First of all, the pelvic floor is a group of muscles, which extends from the pubic bone in the front to the tailbone in the back. It is in the shape of a kite since it widens at the sitz bones (which are the bony structures you feel when you sit on your hand on a hard wooden chair). If you think about a kite, it is like two triangles back to back. The one in the front is called the urogenital triangle, and the back, the rectal triangle. The front triangle has the urethral opening, and the back triangle, the rectal opening.
Refer to the picture of the pelvic floor attached as often as needed in order to be able to visualize what muscles you are engaging.
The first thing that you want to do is to make sure that you are contracting equally, or if anything, slightly stronger in the front triangle. To know which triangle you are using: stopping the passage of gas is contracting the back triangle, and stopping your urine stream, is the front triangle. Since stopping gas or urine is a bit abstract, we tend to use more visual tools to help people understand how to find these muscles. The other thing to remember before we go any further is that you can never contract the front triangle without the back triangle, and vice versa; however, focusing on one triangle at a time initially will teach your brain to equally locate muscles in both triangles so that one triangle doesn’t become stronger than the other. The most common thing we see is that the rectal triangle gets stronger and stronger because the rectal area didn’t get cut or damaged during the surgery (in a radical prostatectomy- the leading reason for male urinary incontinence), and the front triangle lags behind, which is where you need your strength to help control the involuntary loss of urine.
To contract the front triangle, imagine that you are drawing a raisin or peanut up into the urethra. Feel at the base of the penis for the muscle tightening under your fingers. You can also activate these muscles by gently drawing your penis away from your body, and then using the front triangle muscles to pull it back towards the body. This is the front triangle. The back triangle is engaged by imagining drawing a marble into your rectum. Close your eyes as you are visualizing these things since these muscles work well under visual guidance.
For several days or weeks, just practice engaging the front triangle and back triangle on their own (remember, you will feel tightening in the other triangle as you work, but your focus is going to be on the triangle that you are visualizing). Once you feel that you are equally engaging your muscles in both triangles, than you are ready to put them together.
To put the contraction together, you will draw the peanut in with the front triangle and then lift it inside with the back triangle (it is really one continuous motion). Your abdomen, inner thighs and buttocks should not be contracting visibly if someone was watching you while you do this contraction (you may feel slight tension in these areas but no visible movement is allowed). This is really important for men. Men tend to overcompensate with these external muscles.
A couple of thoughts on repetitions and intensity:
Feel how long you can comfortably hold the contraction without pain or letting go; add one second. That’s how long you should be holding the contraction to start. Do a set of 10 repetitions of the front triangle, and a set of ten for the back triangle, 3x/day. Once you are able to put the triangles together, then do 20 repetitions of drawing in the peanut and marble at the SAME time, 3x/day. Generally, men should do approximately 60 repetitions in total per day. You do not want your muscles to get sore and too tired. That is self-defeating. You generally want to relax between contractions for twice as long as you held the contraction. So if you hold for 4 seconds, you would relax for about 8 seconds (or one full breath in between repetitions). You want to add intensity over time by holding the contraction for incrementally longer times until you are doing 10 second holds and 20 second rests.
You must also practice getting the timing of these muscle contractions during activity. See The Knack (What Is The Knack) for more information on using the pelvic floor muscles at the right time to help with stress incontinence.
Be diligent and purposeful in your practice. These muscles take a little bit of concentration, but with some effort your brain will learn how to reuse them and make them strong again. If you are not getting stronger, or this is too abstract to learn without someone palpating (touching) those muscles to give you feedback, seek out the help of a Pelvic Health Physiotherapist who specializes in internal palpation of the pelvic floor muscles.