Pelvic Physical / Occupational Therapy for Prostatectomy

Why Physical Therapy Matters

Following prostatectomy surgery, most individuals will experience some level of urinary leakage (incontinence). It can be distressing, frustrating, and downright annoying. Physical therapy can help patients learn how to correctly retrain the pelvic floor muscles that support bladder control and decrease incontinence, with most people noticing steady progress as the weeks go by. Physical therapy can also assist with pain management, bladder/bowel symptom management, and guidance on returning to prior physical activity — whether that's work-related tasks or recreational activities like tennis and golf.

Before Surgery

Seeing a physical therapist prior to prostatectomy surgery can have many benefits. Beyond training on how to correctly use the pelvic floor muscles after surgery, PTs also provide important education on what to expect post-surgery, dietary modifications that can help with symptom management, and other tips for post-operative discomfort, pain management, and activity modifications. Emerging research shows that individuals who complete a pelvic floor training program 5 weeks before surgery can be 50% drier from the start of their recovery than those who don't undergo a pre-surgery program.

How does a pelvic floor physical therapist assess pelvic floor muscles?

Before surgery, we use a digital rectal assessment technique to fully evaluate recruitment strategy, muscle coordination, and endurance. This helps patients feel confident performing a correct pelvic floor contraction (Kegel), establishing good recruitment, control, and coordination prior to surgery for a quicker return of function afterward. After surgery, this type of assessment cannot be performed for 6 weeks while tissue heals.

The First Few Weeks

Once your catheter is removed, urinary leakage is normal and expected while the pelvic floor muscles heal and retrain. PT typically starts gently, focusing on correct muscle activation, good posture, and mobility work to support circulation and healing. In the clinic, we work on establishing a program specific to you and/or resuming the program established during a pre-surgery appointment.

Learning the Right Technique

A key focus is quality over quantity. Many people accidentally clench their abs, glutes, or thighs instead of (or along with) the pelvic floor. Your therapist may use biofeedback (a sensor showing muscle activity on a screen) or hands-on guidance to make sure you're engaging the right muscles.

Building Strength Over Time and Bringing It Into Daily Life

Over several weeks, exercises typically progress to address the specific situations where you experience leakage. Sometimes leakage occurs when transitioning out of a car, bed, or chair. Sometimes it happens with a cough or sneeze. Sometimes it worsens as the day goes on — you're dry all day, then leakage ramps up around 4 p.m. Your pelvic floor program will be customized to address when and how your leakage occurs.

Tracking Progress

Continence usually improves gradually over weeks to months, and the pace varies from person to person. Expect regular check-ins where your plan is adjusted — most patients benefit from seeing their physical therapist every 2–4 weeks.

Sexual Function

Because the pelvic floor plays a role here too, physical therapy rehabilitation can also address erectile function or pelvic discomfort. Starting at 6 weeks after surgery, your physical therapist can discuss incorporating an erectile recovery program into your home routine. This may not be an initial goal for every patient, but it's worth raising with your physical therapist if it's a priority for you.

What Helps Most

• Consistency with daily home exercises matters more than time spent in the clinic

• Give it time — real progress is often measured in months, not days

• More is not necessarily better — focus on form, not just repetitions

• Flag any concerns (lack of progress, pain, new symptoms) to your surgeon or therapist rather than waiting

  
  

The Bottom Line

Pelvic floor recovery after prostatectomy is a well-understood process with a strong track record of improvement. Most people regain good bladder control with time and consistent practice. Your PT team is there to guide the pace and adjust the plan to fit your recovery.

Questions about your specific plan or progress? Bring them to your next PT or follow-up appointment.

Written by Alison Gallup, PT, DPT, OCS