What is prostatectomy rehabilitation?
The prostate sits directly beneath the bladder, wrapped around the urethra. When it is removed, the bladder is reconnected to the urethra and the internal sphincter that used to hold urine passively is largely lost. Control now depends on the external urethral sphincter and the pelvic floor muscles, which most men have never consciously trained. Nerve bruising during surgery adds to the early leaking.
Most men improve over the first year, but the pace varies enormously, and the pads, planning and loss of confidence in the meantime are demoralising. Pelvic floor physiotherapy teaches you to find and use the right muscles, ideally before surgery so the skill is already there, then builds strength, endurance and the reflex to squeeze before a cough or a stand. The same training supports erectile recovery and pelvic pain that can follow surgery.
Common signs and symptoms
- Leaking urine when you cough, sneeze, stand up, lift or walk
- Leaking at the end of the day when the muscles are tired
- Urgency and difficulty deferring the need to pee
- Dribbling after finishing urination
- Leaks during sex or with erection (climacturia)
- Pelvic or perineal pain, or erectile difficulties, after surgery
What causes it?
- Loss of the internal urethral sphincter when the prostate is removed
- Weak or untrained external sphincter and pelvic floor muscles
- Nerve bruising or damage during surgery
- Bladder overactivity, which can develop or be unmasked after surgery
- Poor pressure management: coughing, lifting or standing without a preparatory squeeze
- Pre-existing bladder or pelvic floor problems, and radiation therapy in some men
How pelvic floor physiotherapy helps
Prostatectomy rehabilitation is a structured program: learn the right contraction, build it, and apply it exactly when leaks happen. Starting before surgery gives you a head start; starting afterwards still shortens the road to dry.
A treatment plan typically includes:
- A pre-surgery session to learn a correct pelvic floor contraction and what to expect after the catheter comes out
- Assessment of pelvic floor strength, endurance and coordination after surgery, externally or, with consent, internally
- A progressive strength and endurance program for the external sphincter and pelvic floor
- “The knack”: squeezing before coughs, sneezes, standing and lifting to stop stress leaks
- Bladder retraining and fluid strategies for urgency and night-time leaks
- Support for erectile recovery and any pelvic pain, coordinated with your urologist
What the research says
The studies below are peer-reviewed and linked to their permanent records so you can read them yourself.
Men who started pelvic floor rehabilitation immediately after catheter removal regained continence much faster: 74% were continent at three months compared with 30% of men who did not receive the program.
Filocamo MT, Li Marzi V, Del Popolo G, et al.. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. European Urology, 2005. View study
Starting pelvic floor muscle exercise before radical prostatectomy led to significantly more men being continent at one and three months after surgery than starting afterwards.
Centemero A, Rigatti L, Giraudo D, et al.. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. European Urology, 2010. View study
This Cochrane review of conservative treatment after prostatectomy found that most men’s continence improves over the first year and that pelvic floor muscle training is widely used and safe, while noting that the added benefit of supervised training over instruction alone was uncertain across the pooled trials.
Anderson CA, Omar MI, Campbell SE, Hunter KF, Cody JD, Glazener CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews, 2015. View study
Treatment at Corelife Wellness in Oakville
Corelife Wellness is a dedicated pelvic health clinic at 3075 Hospital Gate, Unit 312, Oakville, next to Oakville Trafalgar Memorial Hospital. Care starts with a free 15-minute consultation by phone, video or in person, followed by a full assessment with our Registered Physiotherapist. Every pelvis is unique, so your plan is built from that exam rather than a template. No referral is needed, and physiotherapy is often eligible under extended health benefits.
How assessment and treatment work, and how to book, are on our main page: Pelvic floor physiotherapy in Oakville. When hands-on therapy alone is not enough, the Libby Chair (Emsella), a non-invasive pelvic floor stimulation treatment, is available in the same clinic with no new referral.
Helpful reading from our team
When to see a doctor first
Pelvic floor physiotherapy is safe and you do not need a referral, but some symptoms need a medical assessment before or alongside treatment:
- Being unable to pass urine, or severe pain with a distended bladder (seek urgent care)
- Fever, chills or cloudy, foul-smelling urine after surgery
- Heavy bleeding in the urine
- Wound redness, discharge or increasing pain
- Calf pain or swelling, chest pain or breathlessness
