We are thrilled to have a guest post from Dr. Faunice Rebecca Jackson, DPT discussing self treatment strategies for erectile dysfunction. This a sensitive issue that most men do not disclose with their physician, let alone their physical therapist. As we learn in this article, erectile dysfunction describes both the inability to maintain and sustain an erection. Seeking help from a physical therapist that specializes in pelvic health can significantly reduce pelvic pain and erectile dysfunction. If you thought Kegels were only for women…think again. Pull up a chair men!

 

Erectile dysfunction (ED) is a condition that no one wants to have. Still, most men are not taking the necessary steps to educate themselves about ways to prevent it. Studies have shown that 60% of men have erectile dysfunction by the age of 50 (Kampen et al, 2003). 17% of men over the age of sixty have urinary incontinence (loss of bladder control). Research shows that individualized pelvic floor muscle training programs can improve erectile dysfunction in 75% of men (Nygaard et al, 2008). With the proper education of pelvic floor exercises we may be able to eliminate and prevent muscular related erectile dysfunction completely.

Erectile dysfunction is not only considered failure to get an erection, it is also failure to maintain an erection. Trust me, both you and your partner will be happy that you learned how to get those pelvic floor muscles nice and strong! Muscular endurance is key for a happy and healthy sex life.

3 Major Types Of Erectile Dysfunction.

1. Vascular (Blood Flow)

Vascular related erectile dysfunction accounts for about 25% of erectile dysfunction. This is caused by plaque build up in the arteries or coronary artery disease. Coronary artery disease is treated with aerobic exercise and medications. That is why Viagra, a popular medication prescribed to men for erectile dysfunction, is a vasodilator. A vasodilator makes the blood vessels bigger in diameter and allows the blood to flow freely to help maintain an erection.

2. Psychological

The second type of erectile dysfunction is psychological. There is no research to tell us how often erectile dysfunction is psychological. However, I think that all of us can agree that, in order to perform, a person generally needs to be in the mood with good head space.

This is often clinically treated by couples counseling or sex talk therapists. Having open and honest communication with your partner can help. It is okay to say that you are just not in the mood. Sometimes even if you want to be in the mood your mind can be racing and prevent optimal sexual function. If you and your partner have been fighting it may help to talk about the issue calmly and resolve the argument prior to having sex. Try not to be frustrated. This type of erectile dysfunction is not permanent and likely happens to all men at some point in their adult lives.

9 Strategies For Getting Out Of A Rut:

1. Trying a new sex position
2. Not rushing foreplay
3. Making things spontaneous
4. Roll playing
5. Going on a romantic date
6. Writing each other cards of affirmation
7. Cooking a nice meal together or going on a walk
8. Writing down a few reasons why you love each other or find your partner sexy
9. Planning just to cuddle and watch a movie or be intimate in a way that does not include intercourse.

There are many special moments that you can share with your partner that do not include intercourse. 

3. Muscular Related Erectile Dysfunction

Many individuals who believe they are doing Kegels correctly are NOT.  If you aren’t doing Kegels… it may be time to start. 

The third type of erectile dysfunction, that is much less publicized, but far more common, is muscular related erectile dysfunction. In the absence of adequate pelvic floor muscle strength or endurance male erectile dysfunction may occur.

This is the type of erectile dysfunction that we will be discussing the treatment for today. I will outline general pelvic floor muscle exercise principles. However, this article pails in comparison to seeking treatment from a pelvic physical therapist. You can find a pelvic floor physical therapist at Herman and Wallace and Woman’s Health Section of the American Physical Therapy Association website.

What Is The Pelvic Floor?

The pelvic floor is a group of muscles that are at the bottom of your spine and make a hammock at the base of the pelvis.

The pelvic floor provides postural stability. It is composed of approximately 80% endurance slow twitch fibers, the muscles that help marathon runners, and 20% quick flick fibers, the muscle type that helps sprinters. Exercise dosing should take this into consideration. Holding a pelvic floor muscle contraction longer to tap into the endurance fibers will provide the best outcomes. 

 

Do I Really Need To Know The Anatomy?

Being able to visualize these muscles can have a dramatic impact on your ability to use them correctly.

1. The Superficial Layer

   The superficial layer, or outside layer, is the layer that we are most concerned with for erectile dysfunction.

2. The Middle Layer

   The middle layer is composed of round sphincter muscles that help maintain continence (voluntary control of urination). These muscles prevent you from leaking urine, stool, or gas at socially inappropriate times.

3. The Deep Layer 

   The deep layer is the work horse of the pelvic floor. It assists with spinal stability, organ support, balance, continence, and sexual function.

 

 

4 Main Types Of Pelvic Floor Contractions

1. Monophasic [Single Kegels]

2. Quick Flicks [Sounds Like A Netflix Deal… It’s Not.]

3. Long Holds

4.  Eccentric Contractions [Elevator Kegels]

I will walk you through each type of contraction. Describing their usefulness in prevention of erectile dysfunction. Keep in mind that biofeedback tools offered by pelvic health specialists provide optimal outcomes. 

Biofeedback ~ Tools that often include electronic monitoring devices that tell you if you are contracting the muscles appropriately. Often times, people will not contract these muscles optimally or compensate with large muscle contractions. Such as the abdominals and gluteals.

How Do We Contract These Muscles? Kegel Time!

1. Monophasic Contraction [Single Kegel]

Used for INITIAL muscle education.

When first learning how to recruit the pelvic floor muscles you may want to contract the muscles that you would use if you were preventing yourself from passing gas on an elevator. Or the ones used to cut off the flow of urine.

Monophasic contractions consist of engaging the muscle then relaxing the muscle. This is what people typically think of when they hear Kegel. Unfortunately, short duration contractions only use fast twitch muscle fibers, like the sprinters. These fibers only make up a minority of the pelvic floor muscle composition. So it does not help prevent erectile disfunction or incontinence.

*Caution: it is okay for  people to practice cutting off the flow of urine mid-stream to learn to recruit the muscles. However, if repeated too often this can cause urinary tract infections or increased urinary retention.

2. Quick Flick Contraction

The first phase when working toward ENDURANCE of the pelvic floor.

Quick flick pelvic floor muscle contractions consist of a series of multiple contractions followed by a period of rest. 

These are also useful for the treatment of urinary urgency. If you always feel like you need to go to the bathroom.

Many people with pelvic floor muscle dysfunction have an inability to actually isolate these muscles. When these muscles are weak you may be unable to perform a contraction when battling gravity (standing or sitting positions). In this case, starting on your back may be necessary. If your muscles are weak, you also might not be able to tell when you have lost the contraction. Performing repeated contractions (quick flicks) is a good way to establish some control. 

Working on endurance will help you sustain contractions longer. Leading to an improved ability to SUSTAIN an erection.

3. Long Hold Contraction

You are performing a Kegel for a prolonged amount of time.

Your first goal should be to perform a pelvic floor contraction for at least 10 seconds. 

The majority of your muscular training for the treatment and prevention of erectile dysfunction should focus around long hold pelvic floor muscle contractions.

Long holds Kegels are more functional. They are relevant for stress incontinence. Stress incontinence is the loss of bladder control with moving around, sneezing, lifting and running. This contraction uses primarily slow twitch fibers, the marathon runners again.

4. Eccentric Control Contraction 

Time to work on some ELEVATOR KEGELS.

 Elevator Kegels, are used for people that have graduated from basic training and are ready for advanced muscular control. Please do not skip steps!  Gradually build up to this type of contraction. 

Eccentric Contraction~ “During these contractions, the muscles lengthen while producing force—usually by returning from a shortened position to a resting position. Similar to lowering the weight back down during a biceps curl is an eccentric contraction for the biceps.” (sparkpeople.com)

Elevator Kegel~ Start by recruiting the pelvic floor muscles at 25% of maximal capacity, then 50% , then 75%  then 95% , then 75%, then 50%, then 25% , and then rest. Like an elevator… get it?!

This is important for full sexual function. If you are trying this at home you may have to close your eyes and really focus on what you are doing. Seeing the best results may require use of a biofeedback device with a skilled therapist. See links earlier in article for  local pelvic health therapists.

Am I Doing These Contractions The Right Way?

1. The Feel Test

One way to check if you are preforming a Kegel correctly is to press firmly just to the inside of your sit bone, let your fingers sink in deep. When the contraction is preformed correctly, you should feel the muscle lift.

2. Mirror Test

The sphincter muscles should squeeze or tighten like putting a crimp in a hose. The anus should wink.  😉

During a pelvic floor muscle contraction the muscles should squeeze and then actually lift upward. Think of a trampoline. When the muscle is relaxed the trampoline sags without spring in a bowl shape. When the muscle contracts it flattens out and lifts up like a springy trampoline. This can be visually observed by looking at the the spot between your anus and your testicles. In the mirror it should raise in the direction of your head.

You should actually see the penis rise or nod forward slightly if performed correctly.

3. The Pee Test

Practice cutting off the flow of urine midstream. If you can stop it completely without dripping then you are using the right muscles. As we mentioned earlier, do not make a habit of this. Doing this too often can lead to urinary tract infections. 

 

Consider Body Position If Gravity Is Holding You Down

If you are having a hard time doing a basic contraction, try performing exercises while lying down. People with weaker pelvic floor muscles may struggle to work against gravity. Eventually progress to sitting and standing as your pelvic floor contractions strengthen.

 

HOME EXERCISE PLAN

GOAL: 100 to 200 Kegels/Day, 10 Second Holds.

How To Perform Pelvic Floor Contraction

Contract the muscles that you would use if you were preventing yourself from passing gas on an elevator or cutting off the flow of urine.

How To Tell If You Are Doing It Right

1. The Feel Test
2. The Mirror Test
3. The Pee Test

*Caution: Slowly increase frequency, intensity, and duration of pelvic floor muscle contraction to prevent muscle soreness which can present in the pelvic floor as a general ache, or change in urinary symptoms. If this happens stop the experiences.

Phase 1 (Single Kegel)

Learn how to locate and contract the pelvic floor muscles.

Engage the muscle and relax the muscle. Progress if you are able to feel the contraction. The Feel Test, The Mirror Test and The Pee Test come in handy here.

 

Phase 2 (Quick Flicks)

Increase your endurance slowly. 

Quick flick pelvic floor muscle contractions consist of a series of contract, recontract, recontract, recontract, recontract and rest.

Prescription: 

• 3 sets of 10 quick contractions
• 5 second rest between contractions
• 30 seconds to 1 minute of rest in between each set

 

Phase 3 (Long Hold Contractions)   

Build muscle STRENGTH and ENDURANCE.

GOAL: You should be able to hold Kegel contractions for 10 to 20 seconds, at least 15 to 20 times in a row with 15 to 20 second rest breaks in between.

 

Phase 4 (Elevator Kegels)

Become more SKILLED at accessing your pelvic floor by varying strength of contractions and control with contractions.

Start by recruiting pelvic floor at  25% of maximal capacity, then 50% , then 75%,  then 95% , then 75%, then 50%, then 25% , and then rest.

 

Are You Having Pain With Kegels?

*Caution:  If you develop increased pelvic or penile pain after starting a Kegel exercise program then stop doing Kegels and contact a health care provider.

If pelvic floor muscles are too tight then Kegel exercises will make your symptoms WORSE. This condition can be easily treated by a pelvic physical therapist by gently stretching the pelvic floor muscles.

Note~ pain during intercourse, ejaculation, or urination is not normal. If you are experiencing pain you should contact a health care provider. It may be either related to a sexually transmitted disease or pelvic floor muscles that are too tight.

 

Exercises That May Negatively Impact Pelvic Floor Health 

It is important to understand that some exercises may be weakening your pelvic floor. Most exercises are safe if you preform them correctly. Choosing a weight that all of your muscles can tolerate is important. Your quadriceps may be holding up with your squat, but how are your pelvic floor muscles doing?

1. Exercises performed with Valsalva Maneuver (Breath Holding)

Performing exercises where you hold your breath may be unhealthy for your pelvic floor. This can result in bowel and bladder continence issues (leaking urine and fecal matter) and erectile dysfunction.

2. Heavy Weighted Jumping

Jumping is hard on the pelvic floor due to the recoil that occurs after impacting the ground. When you jump your pelvic floor should contract before your feet hit the ground. In severe cases, if a person is jumping with weights and their pelvic floor is not strong enough it can cause pelvic organ prolapse. This is a condition where your internal organs begin to drop down in your pelvis, which is the wrong place! In women,  the organs can drop through the vaginal canal and in men it can drop down into the rectum towards the anus.

TIP:  When lifting weights you should brace your trunk muscles and your pelvic floor during the entire movement. Contracting the pelvic floor helps to stabilize the base of the spine preventing low back injuries. It also helps to maintain pelvic floor strength and integrity during an exercise. If you cannot maintain the Kegel contraction during the entire weight lifting activity try reducing the weight, repetitions and/or time under load. 

3. Long Distance Running

Many young woman and men will leak small amounts of urine or notice fecal staining on their underwear after a long run. This leakage usually occurs as the heel of your foot impacts the ground. This does not mean you need to discontinue running. Instead, you need to start focusing on maintaining a light pelvic floor contraction at about 25% of strength.

This can be achieved either with one very long and light hold of the pelvic floor muscles or a series of pelvic floor muscle contractions prior to your foot hitting the ground. The timing is very hard to master and will take practice. Eventually it will become automatic, no longer requiring conscious thought. 

For long distance runners, you should train your pelvic floor while preparing for races. Pelvic floor strength and endurance will help you maintain pelvic stability during your run. It will also increase your efficiency and performance during long runs.

 

Good Luck With Your Kegels Men! No longer are they just for women. 

Fun Facts About Pelvic Floor Health

• Normal urinary frequency: every 3-4 hours, over 65yrs 2-3 hours
• Normal urination time: Women >8 sec, Men 12-15 sec
• Normal nighttime voiding is one time or less, over 65yrs 1-2 times
• Dietary irritants or foods can affect your bowel and bladder function
• Water daily intake between 6-8, 8oz glasses
• Fiber daily recommended intake: Women 25g, Men 38g
• Your poops should pass and look like a soft banana (Bristol stool type 4)
• Normal bowel movement frequency:  Between 3x/day and 1x/ every third day
• Pain with tampons use and intercourse is abnormal

 

If you have any of the issues described in this article then you are NOT alone and there ARE things that can help! You can find a pelvic floor physical therapist in your area at Herman and Wallace and on the Woman’s Health Section of the American Physical Therapy Association website.

 

Dr. Faunice Rebecca Jackson, DPT

Faunice graduated from University of Maryland School of Medicine with her Doctorate of Physical Therapy. She has worked with pelvic and orthopedic populations. She currently is working in home health treating patients with incontinence and mobility issues. She is passionate about educating people about their body and increasing quality of life one step at a time.

 

 

 

 

References:

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