The Bladder Changes No One Warns You About in Perimenopause

When you hear the words "pelvic floor," what comes to mind? For many people, it's pregnancy, childbirth or women's health. But here's something that surprises many of our male patients: Men have a pelvic floor too. And when these muscles aren't working as they should, they can contribute to a wide range of symptoms that are often overlooked, misdiagnosed or simply accepted as "part of getting older." The good news? Many pelvic floor issues are treatable, and you don't have to live with them. What is the pelvic floor? The pelvic floor is a group of muscles that sits at the base of the pelvis like a supportive hammock. In men, these muscles help: support the bladder and bowel control urination and bowel movements contribute to sexual function provide stability for the pelvis and lower back coordinate with your breathing and core muscles. Like any other muscle group, they can become weak, overactive, poorly coordinated or painful. 1. You're going to the toilet "just in case" Do you find yourself using the toilet before leaving the house, before meetings or whenever you see a bathroom—even when you don't really need to go? While this habit can seem harmless, it may contribute to bladder urgency over time. If you're frequently: rushing to the toilet needing to urinate often waking multiple times overnight struggling to hold on, your pelvic floor and bladder coordination may be worth assessing. 2. You leak urine Bladder leakage isn't just a women's issue. Some men notice leakage: after prostate surgery during exercise when coughing or sneezing after they've finished urinating (post-void dribbling) without warning. Many men are embarrassed to bring this up, but it's a common reason to see a pelvic floor physiotherapist. 3. You have ongoing pelvic pain Pain in the pelvis isn't always coming from the prostate. Persistent pain may be felt in the: perineum (between the scrotum and anus) tailbone lower abdomen groin penis testicles hips. In some men, overactive or sensitive pelvic floor muscles contribute to these symptoms. 4. You struggle to empty your bowels Your pelvic floor muscles need to relax for a bowel motion to pass comfortably. If they don't coordinate well, you may experience: constipation straining incomplete emptying prolonged time on the toilet. Improving pelvic floor coordination can be an important part of managing bowel symptoms. 5. Sitting is uncomfortable Does sitting for long periods increase your discomfort? Persistent aching around the tailbone, deep pelvis or perineum may be related to several different conditions, including pelvic floor dysfunction. A comprehensive assessment can help identify contributing factors. 6. Sex has become painful—or isn't functioning the way it used to The pelvic floor also plays an important role in sexual health. Pelvic floor dysfunction may contribute to: pain during or after ejaculation erectile dysfunction in some cases reduced confidence pelvic muscle tension during intimacy. Because sexual function can be influenced by many factors—including cardiovascular health, hormones, medications and psychological wellbeing—it's important to have a thorough assessment to understand what's contributing to your symptoms. 7. You've had prostate surgery Pelvic floor physiotherapy is commonly recommended before and after prostate surgery. Treatment may help improve: bladder control confidence returning to activity pelvic floor muscle coordination recovery following surgery. If you're preparing for prostate surgery, seeing a pelvic floor physiotherapist beforehand can help you learn the correct exercises and what to expect during recovery. It's not always about weakness One of the biggest misconceptions is that pelvic floor problems are always caused by weak muscles. In reality, some men have pelvic floor muscles that are too tight, don't relax well or aren't coordinating properly. That's why doing pelvic floor exercises you find online isn't always the best approach. A personalised assessment is the safest way to determine what your body actually needs. When should you see a pelvic floor physiotherapist? Consider booking an assessment if you have: bladder leakage urinary urgency or frequency constipation or straining pelvic or tailbone pain pain around the penis, scrotum or perineum pain with ejaculation difficulty returning to exercise after prostate surgery ongoing symptoms that aren't improving. Many men wait months—or even years—before seeking help because they assume these symptoms are normal. They're common, but they aren't something you have to simply live with. Frequently Asked Questions Do men have pelvic floor muscles? Yes. Men have pelvic floor muscles that support the bladder and bowel, assist with continence, contribute to sexual function and work with the core muscles to provide stability. Can a pelvic floor physiotherapist help men? Absolutely. Pelvic floor physiotherapists assess and treat a range of conditions affecting men, including bladder leakage, pelvic pain, constipation, and recovery after prostate surgery. Should men do Kegel exercises? Not always. While pelvic floor strengthening is beneficial for some men, others have muscles that are overactive or poorly coordinated. An assessment helps determine whether strengthening, relaxation or a combination of approaches is most appropriate. The Bottom Line Pelvic floor problems are far more common in men than many people realise. Whether it's bladder leakage, pelvic pain, constipation or changes in sexual function, these symptoms are not something you should ignore or simply put down to ageing. The first step is understanding what's causing your symptoms. From there, a pelvic floor physiotherapist can develop a personalised treatment plan to help you regain confidence, comfort and control. You don't have to put up with pelvic floor symptoms just because you're a man. If something doesn't feel right, book an assessment with one of our pelvic health physiotherapists and take the first step towards getting back to doing the things you enjoy.

If you've ever leaked urine when you coughed, sneezed, or exercised, chances are someone has told you to "just do your Kegels." It's one of the most common pieces of advice given for pelvic floor issues—but it's not always the right advice. In fact, for some people, doing more Kegels can actually make their symptoms worse. The truth is that your pelvic floor isn't just about strength. It's about strength, coordination, flexibility, endurance, and the ability to both contract and relax . Just like any other muscle in your body, your pelvic floor needs balance. What are Kegels? Kegels are exercises that involve consciously contracting and relaxing your pelvic floor muscles. They can be incredibly effective for some people, particularly those with weakness contributing to bladder leakage or reduced pelvic floor support. However, they're not a one-size-fits-all solution. Before starting any pelvic floor exercise program, it's important to know why you're experiencing symptoms in the first place. When should you stop doing Kegels? If you're experiencing any of the following symptoms, it's worth seeing a pelvic floor physiotherapist before continuing with strengthening exercises. 1. You have pelvic pain Pain is not usually a sign that a muscle simply needs to get stronger. Many people with pelvic pain actually have overactive or tight pelvic floor muscles that struggle to relax. Adding repeated contractions may increase muscle tension rather than improve symptoms. 2. Sex is painful Pain during intercourse can have many causes, but an overactive pelvic floor is one possible contributor. If your pelvic floor muscles are already working overtime, strengthening exercises alone are unlikely to address the underlying issue. Treatment often focuses on helping the muscles learn to relax, lengthen and coordinate appropriately. 3. You're constantly rushing to the toilet Urgency doesn't always mean your pelvic floor is weak. Sometimes the muscles surrounding the bladder and urethra remain tense, creating altered bladder signals or poor coordination. A comprehensive assessment can help determine what's driving your symptoms. 4. You struggle to empty your bladder or bowels Your pelvic floor needs to relax to allow urine and stool to pass. If these muscles don't let go properly, you may experience: constipation straining incomplete emptying difficulty starting your urine stream. Doing repeated Kegels without addressing relaxation may not be helpful. 5. You feel tight "down there" Some people describe: a feeling of pressure tightness aching muscle spasms difficulty inserting tampons discomfort during pelvic examinations. These symptoms may suggest your pelvic floor is overactive rather than weak. 6. Your symptoms are getting worse If you've been faithfully doing Kegels for weeks or months but your symptoms haven't improved—or they've become worse—it's time to stop guessing. Pelvic floor dysfunction is complex, and not every problem is solved with strengthening exercises. Isn't a stronger pelvic floor always better? Not necessarily. Imagine someone whose shoulders are permanently shrugged up towards their ears. Would giving them shoulder shrugs all day solve the problem? Probably not. Instead, you'd want to help those muscles relax, move normally and regain healthy function. The pelvic floor works the same way. A muscle that's constantly switched on isn't necessarily a strong muscle—it's often a muscle that's working inefficiently. Healthy pelvic floor muscles need to: contract when needed relax fully respond quickly generate appropriate force coordinate with your breathing and core muscles. So who actually needs Kegels? Kegels may be recommended for people experiencing certain types of: stress urinary incontinence (leaking with coughing, sneezing or exercise) reduced pelvic floor strength after pregnancy some cases of pelvic organ prolapse recovery after certain surgeries. Even then, the exercises should be tailored to your individual needs rather than copied from an app or social media video. How do you know if your pelvic floor is weak or tight? The short answer is—you can't tell based on symptoms alone. Many symptoms overlap. For example, both weak and overactive pelvic floor muscles can contribute to: bladder leakage urinary urgency pelvic discomfort feelings of pelvic heaviness. That's why an assessment with a pelvic floor physiotherapist is so valuable. Rather than guessing, they'll assess how your muscles: contract relax coordinate respond during movement work alongside your breathing and core. From there, they can develop a treatment plan that's specific to your body and your goals. Frequently Asked Questions Can Kegels make pelvic pain worse? Yes. If your pelvic floor muscles are already overactive or unable to relax properly, repeatedly contracting them may increase tension and aggravate symptoms. An assessment can help determine whether strengthening, relaxation, or a combination of both is appropriate. Should I stop doing Kegels if they hurt? Pelvic floor exercises shouldn't be painful. If they cause discomfort or worsen your symptoms, stop the exercises and seek advice from a pelvic floor physiotherapist. Are Kegels bad? Not at all. Kegels are an effective treatment for many people—but only when they're prescribed for the right reason. Like any exercise, they work best when they're matched to the individual rather than applied as a universal solution. The Bottom Line Kegels can be incredibly effective—but they're not the answer to every pelvic floor problem. If you've been doing pelvic floor exercises without improvement, or you're experiencing pelvic pain, painful intercourse, constipation or difficulty emptying your bladder, your muscles may need a different approach. A pelvic floor physiotherapist can assess exactly how your muscles are functioning and develop a treatment plan that's tailored to your needs—not just your symptoms. Don't guess whether you should be doing Kegels. If your symptoms aren't improving, book a pelvic floor assessment and find out what your body really needs.

When most people think about constipation, they picture bloating, hard stools or not being able to go to the toilet. But what many people don't realise is that constipation can also contribute to pelvic pain. If you've been experiencing aching in your pelvis, pain around your tailbone, discomfort with sitting, bladder urgency or even pain during sex, your bowel could be playing a much bigger role than you think. The good news? Once constipation is identified and treated, many people notice improvements not only in their bowel habits but in other pelvic symptoms as well. Can constipation really cause pelvic pain? Yes. Constipation can contribute to pelvic pain in several ways. When stool remains in the bowel for too long, it becomes larger, drier and more difficult to pass. This can place extra pressure on the muscles, nerves and organs within the pelvis. Over time, repeated straining or difficulty emptying the bowels may also affect how your pelvic floor muscles function. The result? Pain, tension and symptoms that extend well beyond the bowel itself. How are the bowel and pelvic floor connected? Your pelvic floor muscles form a supportive sling at the base of your pelvis. These muscles help control: bowel movements bladder function support for your pelvic organs sexual function pressure within your abdomen. When it's time to have a bowel motion, your pelvic floor should relax and lengthen to allow stool to pass comfortably. If these muscles remain tight or don't coordinate well, emptying can become more difficult. In some people, constipation leads to increased pelvic floor tension. In others, an overactive pelvic floor contributes to constipation in the first place. Often, it's a combination of both. Signs your constipation may be contributing to pelvic pain Everyone experiences constipation differently. In addition to infrequent bowel motions, you might notice: aching or heaviness in the pelvis pain around the tailbone lower abdominal discomfort pain with prolonged sitting bladder urgency or frequency pain during or after bowel motions discomfort during sex a feeling that you can't completely empty your bowels. These symptoms don't automatically mean constipation is the cause, but they're clues that your bowel and pelvic floor deserve a closer look. The hidden role of straining Many people think straining is simply part of being constipated. It isn't. Repeatedly straining to empty your bowels places extra pressure on your pelvic floor and surrounding tissues. Over time, this may contribute to: pelvic pain haemorrhoids anal fissures pelvic organ prolapse bladder symptoms increased pelvic floor muscle tension. Learning to empty your bowels without excessive straining is an important part of pelvic health. Could your pelvic floor be making constipation worse? Yes. Some people have a pelvic floor that doesn't relax properly during a bowel motion. Instead of opening and lengthening, the muscles tighten or contract, making it difficult for stool to pass. This is sometimes referred to as dyssynergic defecation or pelvic floor dyssynergia, and it can lead to: prolonged time on the toilet excessive straining incomplete emptying repeated constipation despite eating enough fibre and drinking plenty of water. This is one reason why constipation doesn't always improve with diet alone. It's not always about eating more fibre Increasing fibre is often helpful—but it's not the answer for everyone. If your pelvic floor muscles aren't coordinating properly, adding more fibre without addressing the underlying issue may leave you feeling even more bloated or uncomfortable. That's why it's important to understand why you're constipated rather than simply treating the symptom. How can a pelvic floor physiotherapist help? Pelvic floor physiotherapists regularly assess and treat constipation that's related to pelvic floor dysfunction. Your assessment may include: bowel habits toileting posture pelvic floor muscle function muscle relaxation and coordination breathing patterns abdominal muscle function lifestyle factors. Treatment may involve: education about healthy bowel habits improving toileting posture breathing techniques to reduce straining pelvic floor relaxation training strategies to improve bowel emptying exercises to restore muscle coordination. If needed, your physiotherapist may also work alongside your GP, gastroenterologist or colorectal specialist to ensure all contributing factors are addressed. When should you seek help? It's worth seeing a healthcare professional if you: have constipation lasting more than a few weeks regularly strain to pass bowel motions feel like you can't empty completely experience pelvic pain alongside constipation notice blood in your stool (this should always be medically assessed) develop new or unexplained bowel symptoms. Early assessment can help prevent constipation from becoming a long-term cycle. Frequently Asked Questions Can constipation cause pelvic pain? Yes. Constipation can increase pressure within the pelvis, contribute to pelvic floor muscle tension and lead to pain around the pelvis, tailbone or lower abdomen. However, pelvic pain has many possible causes, so an assessment is important to identify what's contributing to your symptoms. Can constipation make bladder symptoms worse? It can. A full bowel may place additional pressure on the bladder, and constipation is associated with symptoms such as urinary urgency, frequency and bladder leakage in some people. Can pelvic floor physiotherapy help constipation? Yes. If pelvic floor dysfunction or poor muscle coordination is contributing to constipation, pelvic floor physiotherapy may help improve bowel emptying, reduce straining and relieve associated symptoms. Treatment is tailored to the individual and often forms part of a broader management plan. The Bottom Line Constipation is about more than how often you go to the toilet. For many people, it can contribute to pelvic pain, bladder symptoms and ongoing pelvic floor dysfunction that affects everyday life. If you've been treating constipation without success—or you're living with pelvic pain and haven't considered your bowel—it's worth looking at the bigger picture. You don't have to live with constipation or pelvic pain. Our pelvic health physiotherapists can assess how your bowel and pelvic floor are working together and develop a personalised treatment plan to help you move, sit and go to the toilet more comfortably.