What Down Training Actually Is
A kegel is a voluntary pelvic floor contraction. Down training is a voluntary pelvic floor release. The two are opposite halves of one muscular cycle.
Cleveland Clinic describes a hypertonic pelvic floor as a group of muscles that are "too tight and can't relax," noting that men who have had prostate surgery often develop pelvic floor overactivity after the operation.1 The muscle is not weak. It has forgotten how to let go. Asking it to contract harder on top of that chronic contraction is the exact wrong instruction.
Published pelvic floor physical therapy practice teaches down training through four tools: diaphragmatic breathing that drops the pelvic floor on every inhale, positional lengthening that mechanically opens the pelvis, conscious imagery that replaces the bracing habit, and paced relaxation that is longer than any contraction.23 The goal is not relaxation as a general state. The goal is the specific ability to fully let go of the pelvic floor on command.
Who needs down training, who does not
Down training is the right first step if three or more of the following describe you: kegels have not moved your numbers after 2 to 3 months of daily practice; you feel tightness, pressure, or ache in the perineum or lower abdomen; you get post-void dribbling; you have pain with erections or bowel movements; your urgency arrives sudden and without a slow buildup. For a full read on which profile you fit, see Overactive Pelvic Floor in Men: Symptoms, Causes, and the Missing Treatment and Tight Pelvic Floor After Prostatectomy: The 20-40% Problem Nobody Screens For.
If you have a purely weak pelvic floor (you can produce a contraction but cannot hold it, no tightness, no pain), you do not need a release phase. You need the strengthening track in Kegels Not Working After Prostatectomy applied correctly.
The 60:40 Rule
Standard male post-op rehab pamphlets often prescribe "10 kegels, 10-second holds, 3 sets daily." The number nobody prints is the rest ratio. When a pelvic floor is already overactive, rep-to-rep rest is what matters more than rep volume.
Relaxation time ≥ contraction time. Always.
In the release phase, the ratio is 60% relaxation to 40% contraction. Translated to breath: 4 seconds in, 6 seconds out. Translated to reps: a 5-second contraction gets at least a 10-second release.
Published pelvic floor PT protocols consistently specify that the relaxation phase of every cycle must be at least as long as the contraction phase, and longer for patients with overactivity.34 Once you apply this rule, the "why haven't kegels been working" question often resolves itself. The kegels were not the problem. The missing release between them was.
The Five Down-Training Drills
Five drills. No equipment. The sequence is deliberate, moving from supine breathing (lowest demand) to standing integration (highest). Work through them in order during the release phase.
Diaphragmatic 4-6 breath — the anchor
- Lie on your back, knees bent, feet flat.
- One hand on the chest, one hand on the low belly below the navel.
- Inhale softly through the nose for a count of 4. The belly rises under your lower hand. The chest hand stays nearly still.
- Exhale through the mouth for a count of 6 with slightly pursed lips. The belly falls.
- As the belly rises, picture the pelvic floor lengthening downward like a floor dropping one level. Do not contract on the exhale. Let it settle.
- 10 breaths per round. 2 to 3 rounds. Twice daily.
Supine pelvic drop
- Same supine position as Drill 1, knees bent, feet flat.
- Arms relaxed by your sides.
- Inhale through the nose for 4 seconds, belly rises.
- On the inhale only, visualize the pelvic floor lengthening downward toward the chair you would sit on. A common image is a small lift descending one floor.
- Exhale for 6 seconds. Do not contract. Do not push down. Simply release.
- 10 slow breaths, one set, once daily.
Happy baby with long exhale
- On your back, knees lifted toward the chest.
- Open the knees wider than the ribs. Hold the outside edges of your feet (or behind the knees if shoulders are tight).
- Settle into the position. The low back can be flat or slightly arched, whichever is comfortable.
- Breathe slowly into the low belly, 4 seconds in, 6 seconds out.
- Do not rock. Do not force the knees wider. Allow the hips to open over 2 to 3 minutes.
- Hold the position for 2 to 3 minutes, then release the feet and hug the knees to the chest for 5 breaths.
Supported deep squat
- Stand facing a wall, feet slightly wider than hips, toes turned out 10 to 20 degrees.
- Place a folded towel or small book under each heel if your ankles are tight.
- Hold the wall or a door frame for balance.
- Squat down as deep as is comfortable, keeping the knees tracking over the toes.
- Let the pelvis hang below knee height if you can reach it. If not, go as low as feels safe and supported.
- Breathe into the low belly for 2 to 3 minutes. Every exhale, soften the inner thighs and groin.
- Stand up slowly using the wall for support. Do not jump or bounce up.
Child's pose with long exhale — the finisher
- Kneel on a mat or rug. Knees wider than the hips, big toes touching.
- Sit the hips back toward the heels. Fold forward with arms extended in front or by the sides.
- Let the forehead rest on the floor or on a folded pillow. Shoulders heavy.
- Breathe into the low back and sacrum rather than the chest. The feeling is as if the belly is expanding downward into the thighs.
- Hold the pose for 2 to 3 minutes. Every exhale, soften the pelvic floor. Do not contract.
- This is always the last drill of a down-training session. The nervous system registers the full end of the release block here.
Find out if down training is the drill you actually need — free, 3 minutes
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Take the free self-screen → Built from pelvic floor PT assessment criteriaWhat a Down-Training Day Looks Like
Total time: about 30 minutes, broken into three short blocks so the nervous system re-encounters release three separate times through the day. Skipping the blocks together into one session loses most of the benefit.
| Block | Time | What you do |
|---|---|---|
| Morning | 10 min | Drill 1 (diaphragmatic breath, 2 rounds of 10) + Drill 2 (supine pelvic drop, 1 set of 10). Done before coffee. |
| Afternoon | 8 min | Drill 3 (happy baby, 2 minutes) or Drill 4 (supported squat, 2 minutes), alternating days. The one you choose today, you swap tomorrow. |
| Evening | 12 min | Drill 1 again (2 rounds) + Drill 5 (child's pose, 3 minutes). This is the wind-down block before bed. |
Daily. For 2 to 4 weeks as a pure release phase. Then the protocol layers very small amounts of contraction back in, always with longer rest than work, using the 60:40 rule.
Three Mistakes Men Make in Down Training
Every mistake below flips an otherwise clean protocol into a net-zero result. If your numbers have not moved after 3 weeks of daily work, one of these is almost certainly the cause.
Mistake 1 · Doing more, not less
The reflex when something is not working is to double the dose. With down training, doubling the reps reloads the muscle with the exact signal you are trying to unlearn. A pelvic floor that has been braced for 18 months will not release faster just because you squat for 6 minutes instead of 3.
Mistake 2 · Adding kegels back in too soon
Feeling the first release at week 2 is not the signal to start kegels. The nervous system has just relearned the second half of the cycle. Adding contraction work before that pathway is stable resets the bracing pattern. Men who do this often report their first day of "feeling it" was their best day, and then it plateaued.
Mistake 3 · Holding the breath
The most common silent error. A man lies down for Drill 1, tries to concentrate on the pelvic floor, and unconsciously stops breathing between counts. Pelvic floor down training without free breath is ineffective. The pelvic floor tracks diaphragm movement. No diaphragm movement, no pelvic floor lengthening.
When to Layer Strengthening Back In
Down training is not a final destination for most men. For the purely overactive profile (Profile B, about 25% of post-op men), release alone may be enough. For the much larger mixed profile (Profile C, about 40%, where surface tension masks deep-fiber weakness), strengthening is still required. The order is non-negotiable: release first, strengthening second.5
You are ready to layer strengthening back in when all four of these are true:
- You can feel the pelvic floor drop on the inhale during Drill 1 without needing to think about it.
- Perineal tightness or pressure has noticeably reduced.
- Daily leaks or urgency episodes have either decreased or become predictable (you can name the trigger).
- You have completed at least 14 consecutive days of the full daily routine above.
At that point, a small amount of contraction work is added, strictly under the 60:40 rule. A typical first week of re-loading looks like 5 slow 3-second contractions followed by 6-second releases, performed twice daily, always paired with the breath pattern of Drill 1. Volume rises gradually over 2 to 4 weeks until the pelvic floor can produce a strong contraction and a complete release on command.
What most men do
- More kegels when symptoms persist
- Rep count in focus, rest interval ignored
- Contract and release same length
- Stop-start midstream as a "practice"
- Brace the whole core during reps
What the release phase looks like
- Fewer reps, longer rest, release-only blocks
- Rest interval twice the contraction time
- Breath work in every block, every day
- Stop-start never done as an exercise
- Only the pelvic floor, the rest stays soft
Realistic Timeline on a Daily Routine
What actually moves, and when, on a correct daily down-training routine
These are the typical windows seen on structured pelvic floor protocols. They are not guarantees. Men with long-standing pelvic pain, severe guarding, or a history of multiple pelvic surgeries often need 12 to 16 weeks of combined release and loading before the numbers move.
"There may be a subset of patients for whom down-training instead of kegel up-training may be required for maximal improvement of post-prostatectomy incontinence." Source: Renal and Urology News, on pelvic floor overactivity after prostate surgery7
When to See a Pelvic Floor PT
The AUA/GURS/SUFU guideline recommends pelvic floor muscle training as first-line therapy for post-prostatectomy incontinence.8 See a male-specialist pelvic floor physical therapist if any of the following apply:
- You have pelvic pain, not just leaking. Pain often benefits from hands-on manual release that a home program cannot deliver.
- You cannot feel the pelvic floor at all during Drill 1 or Drill 2, even after 2 weeks of consistent practice.
- You have coexisting conditions such as interstitial cystitis, pudendal neuralgia, or chronic non-bacterial prostatitis.
- You have a history of pelvic trauma or multiple pelvic surgeries.
- Daily leaks have increased substantially and persistently after starting down training.
Roughly 15% of US post-op men are actually referred to a pelvic floor PT by their surgical team.9 Waitlists for male-specialist PTs can run 6 to 12 weeks. A structured home down-training and male pelvic floor PT routine built on the same clinical framework is a legitimate starting point while you wait.
Run the Right Protocol for Your Body
The Ironhold Method is the 8-week profile-matched pelvic floor protocol for men after prostate surgery. Week 1 screens you. Weeks 2 through 8 give you the exact plan for your profile, whether that is pure down training, pure strengthening, or the sequenced mix. Built from AUA and EAU first-line treatment guidelines.
See The 8-Week Protocol → $197 one-time · lifetime access · stay-drier-or-don't-payFAQ
What is pelvic floor down training for men?
Down training is pelvic floor relaxation work. Where a kegel teaches the muscle to contract, down training teaches it to fully release. It uses diaphragmatic breathing, positional lengthening, and conscious relaxation to reset a pelvic floor that is stuck in chronic low-grade contraction. In men, this is often the missing step between doing kegels and actually regaining continence after prostate surgery.
How do I know if I need down training instead of kegels?
You likely need down training if: kegels have produced no measurable change after 2 to 3 months of daily practice, you feel tightness, pressure, or aching in the perineum or lower abdomen, you have post-void dribbling, you have pain with erections or bowel movements, or you experience sudden urgency without a slowly building warning. Three or more of these signs point to pelvic floor overactivity, where more contraction work reinforces the problem.
How often should men do pelvic floor down training?
Published pelvic floor physical therapy protocols recommend daily down training during the release phase, with 20 to 30 minutes broken into 2 or 3 short blocks. A common structure is 10 minutes of diaphragmatic breathing in the morning, 5 to 10 minutes of positional release (deep squat, happy baby, or child's pose) in the afternoon, and 10 minutes of breathing plus lengthening before sleep. Consistency matters more than total volume.
What is the 60:40 rule in pelvic floor down training?
During the release phase of rehab, the relaxation time of every breath or rep must be longer than the contraction time. A common starting ratio is 60% relaxation, 40% contraction, which in breath-pacing terms is a 4-second inhale with a 6-second exhale. When any pelvic contraction is added back, the rest interval between reps is at least twice the contraction duration. The rule reverses the normal kegel pattern and is how the muscle relearns the second half of its job.
Can I do pelvic floor down training at home?
Yes. The five core down-training drills (diaphragmatic breathing, supine pelvic drop, happy baby, supported deep squat, and child's pose with long exhale) require no equipment and are routinely taught as home practice by pelvic floor physical therapists. Men with pelvic pain, severe guarding, or no sensation of the pelvic floor at all benefit from at least one in-person pelvic floor PT assessment before starting a home program.
How long until down training reduces leaking?
Published pelvic floor rehabilitation timelines show the first clear release sensation at 1 to 3 weeks, first measurable reduction in leak episodes at 4 to 6 weeks, and full or near-full continence at 8 to 12 weeks in men who follow a structured profile-matched protocol. Men with long-standing pelvic pain or severe guarding often need 12 to 16 weeks. Down training alone is enough for purely overactive profiles. Mixed profiles then layer strengthening on top.
Can down training make incontinence worse?
No. Down training restores the muscle's ability to fully relax, which is a precondition for producing a strong voluntary contraction later. Men sometimes report a brief 1 to 2 week window of increased sensation of leaking during the initial release phase. This is usually the nervous system re-noticing what chronic bracing was masking, not a true worsening. If leaking increases substantially and persistently, stop and consult a pelvic floor PT.
Should I combine kegels with down training?
Not in the first 2 to 4 weeks. During the release phase the muscle needs uninterrupted permission to let go. Once you can feel the pelvic floor fully relax on every inhale (typically week 2 to 3), you add back slow, low-volume contraction work paired with even longer rest. This sequenced approach, release first and strengthening second, is the protocol for the mixed profile, which clinical data suggests is the most common post-prostatectomy presentation.
Sources & Further Reading
- Cleveland Clinic. Hypertonic Pelvic Floor: Symptoms, Causes and Treatment.
- Chicago Pelvic. Pelvic Floor Down Training.
- Beyond Basics Physical Therapy. Pelvic Floor Dysfunction and Down-Training.
- Conservative interventions for urinary incontinence after prostate surgery (PMC, 2023).
- Management of Urinary Incontinence Following Radical Prostatectomy (PMC).
- Pelvic Floor Specialist. Post-Op Prostatectomy Care and Home Drills.
- Renal and Urology News. Kegel Exercises After Prostate Surgery Called Into Question.
- AUA/GURS/SUFU. Incontinence After Prostate Treatment Guideline.
- ZERO Cancer. Beyond Kegels: How Pelvic Physical Therapy Can Help Incontinence After Prostatectomy.
- BJU International (2024). Post-prostatectomy incontinence: a guideline of guidelines.