tomorrow thou.
    I’m actually in central europe (Slovakia) and it’s 1am here so gotta go to bed now ?
    Thanks very much for your answers. Hope to speak to you soon.
    Ludovit

    Reply
  3. Cathy, have you ever worked with any men that have suffered from a condition called “hard flaccid” due to pelvic floor hyper activity ?

    Reply
    • Hi Michael. I have. Its not as well known as some other presentations, but I have worked with some men with this issue.

      Reply
      • I too suffer with the same issue as Michael and feel as though my pelvic floor is in a state of constant spasm. Physios in the past have pointed to a pelvic tilt and weak glutes as potential reasons for the condition but I’ve had no concrete cause given to me. Is it possible to relieve the tension in my pelvic floor and eradicate the problem or can anything be done? Thanks.

        Reply
        • Hi Chris. Best suggestion is to work with a pelvic health physio as they can teach you some techniques to help relieve the pelvic floor muscle tension. Is there a 100% fix? With chronic pelvic pain issues, there often isn’t; however, you learn to manage the discomfort and thereby make some improvement. If you want, let me know what area you live in and I can help find someone for you.

          Reply
          • Hi David. Thanks for your email. Hmmm…if someone feels more discomfort after a session but within a day or two, feels better than before the treatment, then that is going in the right direction. But, if you are feeling more pain, and 5-7 days is a significant amount of time, and don’t feel significantly better than before the session, it might not be the right therapeutic direction for you, for now. It would help if you mentioned the clinic you were in so when I search, I won’t suggest that one…

  4. Looking for a pelvic floor specialist in my area. Bluffton South Carolina. This area is also close to Savannah Georgia. Do you have some recommendations?
    Thanks

    Reply
    • Hi Larry. It took a while, but I finally heard back from someone. There are a couple of pelvic health therapists in Bluffton; at Horizon Rehab; call 843-671-7342 to talk with someone. Good luck with your rehab!

      Reply
  5. Hi Cathy,

    I suddenly have OAB started July 2021, I had a history of on and off back pain/tightness prior to the onset of OAB. Is it possible that I have a hypertonic pelvic floor that causes my OAB? I had several urinalysis and blood test all clear no problem, same with Xray and ultrasound everything is normal. OAB and low back pain stays for 3 months now.

    Reply
    • Hi Ed. Sorry for the incredibly late reply; I wasn’t checking in here for awhile. Yes, it is very common to have overly tight pelvic floor muscles leading to an overactive bladder. Your bladder is contracting when it shouldn’t; when it isn’t actually full. This needs some re-traiing between the brain and bladder as well as either lengthening or strengthening the pelvic floor muscles. If you let me know what area you live in, I will check with my group and suggest some names for you. It’s the best way to know what is going on with your pelvic floor muscles by having an actual in person assessment.

      Reply
  6. Tight pelvic floor muscles troubles peeing sometimes I empty and sometimes I don’t my muscles are changing each day Somedays are better than others peeing is still very stressful for me.

    Reply
    • Hi Branden. Sorry for the incredibly late reply; I wasn’t checking in here for awhile. Yes, it sounds like your muscles may be overly tight. When you pee, your pelvic floor muscles need to be relaxed so your bladder can squeeze all the fluid out. If the pelvic floor is a little tight, it won’t fully let go and this results in not fully emptying, start/stop peeing, a feeling that the bladder is never fully emptying. If you let me know where you are, I can check with my group and see who is in your area. It’s always good to have a pelvic health physio assess your pelvic floor muscles and get you going on something.

      Reply
  7. My P.T. says that I have to relax my very tight plevic floor mussles and to drink more water during the day. During treatment, she pressed more firmly on my lower stomach and in between my anus and testicles and I peed a little. She knows I have accidents while preforming basic tasks while trying to live a normal life. Would catheters / bags be best to help stop the accidents vs taking medication? I have an over active bladder and urge inconsistence .

    Reply
    • Well, by pressing down like that, the pressure is increased and if the pressure is greater than what your pelvic floor can handle, uncontrolled urination will follow. If you have overactive pelvic floor muscles, keep working with your pelvic floor physio to help you learn how to release their tension. Some people do take a medication to calm the bladder so there is less urge incontinence and sometimes that, in conjunction with your pelvic floor PT can help. Some people elect to work on their nervous systems and wait on taking medication. People can experience a lot of change once they understand how to change their nervous systems/have their bladder become less overactive. Have you talked about this with the physio that is working with you?

      Reply
  8. Hi Cathy, I may have a similar condition. When I sleep, I feel all body relaxed except the pelvic floor area. It is always tense. I wake up after two hours maximum with a painful erection and an urge to pee. I go to the bathroom and when done the penis becomes soft again. This cycle continues for 3-4 times/night. I don’t drink water (almost never) and cut all my liquid intake by 7 pm maximum. Yet. I continue to generate urine until the morning. and the amounts are not small. I’m wondering if there is a process in the body that generates this much urine, not as a result of liquid intake.
    have you had a case like this before (the frequent erection with urgency to pee)? Thanks,

    Reply
    • Hi Kal. Yes, this is a common presentation. Have a look on my website, under services, mens health and page down; there is a quick little blurb about proctalgia fugax. This can occur during nighttime. Because it’s normal to have many erections throughout the night, if having an erection causes discomfort, then you wake up, this causes discomfort in the bladder, so emptying helps. It’s best to have a pelvic health physio assess you and if those muscles are too tight, how to release them. If you let me know the area you are in, I can check with my group to see who is around.

      Reply
  9. I don’t leak or have any incontinent issues but l do have pain in my pelvic floor and penis at times. My PT says l have a hypertonic pelvic floor. I assume that you agree with her?

    Reply
    • Hi David. I can’t say from afar, you can have pain for other reasons, but most often, as a pelvic health physio, when a man has that sort of pain, there are one or more overly active areas within the pelvic floor musculature. The main thing is for your pelvic health physio to do an internal check teach you how to release those muscles.

      Reply
  10. Cathy, is having weak contractions (almost unnoticeable) during orgasm a sign of a weak or tight pelvic floor. I don’t suffer from any pain in pelvic area or back, but my urine stream is definitely weaker and I need to press on my perineum to get that last amount of urine out. I feel like I’m too young (mid-forties) to be experiencing this, and it’s been going on for years now. Was told by my urine after ultrasound my bladder does not empty completley either. Didn’t really have a reason why, said prostate felt normal and was normal in size. Any help would be much appreciated. Thanks!

    Reply
    • Hi Matt. It ‘sounds’ like your pelvic floor muscles may be have too much tone in them; overly tight. For example, when you pee, your pelvic floor muscles need to relax so your bladder is able to empty fully. Some men find sitting down helps to fully empty. The best thing is to have a pelvic floor physio assess your pelvic floor and teach you, if the muscles are overly tight, how to release them; it can be a bit tricky. You don’t want to strengthen those muscles if they are too tight; you need to lengthen them first. If you let me know what area you are in, I can check with my group and see who is in your area.

      Reply
  11. Hi Cathy,
    I have been experiencing worsening pain in what I though was my prostate over the last 3 years. I have been through countless tests and now am seeing a urolog specialist who is telling me its my pelvic floor. I got the scenario you outlined (feet slightly extwrnalyy rotated, kaiphosis etc.). So, it would seem that this would be good news right ?!?! Some P.T. and I should get some relief…unfortunately I have bilateral hamstring tendonitis and can’t do any of the PT exercises that stretch my hamstring at all. Many of the exercises we need to do for my hamstrings I can’t do because of my pelvic floor and vice versa. I feel very very stuck and disheartened. Anything that causes pressure to my pelvic floor (sitting, ab strengthening, even trying to press my lower back onto the floor) causes really bad pain in the parineal area. Is there any hope that I might get passed this?

    Reply
    • Hi Ben. You should absolutely been able to make a change. You don’t have to stretch their your hamstrings to get relief for the pelvic floor; there are lots of different movements you can do. The main point is to be able to release your pelvic floor muscles with breath. If you let me know where you are located, I can check with my group and see if there is someone in your area. The best thing is always to see a pelvic health physio in person so they can let you know what is going on with your pelvic floor muscles and how best to access them.

      Reply
  12. Hey Cathy,
    Hope you’re doing allright.
    I am a thirty year old male who thought that he had an yeast infection at first which my doctor thought to, but after the urologist they found out i have a hypertonic pelvic floor. Sometimes it gets more red, it gets irritated randomly. From itchy to burning. Yeast was already rules out because the symptoms keep changing after a few days. Yet my mind is not sure if this is just my pelvic doing this or that the tight pelvic mimics an yeast infection. Also my penis hurts which happens alot i heard from a tight pelvic floor(soft and erect) but also it looks like I’ve lost some color and the head of the penis seems more red and irritated and at the same time more whitish asif the blood flow isn’t going well to my tip. Is this also a possibility of having a tight pelvic floor. I’m also seeing my PT tomorrow but these weird symptoms really are messing with my life. Bless you for being there for so many you are appreciated.

    Greetings,
    Steve

    Reply
    • Hi Steve. I can totally see why those symptoms are causing you a lot of distress. Overly tight pelvic floor muscles can wreak havoc with the rest body. The good news is there is lots we can do. There is a condition called hard flaccid; this is when the penis is semi-rigid at the flaccid state and a loss in erectile rigidity. Look for into that, if that is also occurring. It’s great you have been seen by a specialist to rule out anything more serious causing penile discoloration. Is it a pelvic floor physio you are seeing? If so, they can help you release those tighter muscles, teach you how to do that and you can start working on it while at home. There are lots of options for helping people find those muscles and release them, so make sure you are able to do that.

      Reply
  13. Hi Cathy, thank you for this website and I really feel like you truly understand the issues that some of us guys are going through. I too seem to have the overactive bladder as well as spasms at the back passage and I have long believed its muscle related, but most doctors just want to give you creams, tablets or surgery! Could you recommend a practice in London, UK who could assist me? Thank you.

    Reply
  14. Hi Cathy, when I lie down at night before falling asleep it happens to me to have to go urinate multiple times with small amount of urine coming out and I feel like I can’t empty myself fully and I have trouble falling asleep. Can these be sign of tight pelvic floor muscles?

    Reply
  15. Hi Cathy,

    Thanks for this post and all your helpful replies, I (33M) read through them all. I struggle with urinary hesitancy (slow to start, weak stream, stop and start) and the feeling like I am never “done” after peeing. In the mornings, my bladder area is generally sore until I go to the bathroom, and it subsides after 10-15 minutes. I also have lower left back pain, and tight hip muscles. Very slight symptoms appeared 5-6 years ago, but have been getting much worse the last 2 years. The only thing I can think of that changed was working from home with COVID (more sitting, worse posture?)

    I have had ultrasounds of prostate, kidneys and bladder. Also urine, blood and psa tests. All results normal.

    This year I went for pelvic floor physio for 3 months but the results were not noticeable. I did relaxation/breathing/stretches during this time and have continued to do so.

    Should I give up on hypertonic pelvic floor as a possible cause of my symptoms? Are there any other signs I could look for to confirm or rule it out? Is there anything else you would recommend (eg acupuncture)?

    Thanks so much for all this information. This is an invaluable resource.

    Alex

    Reply
    • Hi Alex. Great you have had all the tests done to rule out any pathology. I would look at the back and hips for sure. Are there any referral patterns between the back and hips and the pelvic floor? Your pelvic floor physio should have mentioned this if there were and you would feel this when they hit a spot inside your pelvic floor; you may feel that in your hips or back/tailbone area. 3 months is more than enough time to change the pelvic floor because ultimately you are changing your nervous system. I find this change comes rather quickly in most cases. Things to check for; does your pelvic floor physio say that he or she can feel your muscles actually softening, has their tone changed? This change, once the client knows how to release their pelvic floor, should happen within the first few sessions. I often add in some dry needling for the tighter hip muscles. I also look at how the person moves. If you think of this example; someone with super crappy posture (rounded shoulders, slumping forward) wanders into the gym. They do all these fantastic exercises to release their pecs and strengthen their back muscles and then they wander back out of the gym in the same crappy posture. Their body hasn’t learned anything. The pelvic floor is the same. That’s why posture and movement needs to be looked at as well. Have you and your physio looked at those things? Has your physio confirmed that your muscles have changed tone?

      Reply
      • I’m (34m) similar to Alex where I have difficulty starting and it’s been correlate to to a very tight pelvic floor. I was explained my pelvic floor feels like a rock and not fleshy like it should. Note I’ve had this condition since birth and have only now just been diagnosed.
        I don’t even know what this means really, does it mean my pelvic floor is always contracted? I now know the pelvic floor is a muscle, so can I relax it? I don’t know but I’m very pessimistic about PT since I’ve gone 4-5 times and no results. Are there options for Botox surgery? I don’t know but I’ve been like this since birth so I classify myself as special.

        Reply
        • It does sound like it’s too tight. Stress will keep tightness in the pelvic floor muscles so if you have a high amount of stress, that needs to be addressed. When muscles are contracted/shortened, it can come from the sympathetic nervous system (fight or flight). With abdominal breathing, you are getting more into your parasympathetic nervous system (rest and digest). I get that you are frustrated if you didn’t see any change with pf physio. Do make sure you are working with someone who does internal work. There are also tools you can use at home to keep the work going. Botox is sometimes used but if muscles are ‘paralyzed’ they can’t help support you or keep you from potentially leaking, so you need to be careful with this. If you have had all pathology ruled out, and it’s more the muscles that need change, your main task is to be able to actually move those muscles. Inhale and pf lowers/stretches. Maybe try someone else? A different approach might be helpful.

          Reply
  16. Around 10-15 times and I have to make some extra effort to push out all of the urine and I still leak a little bit in my pants after I am done.

    Reply
    • Sometimes tight muscles will do this. And the dribbling when you think you are finished is also common, with tight muscles. Most importantly is to make sure you know how to release and stretch the pelvic floor

      Reply
  17. Hi Cathy,

    I’m a 30 year old male who has been dealing with OAB, mainly urgent urination, for the past 6 months. I’ve tried various medications, bladder training techniques, diet changes, etc. with little relief.

    My question to you is, could my leg workouts/training be possibly linked to my urgency issues? In addition to the urgency issues I’ve had constipation as well. I’m just curious if doing things such as heavy squats, lunges, etc. could be linked to causing my pelvic floor to possible become tight, which could possibly be the culprit for some of these issues?

    Thanks so much!!

    Reply
    • Hi Jeremy. It could. When you do those exercises, you are also working your external rotators. When these muscles become tight, they can affect the pelvic floor as well; since one of these muscles you can actually access internally. Have you had a pelvic floor physio assess your pelvic floor? You need to know how to release those muscles from the inside. Externally, making sure you are adding in some glute/piriformis stretches. Do you need to stop these exercises? Some people need to stop what is adding to the problem, start doing the release exercises to lower the tone, then add the exercises back in. Others are ok to keep going with the exercises while they are also doing their release exercises. I would say the first step is to make sure you are actually able to stretch your pelvic floor properly.

      Reply
  18. Cathy,

    I was a big proponent of male kegels, especially for myself. It allowed me to last longer in bed, and my orgasms were very explosive. It was wonderful.

    Then the pain came. I think I over tightened my pelvic floor muscles. Well, I went to a pelvic floor PT about 3 years or so ago (just before Covid), and she agreed. She did a lot of exercises to help me “relax” my pelvic floor area. She believed my pelvic floor was already very strong from a lot of weight lifting (squats, in particular), and that by doing kegels I was just tightening an area that was already strong to begin with.

    Ever since, I stopped doing kegels. Whenever I have sex, of course, and I’m clenching that area to “control” myself, it’s much harder. Also, my orgasms lack that “punch” the way they used to.

    So every now and then I think of doing kegels. Starting off very slow and gentle, and only holding for a second or two, before “pushing” for a second or two. Still, though, after 1 set of ten, the rest of the night my kegel area just feels sore.

    What gives? I love the orgasms and control doing kegels gave me, but hated the pain. However, when I do kegels, even light ones with pushing, I can almost feel that area tightening up again.

    Any help?

    Reply
    • Hi JJ. You’re right; anything too tight starts to cause a problem. But, at the same time, you want those muscles strong. What might be happening is this…are you fully letting go in between your kegels? If you aren’t, the tone will stay higher and you won’t achieve the flexibility and length needed to get the next good rep. I would check that first. Since you’ve worked with a PF physio, your awareness of what the letting go feeling is, should be good. Notice, if you are actually fully letting go in between each rep? It also sounds like you will need to do some regular pf stretching forever, because it sounds like your pattern is to easily become too tight. Just add it in with your stretches or at the end of a stretch session, maybe 3x per week.

      Reply
  19. Hi Cathy,
    For almost 2 years now I been dealing with difficulty starting to urinate which seems to come and go. I’ve been to urologist, PT, and a general surgeon. The general surgeon said it may be due to the result of a sports hernia. I have noticed the symptoms come on after working out or doing something as simple as the elliptical. The PT said my muscles are tight and weak and had me stretch for 6 weeks with no results. Could it be a sports hernia or some other muscle that is resulting in the difficulty starting urination? There’s no pain involved.

    Reply
    • Well, my first thought is that a hernia could do this if it was entangled with the bladder, but you would most likely be getting infections, have way more symptoms, so that sounds less likely. Part of your core helps form the outer layer of the inguinal canal….so if you were not using your core most efficiently and possibly irritating this area, then your muscles tighten up again and affect the bladder? Was the physio you saw a pelvic health physio? Did they do internal work with you? And, if so, were you able to actually move and lengthen those inside muscles? I would want to make sure of that first off. You are changing your nervous system and this does happen quite quickly. If your physio confirmed that yes, you have completely lengthened these muscles, you have good strength in them and they co ordinate well with the rest of your core, it doesn’t sound like that would be the driver of the problem. Which brings us back the hernia…If there is strain there, and the muscles start to tighten up, that would play a big role in difficulty urinating. So, my main question would be, was it confirmed from your physio that there was a big change with respect to your pelvic floor muscles.

      Reply
      • She had me stretch for six weeks and after there was no results she said she did not know what was going on and I could be my abs being too tight or could be my legs being too tight ( hamatrings). It was a regular PT that was familiar with pelvic floor dysfunction. What do you mean by internal work? Should I see one more specialized if so is there one near me I’m in Greenville SC? Regarding the sports hernia, it’s not like a normal hernia. There no bulge. Instead it has something to do with the ligaments that connect the abdomen to the thigh being weak or damaged. With all the research I did the name obturator internus kept coming up. While I never really had pelvic pain I did have gluteal and lower back and hip pain.

        Reply
  20. Hi. I’m here as I don’t know what else to do. I wake up to pee 3-4 times a night, every night. I have had it since April 2021. I used to pee often during the day too, but I am not peeing too much volume as i’ve measured it. It’s just the frequency. Things have improved slightly, but I haven’t done anything for that. Now, when i wake up, sometimes i can go back to sleep without peeing. But it wakes me up again in 1-2 hrs, but i CAN resist. It’s not a strong urge, but it’s enough to wake me. The pee’s that wake me are usually only 100ml, sometimes more, so surely not enough to wake somebody. In the day time, i feel regularly, ‘some pee’, but i can hold off for a few hrs before going. I can have this even after peeing. The doctors think it’s OA bladder, ive had tests, but he said all ok and my bladder is as it should be. i have Anterior pelvic tilt and extremely tight hips, could i also have tight, NOT weak, pelvic floor muscles? I dribble after peeing too, so have to wipe with loo roll everytime. Sometimes i have ‘heavy feeling’ where i have to lift my scrotum (without hands) like a ‘jerking’. I have NO pain and no real urgency. Sometimes when i a larger pee wakes me up, it gives me an erection too, but ONLY when it’s a larger amount and only upon waking, never in the day time. So seems to be worse upon lying down. Sorry for long message. Thanks. Adam from Lancashire, UK

    Reply
    • Hi Adam. I’m glad you have had checks with your Doc to ensure there isn’t any pathology present. That’s always the first step. Tight muscles can wreak havoc with your urinary system. Your bladder may be healthy but your pelvic floor muscles are likely too tight. When they are tight, they are weak; simply because they are held in a shortened position and can’t generate strength beyond that. Compare it to this example; if your elbow was bent as much as possible, your biceps are ‘on’ all the time. you might be somewhat strong in this one position but that’s it. You need to straighten your elbow, to create length in the bicep muscles in order to then, generate strength.
      The feeling is real; you need to pee. Even if you have very little in there. The connection between your brain and your bladder is kinda impaired right now. It’s telling you that you need to pee even when there is very little urine in your bladder. That can be retrained though, which is the good part. The treatment is learning how to relax and lengthen those inside muscles and then retrain the connection between your bladder and your brain. Would you be able to see a pelvic health physio in your area?

      Reply
      • How does one retrain the connection between bladder and brain when there is oab due to tight pelvic floor?

        Reply
        • If the muscles inside are too tight, then breathing to calm down the sympathetic nervous system and be more in the parasympathetic system is the go to. Tight muscles are being fed by an overactive nervous system, so accessing the parasympathetic system will allow those muscles to learn to relax more.

          Reply
      • Thanks. I don’t get an urge to pee, i wake up 3 -4 times a night and feel pee, so it’s probably that waking me up, but I am NOT desperate to pee. I go once or twice, as it’s easier to fall aback to sleep then, but i have gone back to sleep with pee still ‘there’. I have measured it too, sometimes 100ml in my bladder is what wakes me, although, sometimes 200-300ml.

        I often dribble after peeing too, but only a little. My urine stream is ok, and has been checked. The urologist said i have a ‘slight benign feeling’ on prostate and that’s it.

        I also have felt a ‘pressure’ between testicles and anus, where it feels like I have to twitch / lift up my testicles (no hands used). Had this intermittently and started before the pee frequency.

        I have anterior pelvic tilt, lordosis and tight lower back and hips. I had these years before this nocturia started.
        I do feel the urine start building up more when i’m lying flat, that’s why it’s worse at night, but i can feel it during the day too, but i can ignore it during the day, as i know there’s not much there.

        i live in Lancaster, Lancashire, UK, and i can’t find a pelvic floor PT for men near me

        Thanks

        Reply
        • You might have a pelvic floor that is too tight. I’m checking with my group to see if there is someone close to you that can help you. I’ll get back to you as soon as I hear back from them.

          Reply
  21. Cathy,
    I messaged you before about the PT person and 5-7days of soreness do you know one in Olympia Washington and do you think l should check my neuro transmitters to see if l am balanced and could this pelvic pain be anxiety and PTSD causing the pelvic pain. I am on medications and l am still in terrible pain. I stretch and walk on the treadmill but l am still in pain. Any advise or can you give me reputable names of some good PT people and Functional medicine Doctors in Olympia Washington. I really need pointed in the right direction. I am in total pelvic pain and am failing at climbing out. HELP!!! Please Dave

    Reply
  22. Cathy,
    Dave again could my constant pain be from my muscles clenching nerves which cause pain in my rectum. What can l do to make it stop. I am taking muscle relaxers also.

    Reply
    • The main thing is to make sure you know how to and are actively able to release/stretch those inside muscles. Yes, clenching will not help

      Reply
      • How do we activate & stretch those areas thanks as I’m having a hard time with that!

        Reply
  23. Cathy,
    What do. Myou think about ultrasound heat therapy for male pelvic pain have you or heard any successes. That is what my Pt uses on me and wonder if you think it is beneficial?

    Reply
    • Hi Dave. Sorry for the late reply. I don’t know a lot about this; expect it’s like many other modalities; some of them help some of the people some of the time. Everything is worth a shot, especially if you have benefits to cover the treatment. If you are getting some relief, that’s great; keep it up. Because the nervous system is involved in pain, that is the main area I would deal with; trying to change how the nervous system interprets pain. No matter what modality is used, you also need to be taught how to change your nervous system on your own. So as long as that is part of the treatment, I think that’s great.

      Reply
  24. Ihi! I’m 57 y/o and constantly feel urge to pee even after I just peed, right now i go every two hours, but when I’m resting I can wait longer …my pelvic muscles feel tight…is there a pelvic specialist in the colorado springs, colorado area?

    Reply
  25. Cathy Ty for your commitment to this thread.
    Me; difficulty starting and finishing urination, never quite done.
    Difficulty defecting despite good sphincter relaxation.
    Difficulty getting and maintaining erection. Very difficult to orgasm, very tense afterwards.
    No pain of any kind.
    PSA normal as tested every 3mo due to TRT (long term lowT). Colonoscopy normal. No blood. Baclofen suppositories seem to help.
    PT diagnosed hypertonic pelvis due to stress.
    Diagnoses incl non-sexual PTSD and IBS.
    Breath work has helped, and I’m able to completely relax pelvis and there has been some bowel improvement but no urogenital improvement. Any suggestions on relaxing/stretching the pelvic muscles that go up through the pubic area? Other thoughts?

    Reply
  26. I have been diagnosed with a tight pelvic floor. This has been causing severe penile pain near the tip and hypersensitivity. I have difficulty wearing clothing, even underwear. I have had constipation issues. Would dry needling help? Thank you!

    Reply
    • Hi Rick. Dry needling the external muscles may help. You definitely need to be able to release the tight inside muscles though; that is the most important part.

      Reply
    • Hey man same here my urologist says its most likely my pelvic floor but she mentioned Pundendal neuralgia now I’m worried it could be that. Hope you feel better I start Pelvic Floor therapy in 2 weeks

      Reply
  27. Hey Cathy been having Penile pain and had all the test done everything is clear. My urologist thinks its either Pelvic floor dysfunction or Pundendal neuralgia what is the difference? I’m just frustrated and worried. Starting Pelvic floor therapy next week

    Reply
    • Sorry for the long delay in responding Johnny. I’m glad you have started pelvic floor therapy and your physio has probably already explained the difference but just in case; pudendal neuralgia is involved the pudendal nerve. According to specialists, though it is commonly thought to be the problem, they typically find that 80% of the time, the pudendal nerve is not involved; so hopefully that is you too. Pelvic floor dysfunction just says that those muscles aren’t functioning as well as they could be and this means they may be too tight, very common in guys, or too weak. Though, tight muscles are weak muscles. So, typically release work is done first, then strengthening follows. I hope it’s going well for you.

      Reply
  28. Hey Cathy this is Shannon from Long Beach ca. about a month ago my wife noticed that I was peeing more frequently but i paid it no mind until my mind did! Then I found myself going more often like every 5 min! That’s when I went to see a dr! They ran blood test! Urine test! But everything came back negative! Bladder was fine! Prostate was fine! So he prescribed me oxybutynin to help relax the bladder & hold more pee! So I tried that it worked a lil! But I weaned myself off & told my brain to tell my bladder you are not in control! So I went from 5min 4-5 hrs of having to urinate good thing right?

    So I was referred to a urologist & he told me to try not clinch my pelvic floor and I catch myself doing it! & it’s hard to relax the pelvic floor because it tense’s right back up! I’m doing stretches to help loosen but can only do so much should I have the urologist send me to physical floor therapist? Because the tightness is starting to hurt my testicles & Anus area! Urologist says it’s non bacterial prostatitis & prescribed antibiotics but if it’s no bacteria why use antibiotics thanks

    Reply
  29. Hi
    For so long I have been suffering from urgency even after peeping I feel like I have to go again just 1 glass of water is enough for me to go for 3 to 4 times

    Reply
    • Most often, bladder urgency is a sign of muscles that are too tight; have too much tone in them. Releasing them is the most common way to help. Start with diaphragmatic, or belly, breathing. Inhale deeply, belly gets bigger, exhale easily. On your inhale, picture something in your pelvic floor loosening, lowering, releasing. Practice this breathing and when you feel the urge to go, do 3-5 deep breaths. This gets you out of your sympathetic nervous system and into parasympathetic nervous system.

      Reply
  30. Hi cathy,

    I am into weight lifting for the past 2-3 years. I have symptoms like dull ache in perineum, urinary urgency and difficulty starting urine (even when sometimes the bladder is full), fatigueness after urinating and sometimes slight penile discharge in the urine.

    I am done with all the necessary tests like uroflowmetry, urine routine, etc. but nothing has been diagnosed.

    I am somewhat sure that heavy lifting/sqauting is leading to my problem because when I do not workout for a couple of days, it feels better.

    Could you comment on this and let me know if this is hypertonic pelvic floor and possible treatments for it.

    Reply
    • It could be; depending on how you are activating your pelvic floor. With heavy lifting, if you are pressing out into the weight belt or doing a valsalva, this will press down more on top of the pelvic floor and could cause problems. Conversely, if we think ‘tension to task’ … the pelvic floor will have to work harder when there is more load … so if those muscles are already tight and you are squeezing them even more, this can cause a problem. The question is, are they too weak and can’t handle that load or are they too tight? If there are pelvic floor physio’s near you, it would be great to have someone check so you know what is happening. If you lay off the heavy lifting for a bit, definitely add in some pelvic floor stretches; inhaling and allowing those inside muscles to stretch/lower/open up.

      Reply
  31. Hi Cathy, thank you for this article and info. I have a question too. I have also been urinating 3/4 times an hour and have a dull ‘dragging’ sensation around my pubis as well as hip flexors/groin. Sometimes it presents as a ‘locking’ in the SI joint. Could this be pelvic floor tightness or is it weakness and how do you tell the difference?

    Reply
    • Hi Jamie. Tight muscles ARE weak muscles. They can’t move through a full range of motion so they can’t help and support us as much as they should. Tight muscles definitely need to be lengthened first. Most often, if you are peeing 3-4x per hour, those muscles are too tight. Because they pelvic floor muscles/inside muscles need to be able to lengthen and shorten all throughout the day as we are walking around and doing things (because our pelvis needs to move and our pelvic floor muscles are attached on the inside of our pelvis), if they are too tight, they might not be allowing full movement through the pelvis; hence, the feeling of an SIJ not moving well. Best thing, as always, is to have a pelvic health physio assess your pelvic floor, confirm whether or not it is tight and make sure you know how to release it.

      Reply
  32. Hi Cathy

    I’m pretty sure my pelvic floor is over tight. I sometimes notice myself tightening the muscles without being aware I’ve been doing it. I have had the odd issue with constipation lately although it’s not regular. Often in the middle of the night I have to wake up in the night to pee but there isn’t really much that comes out. I then wake up again in the morning and need to pee again and my muscles feel tightest in the morning. They tend to relax somewhat as the morning goes on and I get on with my day. However I’m still not sure how often I’m tightening them and how to get into a better habit whereby I don’t have to really focus 24/7 to relax them. I don’t feel the urge to pee much during the day but it’s normally in the middle of the night.

    I also admit I really probably don’t drink enough water. Could that in some way also cause a problem?

    Reply
    • Hi Mike. Yes, dehydration can cause the bladder to contract more; which is what is happening when you feel like you have to pee. When you say you might be gripping with your pelvic floor, are you also gripping with your abs? They work hand in hand. Sometimes it’s easier to let the belly go; and notice how the pelvic floor lets go. Yin yoga or some calming stretching can help with this. As always, if you can have a pelvic health physio assess your pelvic floor, they can let you know exactly what is going on and start you on something. If you don’t know a PF physio, let me know the area you live in and I can help find someone for you.

      Reply
  33. Hi Cathy! Great info compiled in one place!

    L2-S1 were fused in late ’05. Just ow addressing a lot of issues now than I’m older. SI joint pain is always present, as well as a recent addition Hard Flaccid Syndrome. Tons of other issues, weak glutes, hams, inflexibility, hip flexors, etc.

    After reading your info, I’m absolutely clenching/flexing all day in order to support the SI pain

    ****Question: With the fusion, if I get a nerve block for the SI joint pain, could that allow me to stop compensating so much enough to work on all of my other issues?

    Reply
    • Hey Phil. Thanks for the feedback. I do mean to put some more info on there; I’ve been a little lax lately. You might already be aware, but sometimes nerve blocks work great and other times, they don’t seem to be the answer. But, it is hard to get anywhere when you are in pain. It might work, but even if it does, you need to know how to let those muscles go, so make sure you understand how to release/stretch your pelvic floor muscles. As well, I would wonder about how well your transverse ab muscle is performing. Considering it is a local stabilizer, it tends to come on a tad late when there is back pain and needs to be retrained. It’s not about the superficial abs; though these are important, it’s the deep level of ab muscle we want to make sure is functioning well as it performs a completely different function in our body. Have a look at some of the TVA videos, if you are unsure. We don’t want to keep releasing everything if we haven’t also given our body something to support us. When the local stabilizers aren’t working as well, the bigger muscles (our glutes, our big back muscles, etc.) try to stabilize us, but thats not their job so all they do is create ‘tone’ and all you feel is tight and painful. So, also get those local stabilizers functioning well.

      Reply
  34. I am 17 years old and I feel unsatisfied after urinating, like something left. And I feel discomfort all the time in this area. I did all the important tests and there was no sign of inflammation or anything like that. I tried taking Tamsolin for a few days and it didn’t work. After a little research I saw that my pelvic floor may be tight.
    My question is, what exercises do you recommend doing and how long will it take for the pelvic floor to relax?

    Reply
    • Hi Dan. It’s less about ‘which’ exercise you should be doing and more about ‘how’ you are doing it. You need to learn how to relax/stretch your pelvic floor muscles. So, when you inhale your pelvic floor muscles are relaxing/lengthening/lowering; opposite to when you kegel. If you haven’t done this before, the easiest way is probably this:
      take a nice big belly breath
      exhale and tighten your pelvic floor (kegel) this is when you are trying to stop passing gas, stop peeing, etc.
      inhale and stop tightening; let your muscles go
      exhale and tighten

      sometimes it’s easier to feel a muscle letting go/lengthening after it has been tightened. Ultimately, it sounds like you shouldn’t be doing kugels or a lot of tightening but use this at first with the purpose being, you are trying to feel the subtle lowering movement of your pelvic floor muscles when you inhale…Alternatively, you can let me know where you are and I can look for a pelvic health physio. They would teach you to do this properly and then it becomes your homework.

      Reply

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