Pelvic Floor Physiotherapy Before and After Prostate Surgery

Written By georgia allen

A Guide to Pre- and Post-Prostatectomy Care

Prostate surgery - including radical prostatectomy - can significantly affect bladder control, pelvic floor function, and sexual health.

Pelvic floor physiotherapy plays an important role both before and after surgery, improving recovery outcomes and helping men regain confidence and control.

Why Prostate Surgery Affects the Pelvic Floor

During a radical prostatectomy, the prostate gland is removed. This procedure alters:

  • The urethral support system

  • The internal urinary sphincter

  • Pelvic floor muscle mechanics

  • Nerve pathways related to continence and erection

As a result, men may experience:

  • Urinary incontinence

  • Urinary urgency

  • Reduced bladder control

  • Erectile dysfunction

  • Pelvic discomfort

These symptoms are common - and often temporary - but recovery varies between individuals.

Pre-Prostatectomy Physiotherapy (Prehabilitation)

Research supports beginning pelvic floor training before surgery. This is known as prehabilitation.

Why Start Before Surgery?

Learning correct pelvic floor activation before surgery:

  • Improves muscle awareness

  • Enhances coordination

  • Reduces confusion after surgery

  • May shorten time to continence recovery

Men who begin training pre-operatively often feel more confident managing early post-operative symptoms.

What Pre-Surgery Physiotherapy Involves

Assessment may include:

  • Pelvic floor strength and coordination testing (via ultrasound)

  • Breathing and pressure management assessment

  • Education on bladder function

  • Practice of correct pelvic floor contraction

  • Instruction on relaxation techniques

Importantly, pelvic floor exercises are individualised - not all men require maximum strengthening prior to surgery.

What to Expect After Prostate Surgery

Urinary leakage is common in the early weeks after catheter removal.

Types of leakage may include:

  • Stress incontinence (leakage with coughing or standing)

  • Urgency-related leakage

  • Post-void dribbling

Recovery timelines vary, but most improvement occurs within the first 6–12 months. Persistent symptoms beyond this period should be assessed.

Post-Prostatectomy Pelvic Floor Rehabilitation

Post-operative physiotherapy focuses on:

  • Regaining strength and endurance

  • Improving muscle timing

  • Reducing urgency

  • Addressing compensatory tension patterns

  • Supporting return to exercise

Rehabilitation is progressive and tailored to symptom severity.

Phase 1: Early Recovery (weeks 2-6)

Focus may include:

  • Gentle pelvic floor activation

  • Avoiding breath holding

  • Managing abdominal pressure

  • Education on pad use

  • Bladder diary tracking

Excessive or forceful exercise is not recommended early.

Phase 2: Strength & Endurance Training

As healing progresses, treatment may include:

  • Progressive strengthening

  • Functional training (e.g. coughing, lifting practice)

  • Endurance holds

  • Coordination drills

Strength must translate to real-life activities.

Bladder Urgency After Prostatectomy

Some men experience urgency after surgery.

This may be influenced by:

  • Bladder muscle sensitivity

  • Healing changes

  • Pelvic floor tension

Management may include:

  • Bladder retraining

  • Urge suppression strategies

  • Relaxation work

  • Neuromodulation techniques when appropriate

Strengthening alone is not always sufficient.

Erectile Function and Pelvic Floor Rehabilitation

Pelvic floor muscles contribute to:

  • Penile rigidity

  • Blood flow regulation

  • Ejaculatory control

Evidence suggests pelvic floor muscle training may support erectile recovery in some men.

However, erectile function recovery depends on:

  • Nerve preservation during surgery

  • Pre-operative function

  • Age and general health

Physiotherapy is part of a broader rehabilitation plan and may complement medical management.

When to Seek Help

You should seek pelvic floor physiotherapy if you experience:

  • Ongoing leakage beyond expected recovery

  • Persistent urgency

  • Difficulty returning to exercise

  • Pelvic pain

  • Erectile dysfunction concerns

Early intervention improves outcomes.

Is It Always Weakness?

Not always.

Some men develop:

  • Excess muscle tension

  • Guarding

  • Poor coordination

  • Over-activation

Incorrect or excessive Kegels may worsen symptoms. Assessment ensures appropriate progression.

Book an Assessment

If you are preparing for prostate surgery, or recovering from one, a personalised pelvic floor plan can support your recovery.

Peak Flo Physio provides evidence-based, discreet, and individualised care for men at every stage of prostate surgery recovery.

georgia allen
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