Pelvic Floor Physio After Prostate Surgery

What happens after Prostate Surgery?

Here is a conversation men are rarely offered before prostate surgery. You will likely leak urine for a while afterward, and your erections will probably change, sometimes for months. Most men find this out the hard way, at home, with a pad and no plan. We think that silence is the real problem.

At Blueberry Therapy we talk about pee, erections, and recovery using real words, because the only awkward conversation is the one we are not having. If you are facing a prostatectomy or recovering from one, this post walks through what actually happens to your bladder and your erections, what the research says pelvic floor physiotherapy can do about both, and what a first appointment looks like. None of this is about pushing through or accepting the loss. It is about giving your body a plan.

What prostate surgery does to bladder control and erections

Radical prostatectomy removes the prostate, and in doing so it disturbs the muscles, nerves, and structures that manage your bladder and your erections. Two things commonly follow.

The first is urinary incontinence. When the prostate comes out, the internal valve that helped hold urine closes less reliably, so leaking is common in the early weeks and months. Around 21% of men are still leaking at 12 months after robotic surgery, though for most the amount improves steadily over the first year.

The second is erectile dysfunction. Because the nerves that drive erections run right alongside the prostate, they are often bruised or affected even when a surgeon spares them. Erectile dysfunction affects a large share of men after surgery, roughly 70% at 12 months in some studies, with recovery that can take one to two years. Some men also notice climacturia, which is leaking a little urine at the point of orgasm.

These numbers sound heavy. Read them as the reason to act, not the reason to give up. The same muscles disrupted by surgery are muscles you can train.

Your pelvic floor is doing more than you think

Your pelvic floor is a group of muscles that sits at the base of your pelvis, forming a supportive sling from your pubic bone to your tailbone. In men, these muscles wrap around the urethra and the base of the penis. They help you hold and release urine, they contribute to erections by helping trap blood in the penis, and they play a role in orgasm.

Think of the pelvic floor like a trampoline. Sometimes it needs to get stronger and more responsive, and sometimes it needs to learn to relax and coordinate. After prostate surgery, the job is usually to rebuild strength and timing so these muscles can take over some of the control the surgery took away. That is exactly what pelvic floor physiotherapy trains.

What the research shows about pelvic floor physiotherapy

This is not a hopeful guess. It is one of the better-studied areas in men's rehabilitation.

For urinary incontinence

A 2014 meta-analysis of randomized controlled trials found that pelvic floor muscle training improved continence rates in the short, medium, and long term after prostatectomy. In plain terms, men who trained their pelvic floor regained bladder control faster and more completely than men who did not. The gains tend to be largest in the first three to six months, which is why starting early and getting the technique checked matters so much. Doing the wrong contraction thousands of times does not help. Doing the right one, guided, does.

For erectile dysfunction

Pelvic floor training has real evidence for erections too. In a landmark 2005 trial published in BJU International, Dr. Grace Dorey found that after a program of pelvic floor exercises, 40% of men with erectile dysfunction regained normal erectile function and another 35% improved. After prostate surgery specifically, pelvic floor muscle training is now a recognized part of penile rehabilitation, the structured approach urologists use to protect and rebuild erectile function. It is not a magic fix on its own, and it often works best alongside other treatments, but it addresses the muscle side of erections that a pill simply cannot.

Start before surgery if you can

If you have a surgery date, there is a real advantage to learning this before the operation, something clinicians call prehab.

Here is the honest version. The research on whether pre-operative training shortens long-term incontinence is mixed, and we will not oversell it. What is not mixed is the practical benefit. Learning to find and correctly contract your pelvic floor is far easier when you are not sore, catheterized, and recovering from surgery. Men who arrive at recovery already knowing the technique can start meaningful training the moment their surgeon clears them, instead of losing weeks figuring out the basics. One or two sessions with a pelvic health physiotherapist before surgery can set you up for the whole recovery.

What a men's pelvic health assessment actually looks like

Most men have never been to a pelvic health physiotherapist, and the unknown keeps them from booking. So here is what happens.

We start by talking. Your surgery, your symptoms, how many pads you are using, what has changed with erections and intimacy, and what you want to get back to. Then we assess how your pelvic floor is actually working, whether you can contract it, relax it, and coordinate it with your breath and your daily movements. From there we build a specific program, and we check your technique so you are not guessing. Many men are training the wrong muscles or bearing down when they think they are lifting, and correcting that alone changes results. Appointments are private, respectful, and paced to your comfort. We see men, women, and partners, and post-surgical recovery is part of our everyday work.

The tech side of recovery

Alongside physiotherapy, recovery has a growing technology side worth understanding, and it is exactly what this week's episode of The Hole Shebang gets into.

Kristen sat down with Dr. Elliot Justin, an emergency medicine physician who spent 40 years in the field before building FirmTech and inventing the TechRing, a wearable that measures a man's erections during sleep and during sex. His argument is that nighttime erections are a vital sign, and that after prostate surgery, when those automatic erections stop, the tissue can shrink and scar without rehabilitation. Tracking recovery gives men real data and, just as importantly, a reason to keep going. He shares a story of one man two years out from surgery who had given up, started tracking again, and got back to a sex life he thought was gone. It is a frank, hopeful conversation about a topic almost nobody covers well. Pair the physiotherapy with the mindset in that episode and you have a real plan instead of a shrug.

You do not have to accept this as your new normal

Leaking and erection changes after prostate surgery are common. They are not a verdict. Pelvic floor physiotherapy has strong evidence for continence, real evidence for erections, and it gives you something to actually do with your hands and your body instead of waiting and hoping. Recovery takes time and honest effort, and it is far more possible than most men are told.

Start by listening to the full conversation with Dr. Elliot Justin on The Hole Shebang podcast. When you are ready for a plan built around your body, our pelvic health physiotherapy team sees men before and after surgery. Ideally you come in before the operation, but it is never too late to start. Book a men's pelvic health assessment whenever you are ready. For products our clinicians recommend, visit the Blueberry Therapy Shop. We also have a medical grade vacuum pump that help's ensure the erectile tissue of the penis gets blood flow while the nerves are healing. This is important to retain penile tissue length and if erections improve, erectile tissue function. To encourage at home exercises we sell the kGoal Boost. This device is a sit on top biofeedback tool that helps people understand how their pelvic floor is both contracting and relaxing and can aid in the recovery of pelvic floor function and be done from the comfort of your own home.

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Frequently Asked Questions

Do pelvic floor exercises really help after prostate surgery?

Yes. Pelvic floor muscle training is one of the best-supported treatments for leaking after prostate surgery. A 2014 meta-analysis of randomized trials found it improved continence in the short, medium, and long term after surgery. The muscles you train are the same ones that close off the urethra and support the bladder, so strengthening and coordinating them gives you back control that surgery disrupted. Most men see the biggest gains in the first three to six months when they train consistently, ideally with a pelvic health physiotherapist guiding the technique.

How long does incontinence last after a prostatectomy?

For most men, leaking improves steadily over the first 6 to 12 months, though the timeline varies a lot from person to person. Around 21% of men are still leaking at 12 months after robotic surgery, and pelvic floor physiotherapy is one of the few things shown to speed recovery and improve the odds. Starting early, and getting your technique checked rather than guessing, makes a meaningful difference. If leaking persists past a year, it is still worth assessing rather than accepting.

Can erectile dysfunction after prostate surgery be treated without pills?

Often, yes, or alongside medication. Pelvic floor muscle training has real evidence behind it. In one landmark trial, 40% of men with erectile dysfunction regained normal function through pelvic floor exercises, and another 35% improved. After prostate surgery, pelvic floor work is a recognized part of penile rehabilitation. It is not a guaranteed fix on its own, but it addresses the muscle side of erections that pills do not touch, which is why physiotherapists and urologists increasingly use both together.

When should I start pelvic floor exercises before prostate surgery?

As soon as you have a surgery date, if you can. Learning to find and train the right muscles before surgery, sometimes called prehab, means you walk into recovery already knowing the technique. The research on whether prehab shortens long-term incontinence is mixed, but there is a clear practical advantage. It is far easier to learn the movement when you are not sore and catheterized. A pelvic health physiotherapist can teach you the correct contraction in one or two sessions.

What is climacturia and can physiotherapy help?

Climacturia is leaking urine at the point of orgasm, and it is common after prostate surgery. It surprises men because nobody warns them, and it can affect intimacy and confidence. Pelvic floor muscle training has been shown to reduce climacturia after nerve-sparing surgery. Because the same muscles control the urethra and contribute to sexual function, a targeted program often helps both the leaking and the erection changes at the same time.

Is pelvic floor physiotherapy for men the same as for women?

The core idea is the same, but the assessment and the goals are tailored to male anatomy and to what prostate surgery specifically changes. A men's pelvic health assessment looks at how well you can contract, relax, and coordinate the pelvic floor, and builds a plan around continence and sexual recovery. At Blueberry Therapy we see men, women, and partners, and post-surgical rehabilitation is part of what we do.