David Cowley works as the Men’s Health Clinical Stream Leader at Active Rehabilitation Physiotherapy in Brisbane. He has a special interest in physiotherapy to rehabilitate pelvic floor muscles for men. While he often sees men after surgery for prostate cancer, David’s experience aligns with the evidence that men who undergo a preoperative pelvic floor muscle training program experience better continence and quality of life outcomes.

David enjoys building relationships with patients in the last three weeks before prostate surgery when the process becomes quite intensive, and the men attend his practice two to three times a week in preparation.

It is a privilege for David and his colleagues to work so closely with patients who are experiencing anxiety about one of life’s biggest challenges and guide them through the process. 

David is a PhD candidate at the University of Queensland where he is building on foundational research completed by his supervisors, re-evaluating treatment of pelvic floor muscles in men.

This exploratory research investigates what happens with men’s pelvic floor muscles in various pressure situations, for example, standing and lying down, before and after the prostate gland is  removed. Additionally, David is investigating electrical stimulation as a means of continence treatment. 

Many people do not realise men have a pelvic floor, let alone that the muscles and mechanisms which help maintain continence differ in males. The puborectalis muscle helps provide some constriction of the urethra and is helpful for maintaining continence in men, however David states it is perhaps more important to train the muscle that wraps around the urethra, the external urethral sphincter muscle. David cites that in a study of healthy men, pelvic floor muscle training for three months improved erectile dysfunction in 40% of men and cured premature ejaculation in 80% of men.

The study is available at Physiotherapy Most incontinence in men can be managed through strengthening muscles. “The diversity of pelvic floor muscles is so cool,” says David. “As well as supporting healthy continence and sexual function, pelvic floor muscles are also engaged to support the base of the abdominal muscles and help with breathing when men breathe deeply. If bladder pressure exceeds urethral pressure, incontinence occurs.”

As for the stigma surrounding men seeking medical intervention, David has found that while some patients are initially hesitant to engage with treatment, once the road ahead is explained, the commitment of the patients is something to behold.

He says it is truly rewarding to help treat the condition and by extension the resulting psychosocial impacts. Posed with the question ‘When should men seek treatment for incontinence?' David’s answers are simple: “Do they want to? Is it affecting their life?”

David also recommends exercises men can do at home to help themselves. “When possible, try deferring going to the toilet for a while, although never to the point of pain, and try to imagine stopping the flow of urine. Those small contractions or pulses can help to train the appropriate muscles without unnecessary straining,” says David.


The puborectalis refers to the sling of muscle fibres which form a loop around the rectum. This is one of the major male pelvic floor muscles which supports
the bladder and bowel and may affect sexual function. Pelvic floor muscle exercise involves tightening and relaxing the puborectalis and urethral sphincter muscles.