What are Kegel exercises for men?
Kegel exercises or pelvic floor muscle exercises consist of repeated contraction and realization of the muscles that form part of the pelvic floor, to strengthen the pelvic floor.
Arnold Kegel first described the exercises in 1948, and historically the exercises treated female patients in an effort to aid with stress incontinence following childbirth. However, with time pelvic floor muscle therapy and other forms of behavioral therapy have been demonstrated to be useful in a variety of conditions, including
- overactive bladder,
- male lower urinary tract symptoms,
- post radical prostatectomy,
- urinary incontinence,
- erectile dysfunction and climacteric,
- fecal incontinence, and
- premature ejaculation.
Unlike typical exercise routines, these exercises don't require the participant to buy any weights or expensive machines. However, the success of Kegel exercises is dependent on the proper performance of the exercises.
What are the benefits of Kegel exercises for men?
In men, Kegel exercises are primarily a first-line therapy in men with urinary incontinence after a radical prostatectomy. Studies have demonstrated that patients should start pelvic floor muscle therapy prior to radical prostatectomy and continue postoperatively for the best results.
Overactive bladder symptoms can occur in men as well as women. Contraction of the pelvic floor muscles can suppress bladder contractions and thus pelvic floor muscle therapy is a part of the first-line management of overactive bladder.
Researchers have evaluated the role of pelvic floor muscle therapy, Kegel exercises, in the management of erectile dysfunction and orgasm-associated urinary incontinence (climacteric) after radical prostatectomy. One study demonstrated that men with erectile dysfunction and climacteric one year after nerve-sparing radical prostatectomy had significant improvement in erectile function with pelvic floor muscle training at 15 months and that the effect was maintained during follow-up. In addition, in those men performing pelvic floor muscle therapy, there was a significant improvement in the climacteric.
Pelvic floor muscle therapy, Kegel exercises, is helpful in men with premature ejaculation. In fact, in one study, pelvic floor therapy consisting of biofeedback, pelvic exercises, and electrostimulation led to a cure in premature ejaculation in 50% of patients with a history of lifelong premature ejaculation, within two to six months of starting therapy.
Kegel exercises treat nocturia (awakening at night to urinate). A preliminary study showed that behavioral therapy (including pelvic floor muscle exercises) in men, alone or in combination with an alpha-blocker (medical therapy for benign prostate enlargement), consistently showed large favorable effects on sleep, nocturia reduction, and quality of life.
Kegel exercises are harmless if performed correctly. Some people have reported chest and abdominal pain, but these occurrences are the result of inappropriately performed exercises. Proper education and performance of the Kegel exercises are important to achieve the best results. Patients can learn how to properly perform Kegels at their doctor's office, via paper instructions, or online tutorials. However, success will depend on contracting the proper muscles regularly.
How can men perform Kegel exercises?
Prior to beginning the exercises, it is important to localize the pelvic floor muscles. A simple way to start is to attempt to stop urine flow midway through. The muscles allowing for the pause in urination are the ones targeted by the Kegel exercises. However, several studies have demonstrated the importance of contracting the appropriate muscles and one study demonstrated significant differences in the muscles contracted with the following commands: "shorten the penis," "elevate the bladder," and "tighten the anus." Thus, if one is not responding to therapy, a health care professional should ensure that the patient contracts the correct muscles. Such therapy includes a transperineal ultrasound (placing the ultrasound probe on the area below the scrotum and in front of the anus). Ultrasound evaluation can also be performed transabdominal.
The first technique requires a contraction of the anus muscles as if trying to hold in gas. The feeling of a pulling or lifting sensation on the anus tells you that you are performing the exercise correctly.
The second requires the use of a mirror in order to observe the movement of your penis vertically without moving the rest of your body. An elevator analogy can illustrate the exercise. The anus, in this case, can represent an elevator. The goal of the exercise is to bring up the elevator over five seconds to its maximal level and then to bring it gradually back down to the resting level.
The techniques are interchangeable. Men can perform a different technique each day. However, the important thing is always to use only the pelvic muscles. When men first start performing these exercises, they may use other muscles to help them. Often, they may use their abdominal or gluteal Maximus (buttocks) muscles. It is thus important to become aware of which muscles one contracts. It is also important to avoid holding your breath or crossing your legs.
Arguably, one of the strongest points of Kegel exercises is that they can be performed anywhere without anyone but the participant noticing. Unlike typical core exercises for men requiring sit-ups, planking, or other unusual positions, Kegel exercises can be performed during a variety of activities such as shaving, sitting at one's desk, or even while driving.
How often should men perform Kegel exercises?
Men are accustomed to exercises such as push-ups or sit-ups. However, a very small proportion of them knows how to perform Kegel exercises. This is unfortunate since many doctors recommend incorporating these into one's core routine.
Unlike typical workouts for men, there is no magic number of sets one should do in a day when it comes down to Kegel exercises. However, men should perform at least two sessions of Kegel exercises every day. To keep things simple, men should perform their first session in the morning and their second at night. A session is comprised of 10-30 individual contractions and relaxation exercises. Each exercise should last 10 seconds divided into five seconds of contraction and five seconds of relaxation. Once a man excels at performing these, he can do them in different positions. Of the 10-30 exercises, he can do one-third while laying down, one-third while sitting, and one-third while standing. Counting aloud certainly helps, and as time goes by, many men are surprised at the ease with which they can perform the exercises that at first seemed unnatural to them.
This is of the greatest importance for men undergoing prostate surgery, either for prostate cancer needing radical prostatectomy (complete prostate removal) or for benign prostatic hyperplasia (BPH) needing transurethral resection of the prostate. Both surgeries reduce the resistance to the bladder that can result in postsurgical urinary incontinence. As we can see from the following image, the anatomic changes reduce bladder outlet resistance. As such, strengthening the pelvic floor and sphincter are of paramount importance and Kegel exercises can help. Ideally, the Kegel exercises should start prior to the surgery and continue after the surgery.
How long does it take to see results from Kegel exercises?
Patients commonly experience results, such as improved urinary continence, within three to six weeks of regularly performing Kegel exercises. As with any exercise routine, the key to obtaining results quickly depends on efficient, targeted, and frequent exercise techniques.
Newman, D.K., T. Guzzo, D. Lee, and R. Javadevappa. "An evidence-based strategy for the conservative management of the male patient with incontinence." Curr Opin Urol 24.6 (2014): 553-559.
Sjöström, M., et al. "Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training." BJU Int 116.6 Dec. 2015: 955-964. doi: 10.1111/bju.13091. Epub 2015 Jun 3.
Stafford, R.E., J.A. Ashton-Miller, et al. "Pattern of activation of pelvic floor muscles in men differs with verbal instruction." Neurourol & Urodyn 35.4 (2016): 457-463.
Urology Care Foundation. "What Are Pelvic Floor Muscle (Kegel) Exercises?" Apr. 20, 2018. <http://www.urologyhealth.org/urologic-conditions/pelvic-floor-muscles>.
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