The pelvic floor is commonly overlooked when discussing men’s health. Think about it - it’s natural to consider your knees when you run, your back when you lift, or your shoulders if you sit at a desk all day. But the group of muscles at the base of your pelvis that support your bladder, bowel, and sexual function? This is often taken for granted or ignored - until something goes wrong.
Here’s the truth: the male pelvic floor is working in the background all day. It helps prevent urine leaking when you cough, holds in wind when you need to be discreet, supports the bowel when you use the toilet, plays a role during intercourse, and stabilises the pelvis when you move, lift, or run. When the pelvic floor isn’t working properly, whether due to weakness, tightness or poor coordination, symptoms appear. So what are these signs and symptoms? Here are five signs that you may currently be overlooking your pelvic floor.
1. You unintentionally leak urine, even if it’s “just a few drops”
Many people associate the unintentional passing of urine, even if it’s a small amount, with ageing. The truth is that it’s a sign of pelvic floor weakness, which is why we see it in healthy, active men, too. It can look like:
- A small leak when you cough, sneeze, or laugh
- A few extra drops after you finish using the toilet, or the release of urine earlier than expected
- A bit of leaking when you lift, sprint, or do high-impact exercise
What’s happening?
Your pelvic floor muscles help close the urethra and support the bladder when the pressure in your abdomen suddenly increases (coughing, lifting, landing, pushing, even running). If those muscles are weak, slow to activate, or tired from other compensation patterns, they can’t provide that quick support - so you leak.
In some men, the pelvic floor isn’t weak, it’s too tight. A chronically tight pelvic floor doesn’t switch on and off as well, so it can still underperform when you need it. That can also show up as dribbling after urination because the muscles don’t fully relax, so urine gets “trapped.”
Why it matters
Slight leakage is an early sign - and one that, if you act on quickly, can help you regain function and strength in your pelvic floor. If you ignore it, however, then other symptoms, such as urgency, frequency, and pelvic pressure, may follow. Taking action involves working with a pelvic health physio to assess whether strengthening or another treatment approach will be the best way forward for you. Your physiotherapist will also teach you how to time your pelvic floor contractions with effort and examine whole-body contributors to your pelvic floor dysfunction, such as breathing, posture, and lifting technique.
2. You regularly experience constipation, straining, or feeling not empty after bowel movements
A lot of men don’t connect bowel function to their pelvic floor, but the two are closely linked. Some signs that your pelvic floor may not be relaxing properly include:
- Strain to empty your bowels regularly
- Often feel like “it’s not all out”
- Avoid going because it’s uncomfortable
- Push hard and hold your breath to empty
What’s happening?
To empty the bowel well, the pelvic floor must relax and drop. If it’s tight or overactive - which is surprisingly common in men who lift a lot, run a lot, sit with poor posture, or hold tension in the hips - then the rectum can’t empty easily. Over time, you push harder, which actually increases pressure on the pelvic floor and can exacerbate the problem.
Constipation itself also loads the pelvic floor. Hard stools and repeated straining create downward pressure on those muscles. If you then go for a run or do heavy gym work on top of that, you’re asking the pelvic floor to cope a lot.
Why it matters
Long-term straining is a known contributor to pelvic pain, haemorrhoids, and even nerve irritation around the perineum. This is where your physio can teach you defaecation positioning (as the way you sit can matter), breathing techniques to reduce straining, and mobility work for the hips and pelvic floor so that those muscles can actually relax.
3. Your sexual function has changed without explanation
This is the one men often don’t like talking about, but it can make a big difference to their well-being. Changes to sexual function might look like:
- Difficulty maintaining an erection
- Pain or heaviness after ejaculation
- Perineal or testicular aching after sex
- A sense of “tightness” through the pelvic floor or groin
- Delayed ejaculation or feeling “blocked”
What’s happening
The pelvic floor muscles contribute to erectile function and ejaculation. If those muscles are overactive, they can create pain, pulling, or a “guarded” feeling. If they’re underactive, the blood flow and pressure mechanics involved in erection can be affected. Pelvic floor overactivity is more common in:
- Men who run or cycle a lot
- Men who brace their abdominals and glutes all day
- Men with underlying pelvic or pudendal nerve irritation
- Men who clench in response to stress
In these cases, it’s not just about strengthening your pelvic floor, but also learning to relax it.
Why it matters
Sexual symptoms often show us there’s a coordination problem, not just a strength problem. Leaving it unaddressed can feed into a pain-tension-anxiety cycle. Our pelvic floor physios can help assess your pelvic floor to identify whether the issue is around tightness, weakness, or nerve irritation (or a combination of these), and give you tailored strategies to help - often a mix of release work, breathing, hip mobility, and only then strength.
4. You get pelvic, groin, or perineal pain with running or lifting
If you’ve ever finished a run and felt a deep ache in your groin, or you get a pulling, pressured, or burning feeling between the scrotum and anus after heavy gym sessions, that’s not just part of being active. It’s often a sign of pelvic floor dysfunction. This kind of pain is often described as:
- A deep ache in the perineum
- Tailbone or sit-bone soreness
- Groin or inner-thigh discomfort after impact
- A feeling of “something being pulled up” inside the pelvis
- Irritation with sitting after training
What’s happening
Running, jumping, and lifting all increase intra-abdominal pressure and ground reaction forces. A healthy pelvic floor responds by contracting and relaxing in response to those loads. But if your pelvic floor is already tight (for example, from sitting, from previous injuries, from over-bracing), or if it’s weak and can’t share the load, the tissues and even the pudendal nerve can become irritated.
We also see this in men with imbalanced strength - strong, big muscles (quads, hamstrings, abs) but underperforming deep core and hip stabilisers - so the pelvic floor ends up doing extra work to keep the pelvis steady.
Why it matters
This is often the point where symptoms start to limit a person’s training, and men may begin avoiding running, heavy deadlifts, or longer sessions. Left untreated, this can morph into chronic pelvic pain. This is where your physio will look at:
- Your running or lifting technique
- Load progression (what changed before the pain started)
- Hip and thoracic mobility
- Pelvic floor tone and timing
Then, we build a plan to reduce irritability (down-training, manual therapy, mobility), and gradually re-expose the pelvic floor to load, allowing you to continue training.
5. You’re urinating more than you should, or not fully emptying
A healthy bladder should allow you to urinate every 2–4 hours during the day, without urgency, and you should feel empty afterwards. Signs you may need help with your pelvic floor include:
- Regularly using the toilet “just in case”
- Feeling a sudden, strong urge that’s hard to control
- Getting up at night regularly
- Feeling like you still have urine left after going
What’s happening
An overactive pelvic floor can send “protective” signals to the bladder and urethra, making them more sensitive. You get the message to go earlier than you should. On the flip side, if the pelvic floor doesn’t relax properly, the bladder can’t empty fully - so you need to go again soon after.
Sometimes men think this is to do with their prostate - and yes, the prostate can contribute, especially with age. But we also see these bladder symptoms in younger, active men with no prostate issues, and here, treating the pelvic floor calms the bladder.
Why it matters
Bladder symptoms are one of the most under-reported signs of pelvic floor dysfunction in men. They also affect quality of life quickly - planning runs around toilets, stopping mid-walk, waking overnight. This is where our physiotherapists help you with bladder control, breathing and pelvic floor release, and then layer in strength to help you feel more in control of your bladder.
If you’re worried about your pelvic floor:
Remember that pelvic floor problems rarely resolve on their own if the underlying cause is tension, poor coordination, or repeated overload. Rest might reduce your symptoms, but they usually return as soon as you load the area again. This is where physiotherapy can:
- Identify whether your issue is tightness or weakness (this is crucial as the wrong exercises can exacerbate your existing symptoms)
- Settle pain and irritation before it becomes chronic
- Improve bladder and bowel habits
- Protect sexual function
- Keep you running, lifting, and working without symptoms
The goal here is not just “no pain.” It’s better pelvic control, so you can keep doing the things that matter to you. We recommend seeing a pelvic floor physio if:
- You have symptoms that have lasted more than 2–3 weeks
- You’ve noticed bladder or bowel changes
- Pain keeps coming back after running or lifting
- You’re getting perineal or groin aching with sitting
- Sexual function has changed without a clear medical cause.
Your Appointment With Our Pelvic Floor Physiotherapists
When you visit one of our pelvic floor physiotherapists, we’ll begin by conducting a comprehensive assessment to understand the underlying cause of your symptoms and determine whether they are due to tension, weakness, nerve irritation, or biomechanical overload.
Your treatment then focuses on helping restore optimal pelvic function, rather than just providing symptom relief. If you have overactive muscles, we may explore relaxation techniques, including guided breathing, hip and pelvic mobility work, and pelvic floor release. We typically pair that with manual therapy and biofeedback to reduce muscle tone and nerve irritation. We’ll also review postural techniques, sitting habits, and stress-related clenching patterns. If your muscles are weak or poorly coordinated, we may look at targeted activation training, among other methods.
Your health and well-being are our priority. We have several physiotherapists who specialise in male pelvic health. Book an appointment online by clicking here or call us on +852 2801 4801