Post-Prostatectomy Care: Regaining Continence and Function with Targeted Pelvic Floor Rehabilitation

What is a prostatectomy?

Prostatectomy — the surgical removal of the prostate gland — is a necessary and often life-saving procedure for men diagnosed with prostate cancer. But the surgery disrupts structures central to bladder control and erectile function, and most men experience some urinary leakage afterward.

How much, and for how long, varies widely. Reported rates of post-prostatectomy incontinence range enormously across studies, largely because researchers define “continent” differently — some require zero pads, others allow a single security pad. For most men, leakage improves substantially over the first year. For some, it doesn’t fully resolve on its own. Either way, waiting passively is rarely the best strategy.

Why pelvic floor physical therapy is the first-line treatment

Pelvic Floor Muscle Training (PFMT) is the recognized first-line conservative treatment for post-prostatectomy incontinence. After the prostate is removed, the external urethral sphincter and surrounding pelvic floor muscles carry the full burden of continence — a job they previously shared. PFMT trains exactly those muscles.

The American Urological Association guideline recommends that men who have undergone radical prostatectomy be offered pelvic floor muscle training in the immediate post-operative period, and that it be offered again to any man still seeking treatment for leakage later on.

Starting before surgery may help too. In a randomized trial by Centemero and colleagues (European Urology, 2010), men who began pelvic floor exercise 30 days before surgery and continued afterward were continent at one month at more than twice the rate of men who only started post-operatively (44% vs. 20%), with the advantage still present at three months. Larger analyses suggest this head start mainly accelerates the early recovery curve rather than changing where men end up at a year — but for anyone facing months of pads, getting there faster matters a great deal.

The critical variable is technique. A large proportion of men contract the wrong muscles when first instructed — squeezing glutes, abdominals, or bearing down instead of lifting. Guided training with a pelvic floor specialist, often using biofeedback, is how you confirm you’re training the right muscle in the right way before you build volume.

Sexual function

Erectile function follows its own recovery timeline, driven largely by nerve healing, and it’s typically slower than continence recovery. Pelvic floor rehabilitation is one component of penile rehabilitation — pelvic floor muscles contribute to erectile rigidity and ejaculatory function — and it works best alongside the medical management your urologist provides. Climacturia (leakage at orgasm) and stress incontinence during sexual activity are common, rarely discussed, and very responsive to targeted treatment. Bring them up; we’ve heard it before.

When to call your surgeon rather than your PT

Contact your surgical team promptly for fever, inability to urinate, worsening pain, calf swelling or pain, signs of wound infection, or a sudden increase in leakage after a period of improvement.

The bottom line

Leakage after prostatectomy is common, and it is treatable. It is not something you simply wait out and hope for the best. Guided pelvic floor rehabilitation — starting before surgery where possible, and resuming as soon as you’re cleared afterward — is the most evidence-supported step you can take toward getting your control, confidence, and quality of life back.

Our pelvic health team works with men throughout downtown Manhattan at every stage of prostate cancer treatment, from pre-surgical preparation through long-term recovery. Sessions are private, one-on-one, and paced to where you actually are.

References

• Centemero A, Rigatti L, Giraudo D, et al. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. Eur Urol. 2010;57(6):1039–43.
• Zhou L, Chen Y, Yuan X, et al. Preoperative pelvic floor muscle exercise for continence after radical prostatectomy: a systematic review and meta-analysis. Front Public Health. 2023;11:1186067.
• Sandhu JS, Breyer B, Comiter C, et al. Incontinence after Prostate Treatment: AUA/GURS/SUFU Guideline (2019; amended 2024).
• Castellan P, Ferretti S, Litterio G, et al. Management of urinary incontinence following radical prostatectomy: challenges and solutions. Ther Clin Risk Manag. 2023.