Pelvic Floor Training Can Protect Urinary & Sexual Function in Men Undergoing Prostate Surgery

The male pelvic floor plays a central role in urinary and sexual function, yet it’s often overlooked until problems arise. If you are preparing for prostate surgery, chances are you’ve already been told about possible side effects like urinary leakage or erectile dysfunction. What many men don’t hear is that there are ways to improve outcomes before and after surgery.

This article covers what the pelvic floor is, how it works with the prostate, what happens when that system is disrupted, and why pelvic floor training and physical therapy are proven to help men recover more fully. We’ll also share statistics from recent studies so you can see just how much of a difference proactive pelvic floor care makes.

What Is the Male Pelvic Floor?

The male pelvic floor is a complex network of muscles, ligaments, and connective tissue spanning the bottom of the pelvis. It supports the bladder, rectum, and prostate, and forms the base of your “core.” These muscles control the passage of urine and stool, contribute to sexual function, and coordinate with the diaphragm and abdominal muscles for stability and pressure regulation.

When the pelvic floor is functioning well, you even don’t notice it; it automatically contracts when you cough, sneeze, or laugh, and relaxes when you urinate or have a bowel movement. When weakened, however, it can cause symptoms such as leakage, urgency, or sexual difficulties.

What Does the Prostate Do?

The prostate is a walnut-sized gland that sits below the bladder and surrounds the urethra. Its primary role is producing seminal fluid, which nourishes and transports sperm. The prostate also plays a role in urinary function by contributing to urethral closure and flow resistance.

As men age, the prostate often enlarges (prostatic hyperplasia, or BPH), which can obstruct urine flow. More seriously, prostate cancer is one of the most common cancers in men, and surgery (radical prostatectomy) is often required for treatment. Unfortunately, removing the prostate disrupts the natural urinary control system.

How Do the Pelvic Floor and Prostate Work Together?

Think of urinary continence as a team effort. The prostate, internal urethral sphincter, and pelvic floor muscles share the responsibility of maintaining closure and controlling flow. After prostate removal, the internal sphincter is often damaged or lost, meaning the external sphincter and pelvic floor must take over.

Without strong and well-trained muscles, continence is much harder to regain. Pelvic floor therapy an important part of recovery as it strengthens the “back-up players” on your continence team.

What Happens When the Prostate Is Removed or Damaged?

After prostate surgery, two of the most common complications are:

• Urinary incontinence: Nearly all men experience some leakage immediately after catheter removal. Incontinence typically improves over time, but the speed and degree of recovery vary widely.

• Erectile dysfunction (ED): Depending on age, surgical technique, and nerve preservation, between 20% and 90% of men experience ED post-prostatectomy.

Other possible issues include urgency, incomplete emptying, and urine leakage during orgasm. While these outcomes are common, evidence shows they are not inevitable.

When Should I Start Pelvic Floor Exercises?

The answer is simple: before surgery. This “prehabilitation” approach gives men the chance to learn how to contract and relax their pelvic floor properly, so the muscles are already strong and responsive when surgery occurs.

One sudy (Milios et al. (2020) found that men who performed pre-operative pelvic floor muscle training (PFMT) had less severe incontinence and reported significantly less sexual bother one year after surgery compared to those who did not (18% vs. 66%). This shows that even before you go into the operating room, your actions can directly influence your recovery.

Why Do Men Have to Work Harder Than Women?

Many women are familiar with pelvic floor training after childbirth, but men may be surprised to learn that their situation can be even more challenging. Why?

• After prostate removal, the male system loses one of its major continence mechanisms (the internal sphincter).

• The nerves that control the bladder and penis run directly alongside the prostate, and even with nerve-sparing surgery, they can be stretched or damaged.

• Men typically have less awareness of their pelvic floors and may need more guidance to learn correct activation.

In short, regaining continence after prostate surgery is often more demanding for men than for women, but training makes a real difference.

When Should I Restart Exercises After Prostate Surgery?

Most men can begin gentle pelvic floor activation once the catheter is removed (usually 1–2 weeks after surgery), but always confirm with your surgeon. In the early recovery period, the focus is on gentle contractions, breathing coordination, and avoiding strain. As healing progresses, exercises are gradually intensified, targeting both endurance (to maintain continence throughout the day) and quick contractions (to prevent leakage with coughing or sneezing).

What Do the Statistics Say?

Urinary Incontinence:

• Nearly all men (up to 98%) leak urine immediately after surgery (Yamashita et al., 2021).

• Recovery improves with time: ~30% are pad-free at 3 months, ~58% at 6 months, and ~79% at 12 months post-surgery (Yamashita et al., 2021).

• Long-term, about 14–25% of men still report bothersome leakage even 10 years later (Resnick et al., 2013).

Erectile Dysfunction:

• Incidence ranges from 20% to 90% depending on age, surgical technique, and pre-surgery function (Montorsi et al., 2017; Motlagh et al., 2021).

• Penile rehabilitation strategies (including PFMT and medications) improve outcomes, with one review finding PFMT plus biofeedback had significantly better results for erectile function compared to no treatment (Kannan et al., 2022).

With Training vs Without:

• Men who complete structured PFMT programs recover continence faster and more completely than those who don’t (Gacci et al., 2023).

• One study found that only 18% of men who did pre-operative PFMT had sexual bother at 1 year, versus 66% in those who did not (Milios et al., 2020).

Final Thoughts

Prostate surgery can be life-saving, but it comes with real challenges for urinary and sexual health. The good news is that you are not powerless. Pelvic floor training and physical therapy give you a proactive way to regain control, reduce anxiety, and improve long-term outcomes.

If you’re preparing for surgery, talk to a pelvic health physical therapist now. And if you’re already recovering, it’s not too late! Strengthening your pelvic floor and retraining your system can still improve your function and quality of life.

Learn more about Men's Pelvic Floor PT:

• Gentlemen, Men's Pelvic Floor Physical Therapy May Be For You!

• Why Men’s Pelvic Floor PT Isn’t Weird (The Less-Censored Version)

• Bike Seat Problems? What Every Male Rider Should Know About Issues In the Saddle

• 8 Habits for a Great Pelvic Floor Health (and Better Bladder & Bedroom Confidence)

• Pelvic Floor Training Can Protect Urinary & Sexual Function in Men Undergoing Prostate Surgery

• Bladder Irritants and Urinary Incontinence: What You Need to Know

• Drinking Less and Peeing “Just in Case” Can Make Urinary Incontinence Worse

• The Male Pelvic Floor: Everything You Should Know (And Why It Matters)

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References

• Gacci M, et al. Latest Evidence on Post-Prostatectomy Urinary Incontinence. Curr Opin Urol. 2023.

• Kannan P, et al. Effectiveness of physiotherapy interventions for improving erectile function after prostatectomy. BMC Urol. 2022.

• Milios JE, et al. Early pelvic floor training reduces postprostatectomy impact on quality of life. Support Care Cancer. 2020.

• Montorsi F, et al. Erectile dysfunction after radical prostatectomy. Lancet Oncol. 2017.

• Motlagh RS, et al. Penile rehabilitation after prostatectomy. AUA Update Series. 2021.

• Resnick MJ, et al. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013.

• Yamashita K, et al. Predictors of long-term urinary incontinence after robot-assisted laparoscopic radical prostatectomy. Res Rep Urol. 2021.