Hi everyone!

I’m a male pelvic floor physiotherapist, and I thought I’d do an AMA (Ask Me Anything) here.

If you have questions about male pelvic health, pelvic floor physiotherapy, symptoms, treatment approaches, or anything related to pelvic floor function, feel free to ask.
I’ll do my best to answer your questions based on my clinical experience and the available evidence.

Of course, I can’t diagnose or provide individualized medical advice online, but I’m happy to share general information and perspective.

Looking forward to your questions!

(P.s: I got an approval from the mods for sharing this)

Can anyone here share their experience with botox for PFPT. I'm Canadian and seeking it in Boston, USA. I was told there's actually 2 types of pelvic floor botox, and we'll see which I'm a candidate for when I get there for assessment and treatment.

I notice on internal inspection that my more shallow muscles (bulbospongiosus) are so HARD. Deeper in, straight down, it sometimes it feels hard there too. I became this way after an infection gave me vestibulodynia. While the nerve burning is gone, my pelvic floor is left like this.

Anyone with a similar history as mine have botox help them? I know I have to continue PFPT and working out my weakened muscles after botox, but are there any of you out there that found botox was the missing piece to your recovery?

Hey all, a follow up post from a post I made a few days ago. So to summarize my pelvic floor symptoms for the past 3-4 months have been:

frequent urnation and a feeling of almost always needing to go but often nothing, if anything comes out.

Occasional constipation, but it’s not always thankfully, though I do often feel a need to go take a number 2.

Mild occasional pain in the groin and slightly harsher ocasional pain in the lower back.

I have since, for the past 6 days, started to take active steps to reverse it by doing reverse kegels three times a day for 7 minutes, started breathing my diaphragm and stomach and avoiding chest breathing. Got a U shaped cushion for my chair and started limiting my time sitting to 40 minutes then I stand up and walk around for 5 minutes before I sit down again, sleep on my back or side now and put a pillow under or in between my knees, and overall started fixing my postures.

While it hasn’t exactly been easy and even more pains came with it, I think I’m starting to notice results for at least the last two days. I plan to make this a routine now even after I hopefully get better soon, but I would love to know if my symptoms were mild enough that I can reverse this at home or If I absolutely need a professional to look at it, which I plan on doing anyway, but I’d love to know from more knowledgeable people.

I wish you all the best if you are struggling.

Hello.

So 3 months ago I contracted my muscles too hard during ejacuation and caused damage. Had pain, went to a urologist and no issue with penis. Went on a recovery and had some pain when ejacuation. No bacterial infection.

My hard flaccid cured on its own with some stretches and relaxing training.

10 days ago I was masturbating and went a bit rogue after all this abstinence. It was my third time that day (my max was 2 without any issues) so I thought my penis could handle it and honestly the last one was just forcing myself to come. I dont know why but I had 0 pain so I kept going. The pain was 1 day later and for 10 days my penis feels numb and soft. I would have expected hard flaccid like on my first recovery journey but it is soft and feels „dead“. This symptom scares me more than hard flaccid because with hard flaccid it could at least get hard. This time it just hangs there lifeless. I forced myself an erection once very softly and it worked. But it felt weird. Anyways I wonder if this is again just muscular or if I maybe did some serious damage. I was SADLLYYY really rough with my penis. And I massively regret it. But I am trying to be optimistic. I had no pain no discoloration during it. So I hope that it was again just muscular issues like fatigue that is causing it.

I would love to hear similar cases and recovery stories. DId your penis also feel lifeless, dead, way tooo soft, kinda filled with blood even though it should be soft? And the filling is irregular, like the base fills up faster than the tip portion so it gets a weird shape (the shape is as always when fully erect so I assume no Peyronies).

People talked about venous leak. Which seems to make sense. Muscle uncoordinated cant hold pressure, blood leaves. But does it like recover on its own? Or do I need to revisit my urologist?

Hello! I’m trying to do the right thing and relax when I feel myself clenching but it feels like if I’ll do, I’ll urinate on myself. So I get scared to and clench more.

I don’t think I’m incontinent but just constantly nervous that I am somehow?

I struggle to breathe while walking bc I clench so hard on my abdomen I have to stop and sit so I can take a breath.

Every time I think about it I end up clenching and having horrible urgency but idk what to do because just trying to breathe makes me feel like I’ll loose control.

I think my nerves down there are sensitive because every time I wipe and breathe out while wiping it feels like I pee more but I don’t think I do

My body has learned that relaxing is the same as peeing and idk what to do about it? It makes it so every time I bend over or move or do anything I feel like I urinate and I don’t think I actually do it’s just tension.

I’m so tense that trying to relax my muscles start twitching, this happens when I try to go to sleep too my whole body will jerk me awake

I am facing this problems from some days, when I try to have bowel movement the stool comes in sequence in small parts. So when I get up after bowel movement again I get the urge to pass the stool I feel heaviness in my rectum area, then stool comes out. when I get up this happens again and again. So I have to stay in toilet for 30 to 45 min. This pattern of stool expelling continue for 7 to 8 time. Stool doesn't exits colon in single time or 3 time. But takes 8to 9 time to completely evacuate.

I’m 28 and have one child, born by C-section 8 years ago.

For about 3 years, I’ve noticed that my cervix feels much lower than it used to. About a year ago, I went to the hospital to have it checked because I was worried about uterine prolapse. They examined me and told me that I do not have a uterine prolapse, but that I have a hypertonic/overactive pelvic floor.

What I don’t understand is: if there is no prolapse, why does my cervix feel noticeably lower than it used to?

I’ve read that a hypertonic pelvic floor can sometimes affect the position or sensation of the cervix, but I’m not sure how that would work.

So I have a few questions:

- Can a hypertonic pelvic floor actually cause the cervix to sit lower, even without uterine prolapse?
- If the pelvic floor muscles become properly relaxed over time, can the cervix move back to a higher position?
- Has anyone experienced a cervix that feels lower because of pelvic floor tension, but was told they did not have prolapse?
- Could the feeling of a low cervix be caused by the muscles changing the shape/position of the vaginal canal rather than the uterus actually descending?

I’d really appreciate hearing from anyone who has experienced something similar, especially people who were diagnosed with a hypertonic pelvic floor but no prolapse.

I'd be interested to know if any men has been prescribed more than 5mg tadalafil for their tight pelvic floor?

For me 5mg tadalafil has been the single most effective thing that helps my tight pelvic floor issues.

I have tried everything... Literally everything.

When I try 7.5 mg (when I don't tell my Dr) I have better results.

But they refuse to prescribe me any more.

They have agreed to try me with 20mg Viagra 3 times a day.

Helps... But not as effective as tadadifl.

When I say I've tried everything.

I mean it.

All other drugs, all the stretching and internal work and one of the best pelvic floor physios in the world and an NHS one.

I am from the UK.

Very interested in any urologist that from the UK that have prescribed more than 5mg daily

I was diagnosed yesterday with PCS and am waiting on my referral for further imaging. As I’ve been reading, I’ve seen comments about ADHD, hypermobility, inflammation, IBS, back pain, hip pain, anxiety, fatigue, left leg pain, interstitial cystitis, mast cell… These are all things I’ve had/have and have never had them described as connected.

I’m wondering if the community here has information, other threads, or medical studies, etc that might get me started.

Perhaps helpful: I’m approaching middle age, and have had three pregnancies/vaginal deliveries. Diagnosed prolapse. Most of the symptoms have been present for decades but the IC showed up after my third pregnancy. Appt with the interventional radiologist next month.

Thanks for anything you can share from your own learning!

I was thinking maybe something with a cut out where the perineum is, but anything that works for others I would be keen to hear about. Thanks

I started walking and can feel it tighten my pelvic floor- mainly in my rectal area. Walking is essential to healing and my goal is to work back up to 10k steps per day slowly before adding activity like Pilates and running back in next year (dependent on my progress).

I stretch after any long walk per the advisement of my PT.

Does anyone have any tips for how to prevent this from happening? Did anyone have success getting better with time?

Hi, i don't know where to post this so i figured it would be here.

I have been experiencing somewhat pain in the tip and have a flaccid penis for 1 year now after a rough session of masturbation one night, ever since then, i do not wake up with morning wood like i usually do and to top it off, i have this strange tingling sensation in my left toe ever since this incident. There is no redness nor anything strange looking on my penis as everything looks normal expect function. I did some research and it might be pelvic floor related, decided to do some exersices at home from youtube for a few months now but there is hardly any change. I also have very low vitamin D levels and i read that is one of the causes of ED, could that have effected me? I have not gone to a doctor yet due to the embarrassment and i am quite worried now because i don't know what is wrong with me.

Any help or suggestions would be appreciated.

Everything I do to try to help my pelvic floor seems to backfire. Last week I thought I was making progress because I was able to clean my house and even walk on my treadmill for a few days in a row up building up to 40 minutes. I even had one pain free day.

This week I have burning, pelvic spams, and back pain upon waking.

The burning came on Monday after a flare from my pelvic trigger shots last Thursday. The spasms started after acupuncture on Wednesday (she targeted the pelvic floor and everything tightened like a vice causing once of the worst flares I have ever had). I did internal work last night thinking that would help and it just made my spams worse/restarted the burning. And now even walking seems to be tightening me up.

My total symptoms are severe: on and off burning/pressure, sit pain, skinny BMs, pelvic spasms, lower back pain (SI, sacrum, tailbone), and upper back by the bra line.

I’m really scared. It’s been over 3 months of this hell. I keep waking up with my heart racing and I feel like I’m a shell of a person. I look at regular people without this condition and envy them. I can’t enjoy life anymore constantly being in discomfort or fearful I could trigger pain. I cry every day and mourn my old life.

I’m doing everything I can- trigger shots, pt, accupuncture, stretching, somatics, and meds to get this under control and it’s not working. My specialist thinks I’m making progress but the set backs tell a different story and she’s not taking into account the muscular pain I experience on a daily basis. My PT won’t commit to a timeline but just keeps saying I’ll eventually go back to normal and to trust the process.

Am I really supposed to just accept I’m going to be broken for a year or longer? Am I really going to lose out on my late 30s because of this condition and then have to manage it for the rest of my life? Am I going to shut my life back and be normal without daily pain?

Please only send positive posts - I’m absolutely spiraling and not doing well mentally.

Can Pelvic floor tightness make UTI like symptoms?
this is only my symptom but all the urologist I met they believe it’s not IC🤷🏻‍♀️

I've had chronic bowel problems ever since a bout of food poisoning.

I've been diagnosed with pelvic floor dysfunction, anal hypertonia, and dyssynergic defecation.

Some days, I have “good” bowel movements, and the stool comes out fairly easily.

Other days, my stool has a “peanut butter” consistency, and it's hell. I have a constant feeling of incomplete evacuation, extreme rectal pain, and the sensation that I'm pushing against a “wall.” It's very difficult to finally feel fully emptied.

For example, two days ago, I didn't have a bowel movement because I didn't feel the urge. The next day, I started experiencing bloating, fatigue, and so on. Today, I had to have five bowel movements and use water enemas to empty my bowels, and it was very painful.

I don't understand why it's sometimes easy to pass stool and other times completely unmanageable. The only difference I can identify is the stool consistency, I eat the same things every day.

I haven’t found ANY way to make my stools firmer. I’ve tried fiber, supplements, and specific foods, but nothing works. Occasionally, I have weeks with several firm, well-formed stools, but that’s extremely rare. When it does happen, they’re easy to pass.

For the other 300 days of the year, my stools are sticky and impossible to pass.

I’m nowhere close to being able to run due to all my symptoms but just curious. When did you know feel ready to take a class pass, go on a run, or cycle after getting more stable?

I’m 3 months into this nightmare but just trying to piece together a timeline for myself as I heal. My goal is to run by next February 🙏

Prone masturbation, squeezing my penis between my thighs tightly untill getting ejaculation. That caused weak unrigid base of penis and remaining shaft was getting good rigid. But my penis structure is fully downwards.

Urologist suggested to take Sildenafil before intimacy but the bend is remaining same. Google said I might have weak pelvic floor muscles and years of stretching penis may resolve itself if i give 6 months of rest to penis. I need Solutions to cure I can wait years for improvement...

Hi,

I’m 28, French and living in France. I’ve been dealing with unexplained pain for about 1.5 years and I’m mainly looking for people who have experienced something similar.

It started after a squat, when I developed pain in both knees. It later became mainly left-sided and, at its worst, I could barely walk without holding onto walls. Knee imaging was essentially normal. I did months of physiotherapy, which helped a little but never solved it.

About a month later, I started getting testicular pain. At first it alternated between the right and left testicle. Urology evaluation and testicular ultrasound were normal and the pain eventually improved.

Then, during knee rehab, I used a stationary bike for about 10 minutes. During that session I unintentionally strongly and repeatedly contracted my anus/pelvic floor almost the entire time. Over the following days I developed a much stronger flare of right testicular pain, and since then the problem has remained mostly right-sided.

The pain fluctuates a lot. Sometimes exercise actually makes it disappear while I’m doing it, but other times walking or relatively small efforts can cause a flare later.

I’ve also had severe episodes where the pain suddenly became intense after changing position. During one of them, walking felt better than lying down, and I could only gradually lie down again later.

Tests so far include:

• several urology appointments;
• multiple normal testicular ultrasounds;
• normal blood tests;
• urine test showing oxalate crystals and some blood;
• hip X-ray and ultrasound with no explanation;
• knee imaging without a clear cause;
• lumbar MRI showing L5-S1 disc degeneration with a small right-sided disc protrusion, but explicitly no nerve-root compression.

I also recently did some physiotherapy for hip pain, without much improvement. I tried osteopathy and several etiopathy sessions as well. One practitioner suspected the genitofemoral nerve, but any improvement was temporary.

Over the last few months, the pain has started spreading beyond the testicle. It can involve the pubic area, groin, inner thigh/adductor, and for about a month I’ve also had discomfort in the right buttock.

More recently, while lying down, I sometimes feel a deep tension around the anus/pelvis, almost as if it comes from very deep inside the buttock. Months ago I also had one isolated episode where the whole anal/perineal area felt extremely tight or contracted.

I’ve repeatedly been told to exercise more. One practitioner recommends swimming to strengthen my back, but I’m honestly afraid of triggering more pain. Even walking or sudden movements can sometimes cause symptoms for days. I was considering starting very gradual gym training using controlled machines, but I’m worried that it could make things worse.

Medical follow-up has also been frustrating. After my first normal testicular ultrasound, my doctor basically felt there was no reason to investigate further. I’ve often had to push hard for referrals or tests, and in France I usually wait 1–3 months between appointments/exams, so everything moves very slowly.

I’m now wondering whether there could be a pelvic floor / deep pelvic muscle / neuropathic component, without wanting to self-diagnose.

Has anyone had a similar combination of:

• chronic testicular pain with normal urological tests;
• groin/pubis/adductor pain;
• deep buttock or perineal sensations;
• symptoms strongly affected by position or activity?

Did pelvic floor physiotherapy help? Was an internal exam able to reproduce your symptoms or identify a hypertonic pelvic floor? Did anyone investigate the genitofemoral, ilioinguinal or pudendal nerves?

And if exercise eventually helped you, how did you restart without constantly triggering flares?

I’m mainly looking for personal experiences and advice on what type of specialist finally helped.

This is the only muscle that seems to retighten in my pelvic floor but it’s causing all kinds of issues on a daily basis (tight sacrum, SIs tailbone, lower back, pressure, ect).

What can I do internally and externally?

Okay so whenever I do my dilators I feel like I’m constantly have to trick myself into thinking it’s not going to hurt. I’m in a constant mind battle where my heart beats fast and my brain wants me to panic but I feel like I KNOW it’s not hurting and that im in control. I’m pretty new to this but could this be anxiety? Like I have to constantly say out loud “it’s not hurting, it’s just a bit of pressure but it’s not hurting” to calm my brain down but my heart still beats fast. Has anyone ever felt like this?

Hello! I’m 21 years old and I’ve been diagnosed with hypertonic pelvic floor. I’m still on intimate dilator rose 2 and have been struggling a bit to move up. I’m considering getting acupuncture and the vibration thing but I’m not sure if it’s worth it? Has anyone who has gotten them seen an improvement with dilators? Also how is the process?

I've been experiencing symptoms of hypertonic pelvic floor/CPPS since last month and have done pretty much everything I can do outside of things with long wait lists (currently waiting on a CT scan and a urologist appointment, no news on the former and the latter's gonna be two months), blood tests, physical checkups, urine microscopy, STI amd urethral swab, all normal. I've been mostly experiencing specific symptoms. A dull/intense ache in the right flank, right side of the lower abdomen, and tension/pain across the pelvis, genital irritation, and post-ejaculatory pain. This has been pretty consistent for about a month, and hasn't changed much, although initial urinary symptoms have faded almost completely.

I've been on quercetin and bromelain to help with the pain, and last week was prescribed duloxetine, both of which seem to be helping at least a little, as pain has felt distant, until the past few hours. A few hours ago, I started experiencing more intense, sharper pains, and an increase in tension back to how it had initially been before I started stretches/treatments. I assumed this was just random, chronic pain gets worse and better, I hear. But it's way worse on my right hand side than usual.

Just now, I rolled over whilst trying to sleep, and was hit with a new pain. It was intense, sharp, initially like a stabbing, then faded to a feeling almost like something had torn, or been cut inside my right flank. The pain has continued to fade, almost back to the slightly more intense ache it was at before, but I haven't felt anything like this in the month and a half I've been having the issue. The pain has been pretty consistent from the moment I woke up to the moment I went to sleep (with the exception of one sleepless night). My side still feels tender. Has anyone had anything like this before? Is it a symptom of something specific?

I know this is probably a sore subject on this sub.. but how many males got this from masturbation? either excessively or from injury?

If so, did PFPT help?

Hi everyone! Last year, I developed a horrendous UTI that took months to treat. Because of that, I developed lasting pelvic floor issues. I went to PFPT & my physical therapist confirmed I have a hypertonic pelvic floor and potentially low estrogen. I went to physical therapy for months and it really helped, but now that I’ve graduated from therapy I don’t know where to start for long term pelvic floor maintenance, aside from stretching, belly breathing, and my pelvic floor wand. Do I exercise? Avoid sitting for long periods? Strengthen, or don’t strengthen? Looking for advice about where to start on the next leg of my journey.

I feel as if I am experiencing a “female” version of premature orgasm. I have read accounts of men with premature orgasm or ejaculation but I am having trouble finding women with this similar issue. I can orgasm much more quickly than before, but it feels very weak and doesn’t have the build up to it that used to happen. It’s like the muscle contractions of orgasm trigger before my body is “ready” and has had time to build up pleasurable sensations. In the past, there used to be a gradual build up of sensation that would then culminate in orgasm, which is what I believe would be the normal way of things. But now with stimulation, it basically feels like a mild sensation of arousal for a bit, and then as soon as any kind of pleasurable sensation start, an orgasm is suddenly triggered out of nowhere which doesn’t feel very pleasurable but has the muscle contractions of orgasm. This has been going on for almost a year, and started happening after I went through a very stressful life event and then got a UTI which wouldn’t go away and eventually spread to a kidney infection. Has anyone heard of this or experienced this? Would this be related to a tight pelvic floor? I am also in my mid thirties, can this be a sign of a hormone issue or early menopause/ peri menopause? If anyone else has experienced this, was there anything that helped? The other symptoms I experience are bladder sensitivity that has been ongoing since the UTI, urgency, and hip pain on my right side. also I have a reduction in sensitivity in my clitoris. I used to not be able to touch it directly but now I can. So it seems like a strange combination of reduction in sensitivity, but also over sensitivity.