The Benefits of Pelvic Floor Therapy for Men After Prostate Surgery
- Katherine Koch, PT, DPT
- Aug 12
- 6 min read
Prostate surgery—whether performed to treat prostate cancer, benign prostatic hyperplasia (BPH), or other prostate conditions—can be life-changing. While the primary goal is often to remove disease or alleviate urinary obstruction, many men find themselves facing new physical challenges in the weeks and months after surgery. Common side effects include urinary incontinence, urgency, and changes in sexual function. These symptoms can feel frustrating, even overwhelming, but there’s good news: pelvic floor therapy offers a highly effective, non-invasive path to recovery.
For decades, pelvic floor therapy was largely associated with women’s health, particularly after childbirth. Today, however, research and clinical practice show that men can benefit just as much—especially after prostate surgery. Pelvic floor physical therapists are trained to work with men to restore bladder control, improve sexual health, and rebuild confidence in daily activities.
In this article, we’ll explore why the pelvic floor matters, how surgery impacts it, and the many ways therapy can help men recover faster, more fully, and with less stress.
Understanding the Pelvic Floor in Men
The pelvic floor is a group of muscles, ligaments, and connective tissue that form a supportive sling at the bottom of your pelvis. These muscles wrap around and support the bladder, rectum, and prostate, and they play a vital role in:
Urinary control – contracting to keep urine in, and relaxing to allow urination
Bowel control – supporting the rectum and controlling gas and stool passage
Sexual function – contributing to erectile strength and ejaculation
Core stability – working with the deep abdominal and back muscles to support posture and movement
When the pelvic floor muscles are functioning well, you may not even notice them. But when they are weakened, overly tight, or disrupted—as often happens after prostate surgery—the effects can be significant.
How Prostate Surgery Affects the Pelvic Floor
The prostate gland sits just below the bladder and surrounds the urethra. During surgery—especially radical prostatectomy, where the entire prostate is removed—the surgeon must navigate around the pelvic floor muscles, sphincters, and surrounding nerves. Even with the most precise surgical techniques, some temporary disruption is inevitable.
Common post-surgical effects include:
Urinary Incontinence Without the prostate’s support, the urethral sphincter and pelvic floor muscles must work harder to keep urine in. If these muscles are weak or uncoordinated after surgery, leakage can occur, especially with coughing, sneezing, or physical activity.
Urinary Urgency and Frequency Some men feel a sudden, strong urge to urinate and may not be able to make it to the bathroom in time.
Erectile Dysfunction Nerves involved in erection run very close to the prostate. While nerve-sparing techniques can help, some men experience reduced function, which can be influenced by pelvic floor muscle health.
Pelvic Discomfort Surgical healing and muscle changes can lead to feelings of heaviness, tightness, or aching in the pelvic region.
These challenges can impact quality of life, work, relationships, and emotional well-being. That’s where pelvic floor therapy comes in.
What Is Pelvic Floor Therapy for Men?
Pelvic floor therapy is a form of specialized physical therapy focused on improving the function, strength, and coordination of the muscles in the pelvic region. A physical therapist trained in male pelvic health will perform a thorough evaluation and create a treatment plan tailored to your symptoms, goals, and healing stage.
Therapy may include:
Pelvic floor muscle training (often called Kegels, but with correct technique and progression)
Biofeedback to help you “see” and understand your muscle activity in real time
Bladder training to improve control and reduce urgency
Breathing and core coordination to support pelvic stability
Manual therapy to address muscle tightness, scar tissue, or nerve mobility issues
Home exercise programs for continued progress between sessions
Key Benefits of Pelvic Floor Therapy After Prostate Surgery
1. Faster Return of Bladder Control
One of the most studied benefits of pelvic floor therapy for men post-prostatectomy is its impact on urinary continence. Research shows that men who begin pelvic floor muscle training before and after surgery tend to regain bladder control more quickly.
Why? Strengthening and coordinating the pelvic floor helps the urethral sphincter work more effectively, especially during moments of increased pressure (like standing, coughing, or lifting). Even small improvements in muscle timing can make a big difference in preventing leaks.
2. Reduced Urinary Urgency and Frequency
In addition to leakage, many men experience an urgent need to urinate more often after surgery. Pelvic floor therapy can help retrain bladder habits, reduce overactive bladder signals, and teach techniques for “urge suppression.” This not only improves comfort but also reduces the stress and planning that often accompany frequent bathroom trips.
3. Support for Sexual Function
The pelvic floor plays an important role in sexual health. These muscles contribute to erectile rigidity and ejaculation. After prostate surgery, erectile function may be temporarily or permanently affected, but pelvic floor strengthening has been shown to help improve erectile quality and sexual satisfaction for some men.
A therapist can also address muscle tension, which can sometimes contribute to pelvic pain or interfere with sexual comfort.
4. Improved Core Strength and Posture
Pelvic floor therapy often includes exercises that engage the entire core system—deep abdominals, back muscles, and breathing diaphragm—because all these structures work together. Improving core stability can support bladder function, reduce strain on healing tissues, and help men return to daily activities with confidence.
5. Better Awareness and Control of Pelvic Muscles
Many men have never consciously activated their pelvic floor before surgery. Therapy provides education and awareness, helping you isolate and engage the correct muscles without compensating with thighs, glutes, or abdominals. This precision is key—doing Kegels incorrectly can actually make symptoms worse.
6. Emotional and Lifestyle Benefits
Regaining bladder and sexual function isn’t just a physical win—it’s an emotional one. Therapy can reduce anxiety about leaks, restore confidence in public and social situations, and allow men to resume sports, hobbies, and intimacy with less worry. Feeling in control of your body again often has a ripple effect, improving mood, sleep, and overall quality of life.
When to Start Pelvic Floor Therapy
Many urologists now recommend prehabilitation—starting pelvic floor therapy before prostate surgery. This allows you to learn correct muscle activation and build baseline strength before the surgical disruption occurs.
However, it’s never too late to benefit. Men who start therapy weeks, months, or even years after surgery can still see improvements in continence, urgency, and pelvic comfort.
What to Expect at Your First Appointment
A pelvic floor physical therapist will:
Review Your Medical History Including details about your surgery, current symptoms, medications, and goals.
Explain Pelvic Floor Anatomy Understanding how the muscles work helps you visualize and activate them.
Perform an Assessment This may involve observing your posture, breathing, and movement, as well as gently assessing pelvic floor strength and coordination—either externally or internally, depending on your comfort level.
Create a Plan Your therapist will outline exercises, strategies, and lifestyle tips customized for you.
Practical Tips for Supporting Recovery at Home
While therapy sessions provide guidance and progression, much of your improvement comes from consistent practice between visits. Your therapist might recommend:
Doing targeted pelvic floor exercises daily (with correct form)
Avoiding bladder irritants like caffeine, alcohol, and artificial sweeteners
Spacing out fluid intake to avoid overload at once
Practicing good bowel habits to avoid straining
Using breath control during lifting or exertion to protect the pelvic floor
How Long Does Recovery Take?
Recovery timelines vary. Some men regain bladder control within weeks, while others need several months. Factors like age, overall health, nerve preservation, and pre-surgery muscle strength all play a role. Regular pelvic floor therapy—combined with patience and persistence—can maximize your recovery potential.
The Research Behind Pelvic Floor Therapy for Men
Multiple studies support pelvic floor therapy’s effectiveness after prostate surgery:
Burgio et al., 2011 found that men who received behavioral therapy including pelvic floor training had significantly reduced incontinence compared to a control group.
Hunter et al., 2007 reported that supervised pelvic floor muscle training improved both urinary continence rates and quality of life in post-prostatectomy patients.
Goode et al., 2010 concluded that pelvic floor therapy can reduce leakage episodes and improve patient satisfaction, even in men several years post-surgery.
Why Professional Guidance Matters
While you can find plenty of “Kegel” instructions online, unsupervised exercises may be ineffective—or even counterproductive—if done incorrectly. A pelvic floor physical therapist ensures:
You’re engaging the right muscles (and not overusing others)
Exercises are tailored to your specific symptoms
Progressions match your healing stage
Other contributing factors (posture, breathing, scar tissue) are addressed
This personalized approach often accelerates recovery compared to self-directed programs.
Taking the Next Step
If you’re facing prostate surgery—or you’re already in recovery—consider making pelvic floor therapy part of your plan. It’s a safe, evidence-based approach that addresses the root causes of urinary and sexual symptoms, rather than just masking them.
Talk to your urologist or primary care provider about a referral, or seek out a physical therapist with advanced training in male pelvic health.
Final Thoughts
Prostate surgery can feel like the start of a long road, but it doesn’t have to mean permanent changes in bladder or sexual function. With pelvic floor therapy, many men regain control, strength, and confidence—often sooner than they expect. By investing in your pelvic health, you’re not just recovering from surgery—you’re taking an active role in your long-term well-being.
