Kegel Exercises for Men Over 40: What Pelvic Floor Training Does for Erections, Dribbling and Leakage

Kegel exercises for men can help with erectile dysfunction and after-dribble, with the best trial showing 40% of men with ED regaining normal function. The evidence for premature ejaculation is early, and for leakage after prostate surgery it is mixed.

Do Kegel exercises for men actually work? For some problems, yes. In a randomized trial of 55 men with erectile dysfunction, pelvic floor exercises with biofeedback left 40.0% of the men with normal erectile function and another 34.5% improved. Kegel exercises for men also cut after-dribble in two small trials. For leakage after prostate surgery, the largest trial found no benefit from formal one-to-one training, and the evidence for premature ejaculation is still early.

The pelvic floor gets attention in women's health and almost none in men's, even though the same muscles sit at the base of the penis. This guide covers what the male pelvic floor does, what the trials measured for erections, dribbling, premature ejaculation and post-prostatectomy leakage, and how to do the exercises properly. Every figure comes from studies and NHS guidance opened and checked for this article.

The male pelvic floor is a sling of muscle under the bladder and around the base of the penis and the anus. The pelvic floor muscles help hold urine in, push the last urine out of the urethra after peeing, and contract during erection and ejaculation. Dorey and colleagues started their 2004 trial from that premise, writing that the pelvic floor muscles are active in normal erectile function, and tested whether weak muscles could be a cause of erectile dysfunction.

A Kegel exercise is a deliberate squeeze and lift of the pelvic floor, followed by a full release. The University Hospitals Sussex NHS leaflet for men notes that when the technique is right, a man may feel the base of his penis move up slightly towards his abdomen. That small lift is the easiest way to tell the right muscles are working rather than the buttocks, thighs or stomach.

Kegel exercises helped erectile dysfunction in the best-known trial on the question. Dorey and colleagues enrolled 55 men with erectile dysfunction at a urology clinic in Taunton, UK, with a median age of 59.2 and a range of 22-78. Twenty-eight men were randomized to pelvic floor exercises, biofeedback and lifestyle advice, and 27 controls got lifestyle advice only. After 3 months the controls switched to the exercise program, and an assessor blind to the groups measured everyone.

At 3 months the exercise group gained 6.74 points on the erectile function domain of the International Index of Erectile Function compared with controls, and their anal pressure rose by 44.16 cmH2O, a direct measure of pelvic floor strength. All of these measures improved further by 6 months, and the control men showed similar gains after they switched. Across the whole trial, 22 men (40.0%) reached normal erectile function, 19 (34.5%) improved and 14 (25.5%) did not improve.

The Dorey result needs two caveats. The program included biofeedback, where a probe shows a man how hard he is squeezing, so the trial does not show what home exercises alone would do. And it was one trial at one hospital. A 2024 meta-analysis in Andrology by Chen and colleagues pooled 7 randomized trials of exercise in men with erectile dysfunction who were not taking PDE5 inhibitors such as sildenafil or tadalafil. Physical activity overall improved erectile function with a standardized mean difference of 0.69, aerobic training alone reached 0.81, and pelvic floor muscle training showed no significant effect at 0.03.

The fair reading is that supervised pelvic floor training with biofeedback has one strong positive trial behind it, while the pooled evidence for pelvic floor training in general is weak and the evidence for aerobic exercise is stronger. For a man over 40 with erectile dysfunction, Kegels are a low-cost addition to cardio, not a replacement for it. Erectile dysfunction can also be an early sign of heart disease, which our guide to erectile dysfunction as a heart warning covers, so it deserves a medical check before any self-treatment.

Pelvic floor exercises reduced after-dribble in both trials that tested them. After-dribble, called post-micturition dribble, is the small leak that shows up on underwear a minute after a man has finished peeing. In the same group of 55 men from the Dorey erectile dysfunction trial, 36 (65.5%) reported after-dribble at the start. Their program included a strong post-void "squeeze out" contraction, which pushes the urine left in the urethra out before zipping up.

After 3 months of supervised exercise and 3 months of home exercise, 27 of those 36 men (75%) had no after-dribble, 3 (8.3%) had improved, 5 (13.9%) dropped out and 1 (2.8%) still had it. Dribble did not correlate with age, erectile function or muscle strength, so the squeeze-out habit may matter as much as raw strength.

An earlier Australian trial by Paterson and colleagues, published in the British Journal of Urology in 1997, randomized 49 men aged 36-83 who had never had prostate or bladder surgery to pelvic floor exercises, urethral milking or counselling for 12 weeks. Urethral milking means pressing along the underside of the penis from behind the scrotum to push out the last urine. After allowing for how much each man leaked at the start, the counselling group showed no improvement, milking reduced urine loss by 2.9 g and the exercise group by 4.7 g at 13 weeks.

Early studies suggest pelvic floor training can help lifelong premature ejaculation, but the evidence is thin. Pastore and colleagues in Rome treated 40 men whose intravaginal ejaculatory latency time, the time from penetration to ejaculation, was 1 min or less, with 12 weeks of pelvic floor rehabilitation. By the end, 33 men (82.5%) had gained control of the ejaculatory reflex. Mean latency rose from 39.8 seconds at baseline to 146.2 seconds, and the 13 of 33 men checked at 6 months held a mean of 112.6 seconds.

The 2014 Pastore study had no control group, so some of that gain may be placebo or simple practice. The same team ran a small randomized comparison in 2012 against dapoxetine, a short-acting SSRI used on demand for premature ejaculation. In the International Journal of Andrology, 11 of 19 men (57%) on rehabilitation could control ejaculation, with a mean latency of 126.6 seconds. On dapoxetine, 5 of 8 men (62.5%) on 30 mg and 5 of 7 (72%) on 60 mg passed 180 seconds. Pelvic floor work looked useful but not better than the drug, in groups too small to settle the question.

For men who are already leaking 6 weeks after prostate surgery, formal one-to-one pelvic floor training did not reduce leakage in the largest trial. The MAPS trials, published in the Lancet in 2011, randomized UK men after radical prostatectomy or transurethral resection of the prostate (TURP) to four sessions with a therapist over 3 months or to standard care with lifestyle advice. At 12 months, 76% (148 of 196) of the trained men after prostatectomy were still incontinent, against 77% (151 of 195) of controls. After TURP the figures were 65% and 62%.

The MAPS authors pointed out that the control men also had access to pelvic floor advice, which was widely available in the UK, so the trial tested extra one-to-one therapy rather than exercise against nothing. The training added about £180 and £209 per patient in the two trials without a meaningful gain in quality of life. The authors also flagged the high rate of leakage still present after a year as an unmet need.

A 2015 Cochrane review by Anderson and colleagues pooled 50 trials with 4717 men. In men who were already incontinent after radical prostatectomy, pelvic floor training was not clearly better than control, with 57% still incontinent at 12 months against 62%. Across trials that also included men starting the exercises to prevent leakage, 10% of trained men were incontinent at one year against 32% of controls, but pad tests did not back this up and the reviewers rated the trials as having methodological limitations. For erections after prostatectomy, a 2019 meta-analysis by Kannan and colleagues found that pelvic floor training plus biofeedback improved erectile function at 12 months, while training alone was inconclusive.

To do a Kegel exercise, squeeze and lift the muscles around the back passage and the base of the penis together, hold, then let go fully. The NHS advises starting with a quick squeeze held for 2 seconds, relaxing, and repeating 10 times, then gradually building the hold to 10 seconds with each squeeze. Breathe normally throughout and try not to pull your stomach in.

The University Hospitals Sussex NHS leaflet for men gives a fuller routine. Hold each slow squeeze for a count of five, building to ten seconds, for up to 8 to 10 squeezes with a rest between each one. Follow with five to ten short, fast, strong contractions, and do the whole routine at least 4 to 5 times every day, lying, sitting or standing. The leaflet warns against holding your breath, pushing down instead of lifting, or tightening the stomach, buttocks or thighs, and says a few good squeezes beat many half-hearted ones.

Stopping the flow of urine mid-stream is a way to find the muscles, not an exercise. The Sussex leaflet says to do it only to learn which muscles to use, because making a habit of it may interfere with normal bladder emptying. Men who cannot feel any squeeze or lift should ask for a referral to a pelvic floor physiotherapist, since the trials with the best results used supervision and biofeedback.

Kegel exercises usually take weeks to months to show results. The NHS says you may have to do pelvic floor exercises for a few months before you see any benefit. The Sussex leaflet tells men they probably will not notice an improvement for several weeks and will not reach maximum performance for a few months, and to keep exercising twice a day for life once control returns. The trials match that timescale: the Dorey erectile dysfunction results were measured at 3 and 6 months, and the Paterson and Pastore programs ran for 12 weeks.

This article is for educational purposes only and is not medical advice. It does not diagnose, treat, cure or prevent any disease. Speak with a doctor or a pelvic floor physiotherapist before starting a program for any urinary or sexual symptom.

• Dorey G et al. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. British Journal of General Practice, 2004. https://pubmed.ncbi.nlm.nih.gov/15527607/
• Dorey G et al. Pelvic floor exercises for treating post-micturition dribble in men with erectile dysfunction: a randomized controlled trial. Urologic Nursing, 2004. https://pubmed.ncbi.nlm.nih.gov/15658735/
• Paterson J, Pinnock CB, Marshall VR. Pelvic floor exercises as a treatment for post-micturition dribble. British Journal of Urology, 1997. https://doi.org/10.1046/j.1464-410x.1997.00180.x
• Glazener C et al. Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS). Lancet, 2011. https://doi.org/10.1016/S0140-6736(11)60751-4
• Anderson CA et al. Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews, 2015. https://doi.org/10.1002/14651858.CD001843.pub5
• Pastore AL et al. Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach. Therapeutic Advances in Urology, 2014. https://doi.org/10.1177/1756287214523329
• Pastore AL et al. A prospective randomized study to compare pelvic floor rehabilitation and dapoxetine for treatment of lifelong premature ejaculation. International Journal of Andrology, 2012. https://doi.org/10.1111/j.1365-2605.2011.01243.x
• Kannan P et al. Effectiveness of physiotherapy interventions for improving erectile function and climacturia in men after prostatectomy. Clinical Rehabilitation, 2019. https://doi.org/10.1177/0269215519840392
• Chen Z et al. Effect of different physical activities on erectile dysfunction in adult men not receiving phosphodiesterase-5 inhibitors therapy. Andrology, 2024. https://doi.org/10.1111/andr.13682
• NHS. How to help a weak bladder. https://www.nhs.uk/conditions/urinary-incontinence/10-ways-to-stop-leaks/
• University Hospitals Sussex NHS Foundation Trust. Male Pelvic Floor Exercises. https://www.uhsussex.nhs.uk/resources/male-pelvic-floor-exercises/

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