Exploring pelvic floor muscle function in men with and without pelvic floor symptoms: A population-based study

Francoise J. M. Notenboom-Nas*, Grietje E. Knol-de Vries, Lotte Beijer, Yme Tolsma, Marijke C. Ph Slieker-Ten Hove, Janny H. Dekker, Gommert A. van Koeveringe, Marco H. Blanker

*Corresponding author for this work

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Background Pelvic floor symptoms (PFS), such as lower urinary tract symptoms, defecation disorders, sexual problems, and genital-pelvic pain, are prevalent in men. Thorough physical assessments of the external anal sphincter (EAS) and the puborectal muscle (PRM) are the keys to unraveling the role of muscle dysfunction. Objectives To explore associations within and between the EAS and PRM and between muscle (dys-) function and the number of male PFS. Methods This cross-sectional study purposively enrolled men aged >= 21 years with 0-4 symptoms from a larger study. After extensive external and internal digital pelvic floor assessment, we explored (1) agreement between muscle function of the EAS versus PRM (using cross tabulation), (2) associations within and between the EAS and PRM (using heatmaps), and (3) associations between muscle function and number of PFS (using a visual presentation [heatmaps] and chi(2) tests). Results Overall, 42 out of 199 men (21%) had completely normal muscle function. Sixty-six (33.2%) had no symptoms, of which 53 (80%) had some degree of muscle dysfunction. No clear dose-response relationship existed between muscle (dys-) function and the number of symptoms. The PRM showed both more dysfunction and severer dysfunction than the EAS. Conclusions No clear association exists between muscle dysfunction and the number of symptoms, and the absence of PFS does not indicate normal muscle function for all men. Dysfunction levels are highest for the PRM. Further pelvic floor muscle research is warranted in men with PFS.

Original languageEnglish
Number of pages10
JournalNeurourology and urodynamics
Publication statusE-pub ahead of print - 25-Jul-2022


  • digital assessment
  • heatmap
  • male pelvic floor musculature
  • male pelvic floor symptoms
  • PAIN

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