Pelvic floor muscle training (PFMT) has been described since ancient times in Rome but Kegel popularised it to improve sexual and urinary health after childbirth. In the paediatric population, there is a paradigm shift towards biofeedback-based PFMT for lower urinary tract (LUT) dysfunction, incontinence, urinary tract infection (UTI) and dysfunctional voiding. This review article looks at its practical applications in men – stress urinary incontinence (SUI), overactive bladder (OAB), post-void dribbling (PVD), erectile dysfunction (ED), ejaculation issues including premature ejaculation (PE), and pelvic pain due to levator muscle spasm – pelvic floor tension myalgia. The PFMT consists of 70% slow-twitch type 1 (fatigue-resistant fibers – static tone) and 30% fast-twitch type 2 (fatigue-prone fibres – active contraction). A decrease in the proportion of the fast-twitch fibres can occur with ageing, inactivity, and nerve damage. The external (unlike internal) sphincter is not designed for sustained contraction and PFMT improves urethral closing pressure, guarding and coughing reflex in SUI, especially post prostatectomy. The ‘knack’ manoeuvre helps in SUI with known triggers. In OAB, the ‘antagonistic’ relationship between the detrusor and PFMs (inhibitory reflexes) can be exploited by deploying PFMs when bladder contraction is felt. In the ‘quick flick’ technique, PFMs are rapidly pulsed three to five times when perceiving urgency. The American Urological Association (AUA) recommends PFMT as first-line treatment for OAB. The superficial PFM – the bulbocavernosu (BC), ischiocavernosus (IC), and transverse perineal muscles – maintain erectile rigidity and the expulsion of the contents of the urethra. Dorey et al. demonstrated the effectiveness of PFMT for PVD. They concluded that ED and PVD are parallel problems, one sexual and the other urinary, and are manifestations of PFM weakness. In PE – the most common male sexual disorder – the ‘squeeze technique’ invokes the bulbocavernosus reflex, mimicked by slow pace intercourse, pause pelvic thrusting, and sustaining PFM contraction until the ejaculatory urgency disappears – internal ‘squeeze’ instead of external hand squeeze. Tension myalgia of the levator ani can be a factor in chronic prostatitis / chronic pelvic pain syndrome (CP / CPPS). This can be triggered by stress. The relaxing phase of PFMT is as important as the contracting phase and PFMT instils awareness and helps in relaxing the involved muscles. The author recognises PFMT as the essence of ‘functional fitness’ and an economical alternative to other treatments, although there is a need for randomised controlled trials and well-designed, comprehensive, easy-to-follow programmes. 

Pelvic floor muscle training in males: practical applications.
Siegel AL.
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Gokul Vignesh Kanda Swamy

ABM University Health Board, Swansea, UK.

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