male pelvic muscles

There is a complex neurovascular bundle found on either side of the prostate within its fascial sheath. These nerves are particularly responsible for erectile function. This neural plexus is often damaged during the surgical removal of the prostate. In 1982 two Surgeons Walsh and Donker pioneered the nerve-sparing surgical procedure when conducting a radical prostatectomy.[2] Before this, the neurovascular bundles were simply removed along with the prostate leading to complete, incurable erectile dysfunction and severe incontinence. Since then the procedure of performing a prostatectomy has been significantly refined and there are now 3 types of procedures, non-nerve-sparing (usually for severe cancers that have spread), unilateral nerve-sparing and bilateral nerve-sparing.[3]

The length of the urethra that runs through the prostate is surrounded by the sphincteric muscle.[1] The proximal sphincter is made up of smooth muscle as is responsible for closing the urethra during ejaculation to prevent retrograde ejaculation (sperm entering the bladder). The distal sphincter is made of more striated muscle and damage to this sphincter (through surgery) can lead to incontinence.[1]

The male pelvic floor muscles make up a dome-shaped structure in the pelvis (similar to a hammock). They are responsible for the maintenance of continence, sexual function and pelvic organ support. The pelvic floor muscles are comprised of 3 layers and have a complex relationship with the surrounding bony pelvis, fascia, ligaments and nerves.[4]

The superficial perineal pouch is the most superficial of the layers and is made up of the bulbospongiosus, ischiocavernosus, superficial transverse perineal and external anal sphincter. This layer of muscles is particularly involved in ejaculation as well as urinary and faecal continence.[4][5]

An erection occurs due to a complex interaction between the vascular system, the parasympathetic, sympathetic, somatic and central nervous system with hormones and the muscular system also playing a significant role. An erection occurs when blood flows into the corpus cavernosa (tubes within the penis) faster than it can leave the penis and a closed hydraulic system maintains the erection.[4]

A correct pelvic floor muscle contraction combines the closure of sphincters, as well as a general upward lift of the muscles (think of lifting the bladder towards the belly button)[3] Pelvic floor physiotherapy for underactive or overactive pelvic muscles has been found to be beneficial in male patients.[6]

When activating specific areas of the pelvic floor to target continence and sexual function it can be helpful to divide the hammock into 3 sections a front, middle and back. Different cues can be used to activate the different areas. “Shorten your penis” and “stop the flow of urine” can be helpful activating the anterior and middle sections for erectile function and urinary continence while “tighten around the anus” is more helpful for the posterior region and faecal continence.[7]