Pelvic Floor Rehabilitation for Men After Prostate Surgery: Exercises – Complete Month-by-Month Protocol

Radical prostatectomy, while highly effective in treating prostate cancer, leaves around 70% of men with temporary urinary incontinence in the weeks following surgery. This figure, based on 2024 data from the French Urology Association, may sound alarming, but it reflects a much more encouraging reality: with a well-structured pelvic floor rehabilitation programme, 90% of patients regain satisfactory continence within a year after surgery, and 76% as early as the third month.

If you are preparing for this procedure or currently recovering, this comprehensive guide will support you month by month through your rehabilitation. We will break down each exercise and each step with the precision of a medical protocol, but in clear, accessible language. Because regaining bladder control after prostatectomy is not just about patience: it is about method, consistency and correct technique.

Why rehabilitation is essential after prostatectomy

Prostatectomy profoundly changes the anatomy and physiology of the male urinary system, requiring complex muscular and neurological adaptation.

How surgery impacts the sphincter

Removing the prostate eliminates a natural support zone for the urethra and inevitably affects the smooth (internal) sphincter located at the bladder neck. The external striated sphincter, usually secondary in male continence, suddenly has to take over the entire urine-holding function on its own. This new responsibility requires a major increase in both strength and endurance.

According to the work of Professor René Yiou, a specialist in functional urology, spontaneous recovery without rehabilitation concerns only 20% of patients one month after surgery. With structured rehabilitation, that rate rises to 45%, illustrating the critical importance of active muscle training. Even with nerve-sparing techniques, surgery often causes a temporary “shock” to the nerves that control the sphincter, which is why regular stimulation is needed to regain normal function.

The crucial role of the pelvic floor in post-op continence

The male pelvic floor, a muscle group that is often overlooked, becomes the main driver of continence after prostatectomy. Made up of several interlaced muscle layers, it forms a supportive “hammock” for the pelvic organs. Its anterior portion, the bulbospongiosus muscle, actively contributes to urethral closure. The levator ani muscle, the primary component of the deep pelvic floor, helps maintain the bladder-urethra angle that supports continence.

Rehabilitation aims to hypertrophy these muscles to compensate for the loss of the smooth sphincter. A trained pelvic floor can generate a urethral closure pressure of 80 to 100 cmH2O, which is more than enough to maintain continence even during significant exertion. Training also improves proprioception, enabling a reflexive, anticipatory contraction when abdominal pressure rises.

Recovery timeline: with and without rehab

Without structured rehabilitation, recovery follows a slower curve: 20% continence at 1 month, 50% at 6 months, and 70% at 1 year. The remaining 30% continue to experience disabling leakage that often requires secondary intervention. Quality of life stays significantly impaired during this prolonged “wait and see” phase.

With rehabilitation started early (ideally before surgery), outcomes improve dramatically according to the HAS/Clikodoc 2025 report: 45% of patients continent at 1 month, 76% at 3 months (French Urology Association data), and 90% at 1 year. Recovery is not only faster, but also more complete, with better long-term continence quality. During this period, using appropriate men’s protection can help you maintain daily activities safely and confidently.

Benefits beyond continence

Post-prostatectomy pelvic floor rehabilitation offers benefits that go well beyond urinary control. Erectile function, often affected after surgery, can improve directly through pelvic floor strengthening. The ischiocavernosus muscle, engaged during training, contributes to penile rigidity by compressing the base of the erectile tissues. About 65% of patients report improved erectile function after 6 months of pelvic floor rehabilitation.

Overall posture can improve thanks to strengthening the pelvic “core”. Low back pain, common after abdominal surgery, decreases by 40% in patients who follow a structured rehabilitation protocol. Confidence, a crucial psychological factor, rebuilds progressively with each improvement, making it easier to resume social and intimate activities.

Why you should start before surgery

Pre-op preparation can dramatically improve post-surgical results, an important and still under-discussed strategy to optimise recovery.

Prehab: a major but underrecognised advantage

Starting rehabilitation 4 to 6 weeks before surgery can double your chances of a faster recovery. First, it helps you identify and learn how to correctly contract the pelvic floor muscles, a skill that becomes essential but harder to learn in the immediate post-op period. A patient who already knows how to activate the pelvic floor often gains 3 to 4 weeks in post-op recovery.

Pre-op muscle hypertrophy creates a valuable “functional reserve”. A toned pelvic floor tolerates surgical trauma better and recovers faster. Pretrained muscle fibres have better blood supply, which supports healing and limits post-op atrophy. This preparation can cut the duration of protection use in half according to GEM-K Formation 2023 data.

Learn the right moves while you feel strong

Learning technique before surgery happens under ideal conditions: no pain, full mobility and maximum concentration. You can experiment with different positions, identify the correct sensations and build automatic movement patterns. This stage helps correct common mistakes: pushing instead of contracting, overusing surrounding muscles and poor breathing coordination.

Neuromuscular memory becomes deeply established during this period. The brain builds specific neural circuits that persist despite the stress of surgery. After surgery, you will be able to find these motor patterns more easily, even with anatomical changes. It is like learning to ride a bike: once learned, the movement stays with you.

Create a routine that will last

Building a daily routine before surgery makes it much more likely you will continue afterwards. Scheduling exercises into your day (morning after waking, evening before bed) creates an automatic habit that is more resistant to post-op disruptions. Patients who set up a pre-op routine maintain about 85% adherence after surgery compared to 60% for those who start only afterwards.

A tracking journal started before surgery becomes a powerful motivation tool. Recording progress (number of contractions, hold time, perceived quality) makes improvement visible and helps maintain commitment. Involving family or a close support person before surgery also strengthens ongoing support during recovery.

Simplified male pelvic floor anatomy

Understanding your anatomy leads to more effective, intentional rehabilitation, turning mechanical exercises into targeted training.

Where the muscles are and what they do

The male pelvic floor forms a muscular diamond stretched between four bony landmarks: the pubic bone in front, the tailbone in back, and the sitting bones on each side. This complex structure is divided into three layered planes. The superficial plane includes the external anal sphincter, the bulbospongiosus muscle (around the base of the penis), and the ischiocavernosus muscles (along the erectile tissues). These muscles, relatively easy to feel, help as landmarks during learning.

The middle plane, also called the urogenital diaphragm, contains the external urethral sphincter and the deep transverse perineal muscle. This is the key zone for urinary continence, forming a muscular ring around the urethra. Its voluntary contraction is what allows you to “stop” the urinary stream, a one-time identification test that should not be repeated.

The deep plane, dominated by the levator ani muscle, forms the true pelvic floor. This funnel-shaped muscle supports the bladder and rectum and maintains the bladder-urethra angle needed for passive continence. Its puborectalis portion, particularly developed in men, plays a crucial role in pelvic “bracing” during exertion.

The voluntary striated sphincter after prostatectomy

After prostate removal, the external striated sphincter becomes the primary guardian of active continence. Normally an “assistant” muscle, it now must work continuously. Its average thickness of about 5 mm ideally needs to increase by 30% to 50% to compensate for the loss of the smooth sphincter. That hypertrophy requires specific training for both strength and endurance.

Nerve recovery after surgery follows a predictable timeline: axonal regrowth occurs at roughly 1 mm per day, meaning around 3 to 6 months for full reinnervation from the sacral roots. During this phase, regular muscle stimulation maintains tissue health and supports neuromuscular reconnection. Electrical stimulation can speed up this process by 20% to 30%.

Before vs after surgery: what changes

Post-prostatectomy anatomy involves major changes that require functional adaptation. The urethra, shortened by about 2 to 3 cm, loses its natural angle at the bladder neck. The bladder, now directly reconnected to the urethra, drops about 1 to 2 cm within the pelvis. These shifts change force directions and require a new continence strategy.

Scar tissue around the urethra, forming during the first 3 months after surgery, can either help continence by providing support or impair it through excessive fibrosis. Early, regular mobilisation helps guide healing in a favourable direction. Adhesions, more common after open surgery, can limit urethral mobility and sometimes require specific mobilisation techniques.

How to identify the right muscles

Palpation is the first identification step. Lying down, place two fingers between the scrotum and the anus. A correct pelvic floor contraction gently lifts that area inward, without engaging the glutes or abdominal muscles. This “lift” differs from pushing, which worsens leakage.

Visualisation helps a lot: in front of a mirror, observe subtle testicular and penile retraction during contraction. The penis should shorten slightly and lift, and the testicles rise symmetrically. No visible movement often indicates a weak or incorrect contraction that may require professional guidance.

Complete month-by-month protocol

30 days before surgery: intensive preparation

This crucial phase maximises your chances of a fast recovery. Start by locating your pelvic floor: lying down with knees bent, contract as if trying to hold in wind. Hold for 3 seconds, relax for 6 seconds. Repeat 10 times, 3 times per day. Progressively increase to 5 seconds of contraction and 10 seconds of rest.

Add fast contractions in week 2: 10 contractions for 1 second, rest 2 seconds. These fast-twitch fibres prevent leaks during sudden effort. Alternate with slow contractions to train all fibre types. In week 3, add varied positions: sitting, standing and walking. The contraction must remain effective regardless of position.

In the week before surgery, reduce intensity but maintain frequency. Prepare your “recovery kit”: men’s absorbent briefs of different absorption levels, a tracking journal and a timer. Establish your schedule: 8 a.m., 2 p.m., 8 p.m., for example, easy to remember and follow even while in hospital.

Post-op days 1 to 7: the acute phase

The first days focus on gentle activation without forcing. With the urinary catheter in place, perform only very light contractions for 1 to 2 seconds, 5 times every 2 hours while awake. These micro-contractions maintain circulation without risking catheter displacement. Keep breathing normally, with no breath-holding.

After catheter removal (typically day 5 to day 7), carefully test contraction. Leaks are normal and can be heavy (around 800 to 1,000 ml per day). Wear a high-absorbency option such as leakproof boxer briefs (300 ml+ capacity), changing every 3 to 4 hours. Track every urination and every protection change to objectively measure progress.

Exercises remain gentle: 10 contractions for 2 seconds, rest 5 seconds, 3 times per day. Quality matters more than quantity. If pain or bleeding occurs, stop and consult your care team. Lying down makes training easier by reducing gravity effects. Avoid abdominal straining and lifting.

Weeks 2 to 4: gradual return

Improvement becomes noticeable as leakage decreases to about 400 to 600 ml per day. Increase gradually: 3 to 4-second contractions, 6 to 8 seconds of rest, 15 repetitions, 4 times per day. Introduce sitting contractions, which are harder because gravity works against you. Keep your back straight and feet flat.

Begin functional exercises: contract before standing up, before coughing, and before lifting light objects. This preventive “pelvic lock” becomes automatic over time. Aim for 50 of these mini-anticipatory contractions per day. Night-time leaks usually improve first, which is a positive sign.

Biofeedback, if available, can dramatically improve this phase. Seeing your contraction helps eliminate compensations. If you do not have a device, use perineal palpation to verify contraction quality. A pelvic floor physiotherapist can typically begin structured sessions here, often twice per week.

Months 1 to 3: intensification

This turning point is where 76% of patients regain “social continence” (0 to 1 pad per day) based on French Urology Association data. The programme intensifies: 5 to 8-second contractions, 10 seconds rest, 20 reps, 4 times per day. Add “stair-step” contractions: 30% effort for 2 seconds, 60% for 2 seconds, 100% for 2 seconds, then a gradual release.

Harder positions strengthen control: standing with one leg raised, squatting, lunges. Each position challenges the pelvic floor differently. Dynamic drills include: walking while holding a contraction for 10 steps, climbing stairs with pelvic bracing, picking objects up in a squat while contracted.

Build endurance with longer sets: a submaximal hold (about 70% effort) for 30 to 60 seconds. These exercises mirror real-life demands (standing for long periods, walking). You can gradually step down protection: light liners (50 to 100 ml) for daytime, and higher capacity (150 to 200 ml) for outings or higher-activity periods.

Months 3 to 6: consolidation

Progress typically stabilises with about 100 to 300 ml of daily leakage, mostly during exertion. Training becomes more specific: maximal strength work (10 maximal contractions held for 10 seconds), speed work (30 fast contractions in 30 seconds), and endurance work (a 2-minute hold at about 50% of max effort).

Gradual return to exercise begins: swimming (excellent and low-impact), stationary cycling (strengthens without excessive pressure), Nordic walking (gentle full-body load). Avoid running, tennis and heavy lifting for now. Start each activity at 10 minutes and increase by 5 minutes per week.

Sexual function, often possible again after about 3 months, can improve directly with pelvic floor strengthening. Specific exercises include: contractions during erection (targets the ischiocavernosus muscles), maintaining erection with sequential contractions, and training the bulbospongiosus muscle for ejaculation. Sexual counselling can be a helpful addition.

Months 6 to 12: towards full independence

By 6 months, about 85% of patients are continent. The remaining 15% usually experience occasional leaks and may prefer a “just in case” level of protection. The programme shifts to maintenance: three 15-minute sessions per week are typically enough. Vary exercises to prevent boredom: pelvic floor circuit training, resistance band work and adapted yoga positions.

Normal sports can gradually resume. Running starts with walk/jog intervals (1 minute/1 minute). Racquet sports should begin without sudden lateral movement. Strength training returns with light loads, increasing about 10% per month. Wearing leakproof boxer briefs during your return to sport can provide reassurance.

The one-year evaluation determines next steps: if continence is satisfactory (90% of cases), maintain lifelong prevention (about 5 minutes daily). If significant leakage persists, specialist consultation is needed for urodynamics and discussion of options (male sling, artificial urinary sphincter). Pelvic floor training remains beneficial even if additional surgery is required.

Core exercises: Kegels for men

Kegel exercises, specifically adapted to the male anatomy after prostatectomy, are the foundation of pelvic floor rehabilitation.

Identifying the pelvic floor: the “stop-stream” test explained

The stop-stream test, done only for identification, helps you find the correct muscles. Mid-urination, try to stop the flow. The muscles you use are your pelvic floor. Memorise the sensation of “closing” and “lifting”. Do not repeat this exercise: repeating it can disrupt normal voiding reflexes and increase infection risk.

When not urinating, reproduce that contraction: imagine holding in wind while gently lifting the penis towards your belly button. A correct contraction creates: a tightening sensation around the anus, a slight lift/shortening of the penis, a symmetrical lift of the testicles, and a subtle inward lift in the lower abdomen. Your glutes, thighs and upper abdominals should stay relaxed.

Basic contractions: timing and progression

Start lying down with knees bent and feet flat, placing one hand on your abdomen to ensure your abdominals stay relaxed. Build the contraction over 2 seconds, hold for 3 seconds at maximum effort, then release over 2 seconds. Fully relax for 10 seconds. This 2-3-2-10 sequence is the foundation.

Standard weekly progression: Weeks 1-2: 3-second holds, 10 reps, 3 times/day. Weeks 3-4: 5-second holds, 15 reps, 3 times/day. Weeks 5-8: 8-second holds, 20 reps, 4 times/day. Weeks 9-12: 10-second holds, 25 reps, 4 times/day. After that: maintain based on tolerance, minimum 3 times/day.

A structured daily routine

Best timing to maximise consistency: Morning upon waking (before getting up): 20 slow contractions. Midday before lunch: 15 slow + 15 fast. Afternoon (around 4 p.m.): 20 contractions sitting. Night at bedtime: 20 slow contractions + gentle stretching.

Build exercises into daily life: shower: 10 contractions under warm water (improves awareness). commuting: rhythmic contractions at red lights or stops. TV: one set during ad breaks. reading: 5 contractions per page. This approach makes it easy to reach 100+ contractions per day without feeling overwhelmed.

Why breathing matters

Coordinated breathing increases exercise effectiveness. Inhale slowly through your nose while relaxing the pelvic floor. Exhale through your mouth while progressively contracting. This exhale-contract synergy matches the natural effort mechanism. Chest breathing, without belly bulging, helps protect pelvic floor pressure.

Avoid breath-holding, a common beginner mistake that increases abdominal pressure and pushes down on the pelvic floor. If you cannot speak during a contraction, you are holding your breath. Done correctly, you should be able to talk normally. Count out loud during the hold to check.

Progressive week-by-week programme

Weeks 1-2: gentle relearning

These first two crucial weeks lay the foundation for recovery. The goal is not performance, but quality and consistency. Each day begins with 10 gentle 2-second contractions lying down, the least demanding position. After breakfast, wait 30 minutes and do a second set sitting on a firm chair.

In the afternoon, add “flash” contractions: 10 quick contractions lasting about half a second. These fast-twitch fibres help prevent leaks during sudden effort (coughing, sneezing). At night before bed, combine 5 slow and 5 fast contractions. Daily total: 40 contractions split across 4 sessions.

Wearing a men’s absorbent brief with about 200 to 300 ml capacity provides the security you need. Change every 4 to 6 hours depending on leakage. In your journal, record: how many products you used, the approximate volume of leakage, and what triggered it (effort, urgency, post-void dribble).

Weeks 3-4: gradual increase

Improvement becomes clearer: night-time leakage decreases, often the first encouraging sign. Increase holds to 3 to 4 seconds, with rest time at least double (6 to 8 seconds). Muscle fatigue is normal; if you feel cramps or pain, temporarily reduce intensity by about 20%.

Add standing work: 10 contractions while leaning against a wall, feet hip-width apart. This increases difficulty by about 30% compared to lying down. Add “preventive locking”: contract briefly before standing, coughing, sneezing, or lifting. Practice 30 to 50 of these anticipatory micro-contractions daily until they become automatic.

Begin proprioceptive training: eyes closed, visualise your pelvic floor and contract as if you were “drawing water up” through the urethra. This mental image can improve contraction quality significantly. Weekly total: at least 420 contractions, ideally closer to 600.

Weeks 5-8: intensification phase

The second month often marks a decisive turning point. Holds increase to 5 to 6 seconds at about 70% to 80% of maximum effort. Introduce “stair-step” contractions: 30% effort for 2 seconds, 60% for 2 seconds, max for 2 seconds, then a controlled release. This builds fine motor control, essential for adapting contraction strength to real-life needs.

Vary positions systematically: sitting and leaning forward (reading), standing with one leg raised (balance), squatting (picking something up), lunge position (stair simulation). Each position targets different muscle fibres. Do a circuit of 4 positions with 5 contractions each, twice per day.

Build endurance in stages: hold a submax contraction (about 60%) for 15, 20, then 30 seconds. Breathe normally and count out loud. These longer holds prepare you for daily life (standing, walking). Protection can gradually become lighter: discreet men’s protection around 100 to 150 ml during the day, and about 200 ml for outings.

Advanced exercises after 2 months

Standing and movement-based training

Fully upright pelvic floor work reflects real-world demands. Standing with feet hip-width, contract as if “lifting the testicles”. Hold for 8 to 10 seconds, 15 reps. Gradually add movements: arm raises (increases abdominal pressure), trunk rotation (engages obliques), shallow knee bends (strength position).

Pelvic floor walking can be a game-changer: walk slowly while holding a 50% contraction for 10 steps, then relax for 10 steps. Gradually increase to 20, 30, then 50 steps while contracted. Stair climbing with a maintained contraction is one of the most functional drills.

Dynamic exercises include: pelvic floor squats (relax on the way down, contract on the way up), lunges with bracing, glute bridges with a strong contraction at the top. Do 3 sets of 10 reps, resting 1 minute between sets.

Strength and endurance training

Max strength is built with isometric holds: maximum contraction for 10 seconds, rest 20 seconds, 10 reps. Do this intensity only once per day to avoid overfatigue. Use the “10-10-10” challenge: 10 maximal 10-second holds with 10 seconds rest.

Long-duration endurance prepares you for active days: hold a 40% to 50% contraction for 2 minutes, rest 2 minutes, repeat 5 times. Progress by adding 30 seconds every 2 weeks. This helps prevent end-of-day leaks when fatigue builds.

Speed work, often overlooked, prevents sudden stress leaks: 30 maximal contractions in 30 seconds, a true pelvic “sprint”. Rest 2 minutes and repeat 3 times. A helpful balance is about 60% slow work and 40% fast work.

Harder positions

The “downward dog” yoga position changes gravity demands and challenges the pelvic floor in a different way. Hold for 30 seconds with a light continuous contraction. Modified knee push-ups with pelvic bracing synchronised to the movement improve coordination. Side plank holds with a pelvic contraction strengthen the pelvic floor in the frontal plane.

Single-leg balance work (one foot) with a contraction can reveal asymmetry. Hold for 30 seconds per side, eyes open then closed. Increase difficulty on an unstable surface (pillow, foam pad). These proprioceptive drills build automatic control that supports spontaneous continence.

Finish with active stretches: butterfly stretch (seated, soles of feet together), contract for 5 seconds, then relax as the knees drop. Child’s pose with rhythmic contract/relax helps release pelvic tension. These stretches help prevent tightness and improve recovery.

Pelvic bracing before exertion

Understanding the preventive mechanism

Anticipatory pelvic bracing is the key to stress continence. This preventive contraction triggered 1 to 2 seconds before abdominal pressure rises pre-closes the urethra. Over time, this moves from conscious brain-based control to a reflexive spinal pattern, requiring less conscious effort once automated.

Abdominal pressure during a sneeze can reach 150 cmH2O within 0.2 seconds. Without bracing, that pressure can push urine out instantly if the sphincter is weak. With bracing, the pelvic floor can generate a counter-pressure of 100 to 120 cmH2O, enough to maintain continence. This strategy, called “The Knack”, can reduce stress leakage by 75% in the research literature.

Specific bracing drills

Start in controlled situations. Sitting, contract, then cough on purpose while maintaining the contraction. Repeat 10 times, 3 times per day. The contraction should start 1 second before the cough and remain for 2 seconds after. Progress to stronger coughs, simulated sneezes and forced laughter.

Train bracing in daily life: before standing up (contract, then stand), before lifting (contract, bend knees, grab, lift while exhaling), before pushing a heavy door. Practice 50 to 100 bracing events per day across varied contexts. Repetition builds automaticity within 4 to 6 weeks.

Sport-specific training adapts bracing to your activity: before a golf swing, a tennis serve, or a jump. Every sport has critical moments that require anticipation. Wearing leakproof boxer briefs during training can provide reassurance and allow you to progress without fear.

Automation: the key to success

Automation turns conscious bracing into an unconscious reflex. This motor learning process requires thousands of repetitions. At 100 bracing events per day, automation typically occurs within 2 to 3 months. Synaptic connections strengthen, creating a “neural highway” from brain to pelvic floor.

Automation strategies include: consistent pairing (always brace before effort), varied practice (different places, positions, intensities), immediate feedback (track successes and misses), and mental rehearsal (visualise bracing before sleep). Over time, your brain integrates this pattern as a default motor programme.

Biofeedback and electrical stimulation

When and why to use them

Biofeedback is especially helpful when progress stalls, often after 6 to 8 weeks of independent training. About 40% of men unknowingly contract incorrectly: paradoxical pushing, excessive co-contraction, or right/left asymmetry. Biofeedback makes these invisible errors visible and correctable immediately.

The main indication is a lack of progress despite consistency. If, after 2 months, leakage remains above about 400 ml per day, biofeedback can help unlock improvement. Patients with neuropathy (diabetes, Parkinson’s disease) often benefit especially from visual feedback that compensates for reduced sensation. In France, insurance cover can include a set number of sessions with a trained therapist.

Effective protocols

A standard protocol includes two 30-minute sessions per week for 6 weeks. An anal probe with pressure sensors converts contractions into a visual signal on a screen. You can see your contraction curve in real time: rise, plateau, release. The goal is to match a model curve with a quick rise, stable plateau and controlled release.

Functional electrical stimulation uses low-frequency current (10 to 50 Hz) through the same probe. Typical post-prostatectomy settings: 35 Hz for slow-twitch fibres (endurance) and 50 Hz for fast-twitch fibres (strength), with intensity increased gradually to a strong but non-painful level. A common cycle is 5 seconds on, 10 seconds off, for 20 minutes total. Combining biofeedback and stimulation can improve effectiveness significantly.

At-home devices

Home devices have made these tools more accessible. 2024-2025 models often include Bluetooth smartphone connection, post-prostatectomy presets, automated progress tracking and exercise reminders. Typical price range: around £130 to £350 depending on features. Monthly rental options can help you try before buying.

At-home use requires consistency. A sample schedule: 20 minutes 3 times per week, alternating biofeedback (Monday), stimulation (Wednesday), and guided free training (Friday). Apps can analyse performance, detect plateaus and suggest changes. After about 3 months, most patients develop enough skill to continue without a device.

Common mistakes to avoid

Pushing too hard too fast

Early overtraining can compromise recovery. Trying to regain continence in a few weeks often leads to doing too much. Excess fatigue can cause painful pelvic cramps, local inflammation, and paradoxically a temporary worsening of leakage. Like any muscle, the pelvic floor needs recovery time between sessions.

Signs of overtraining include persistent pain after exercises, a paradoxical increase in leaks, a heavy pelvic sensation, or difficulty starting urination. If these occur, cut volume by 50% for 3 days, then rebuild gradually. A good progression rule is about a 10% weekly increase in training volume.

Incorrect contraction technique

Paradoxical pushing is the most common error and worsens incontinence. Instead of “lifting”, the person pushes as if having a bowel movement. This confusion affects many men without professional guidance. Consequences can include increased bladder pressure, stretching of supportive structures, more leakage, and potential pelvic organ strain.

Compensations reduce effectiveness: clenching glutes (steals effort from the pelvic floor), breath-holding (increases abdominal pressure), and overall tension (causes early fatigue). A correct contraction isolates the pelvic floor: glutes relaxed, breathing free, face relaxed. A pelvic floor physiotherapist can correct these errors in a few sessions.

Forgetting to fully relax

Full relaxation between contractions is as important as contracting. A constantly clenched pelvic floor can lead to painful over-tightness, pelvic myofascial pain, voiding difficulty, and constipation. Rest time should be at least equal to hold time.

Active relaxation techniques include deep diaphragmatic breathing, visualising the pelvic floor “melting”, gentle butterfly stretching, and external perineal self-massage. A 5-minute post-session relaxation in a side-lying foetal position can improve recovery. A flexible, responsive pelvic floor often performs better than a rigid, overtrained one.

Specialised pelvic floor physiotherapy: when to seek help

When therapy is indicated

A pre-op consultation, ideally 4 to 6 weeks before prostatectomy, can significantly improve outcomes. The physiotherapist assesses baseline function, teaches correct technique and builds a personalised plan. This preparation can cut post-op recovery time substantially.

After surgery, therapy is recommended if: no improvement after 4 weeks of self-training, leakage above about 500 ml per day at 2 months, pelvic pain during exercises, or uncertainty about technique. In France, these sessions are typically covered with a doctor’s prescription.

What sessions look like

The first session (45 to 60 minutes) includes: detailed history (surgical background, current symptoms, goals), clinical assessment (manual muscle testing and compensation evaluation), possible instrument assessment (EMG, pressure) if available, and a personalised treatment plan.

Follow-up sessions (about 30 minutes) may include: manual work (mobilisation, stretching, resistance), biofeedback/electrical stimulation as needed, supervised exercise with real-time corrections, new skill instruction, and progress tracking. A common schedule is twice weekly for 6 weeks, then weekly until full independence.

Specialised techniques used

A physiotherapist can use tools not available in self-training. Manual techniques may include pelvic fascia mobilisation, trigger point release, targeted stretching of deep hip rotators, and neuromuscular facilitation techniques.

Whole-body postural work addresses common issues: excessive pelvic tilt, increased low-back curve, and diaphragm tension. These dysfunctions, common after abdominal surgery, can compromise pelvic floor function. Posture work can represent a significant part of recovery and is often underestimated in self-training.

Maintaining exercises long term

Building a sustainable routine

Long-term integration of pelvic floor training helps maintain results. After full recovery, 5 to 10 minutes daily is often enough. A simple maintenance plan: 20 slow contractions in the morning, 20 fast contractions in the evening, and consistent preventive bracing before exertion. This minimalist routine helps prevent relapse and maintains strength.

Behaviour anchoring uses existing habits: do exercises while brushing your teeth (2 minutes morning and night), at red lights while driving, or during TV ad breaks. These automatic pairings keep practice consistent without mental effort. After several months, the habit becomes stable.

Preventing relapse

Relapse risk factors include weight gain (increases abdominal pressure), chronic constipation (repeated straining), chronic cough (repeated impacts), and inactivity (muscle loss). Monitoring these factors helps prevent decline. Maintaining a healthy BMI remains important.

An annual “pelvic floor check-in” can assess maintenance: maximal contraction strength, endurance hold time, and bracing quality. If performance drops by about 20% on any measure, temporarily increase training. This preventive monitoring helps detect weakening before symptoms return. During these periods, light men’s protection can provide reassurance.

Adapting with age

Normal ageing requires adjustments. After age 70, prioritise frequency over intensity (3 sets of 15 instead of 1 set of 45), choose safer positions (seated rather than unstable standing), allow longer recovery (rest time at least double the effort time), and maintain good hydration.

Combine pelvic floor work with other helpful activities: tai chi (coordination and balance), gentle yoga (flexibility and breathing), swimming (strength without impact), and Nordic walking (overall endurance). These complementary activities support pelvic health as part of overall wellbeing. The pelvic floor ages well when it is trained consistently.

Measuring progress

The bladder diary

Simple but essential, a bladder diary makes progress measurable. For 3 consecutive days, record: each time you urinate, approximate volume (using seconds as a rough proxy), leakage episodes and triggers, and how many protection products you used. Repeat this assessment every 2 weeks to track progress.

Key markers to watch: time between voids (goal: more than 2 hours), typical void volume (goal: more than 200 ml), day/night ratio (goal: fewer than one night-time wake), and number of daily leak episodes. Improvement often follows this sequence: night-time leakage decreases first, then daytime leak volume drops, then episodes become less frequent.

Practical assessment tests

The standardised pad test objectively measures leakage. Weigh a dry protection, wear it for 2 hours while performing standardised activities (drink about 500 ml of water, walk 15 minutes, climb stairs 10 times, cough forcefully 10 times), then weigh again. Weight gain under 10 g suggests continence; 10 to 20 g indicates mild leakage; 20 to 80 g moderate; over 80 g severe. Do this monthly to measure progress.

The maximal contraction test measures strength: contract as strongly as possible and hold as long as you can, timing yourself. Progressive goals: 5 seconds at 1 month, 10 seconds at 3 months, 15 seconds at 6 months. Track subjective contraction quality on a 1 to 10 scale as well.

When to worry about a plateau

No improvement after 4 to 6 weeks of consistent exercise suggests the need for reassessment. Common causes include: incorrect technique, not enough intensity, surgical complications, uncontrolled aggravating factors, or resistance to training. A specialist evaluation helps identify and correct the issue.

Warning signs include worsening leakage despite exercises, persistent pain, increasing difficulty urinating, blood in urine, or fever with chills. These symptoms require urgent medical evaluation to rule out complications such as narrowing at the surgical connection site, infection, or fistula.

Managing incontinence during rehabilitation

Choosing the right protection

Matching protection to your leakage level improves comfort and cost. Initial phase (0 to 4 weeks): high-absorbency briefs or pull-up incontinence pants for maximum security. Improvement phase (1 to 3 months): washable men’s incontinence boxer briefs with about 200 to 300 ml capacity for day and night. Consolidation phase (3 to 6 months): anatomical pads around 100 to 150 ml, or washable men’s leakproof briefs.

Move down in absorption level as you improve: when a protection stays dry for more than 4 hours, step down one level. Always keep a higher-absorption option for long outings or physical activity. Mixing washable and disposable based on situations can optimise both convenience and cost.

Optimising lifestyle habits

Balanced hydration helps prevent infections while limiting leaks: drink about 1.5 to 2.0 litres per day, with about 70% before 4 p.m., avoid coffee/tea after 2 p.m., and stop liquids 2 hours before bed. This distribution can reduce night-time urination significantly without increasing infection risk. Pale yellow urine is a good hydration sign.

Diet directly impacts symptoms: limit bladder irritants (spicy foods, citrus, tomatoes, alcohol), increase fibre to prevent constipation (about 25 to 30 grams/day), and split meals to reduce abdominal pressure. Maintaining a stable healthy weight can reduce leakage compared with being overweight.

Staying socially active

Your social life should not stop during rehabilitation. Practical strategies: locate toilets on arrival, wear a higher absorption level for peace of mind, bring a spare change in a discreet bag, and use preventive bracing. Confidence returns gradually as symptoms improve.

Choose supportive activities: films (aisle seat), restaurants (limit alcohol and coffee), gentle exercise (swimming is excellent), and shorter trips at first. Tell one trusted person so you feel supported if needed. Isolation increases anxiety, and anxiety can worsen leakage. Maintaining a moderate social life can support overall recovery.

Common questions and practical solutions

What if you feel pain?

Pelvic floor pain affects about 20% of patients during rehabilitation. Distinguish normal soreness (dull discomfort after exercise that resolves within 24 to 48 hours) from abnormal pain (sharp, persistent, radiating). Normal soreness responds to local warmth (heating pad for 15 minutes), gentle stretching, and temporarily reducing intensity.

Cramps (painful involuntary contractions) can improve with immediate stretching (deep squat with heels down), gentle circular external perineal massage, and magnesium supplementation if recurrent. If pain persists more than 72 hours or radiates towards the testicles or anus, consult a professional, as excessive pelvic floor tightness may require protocol adjustment.

How to handle urgent situations

Sudden urgency with imminent leakage requires a strategy: stop moving, contract strongly for 5 seconds, breathe deeply, contract again, then walk slowly towards the toilet while maintaining a light contraction. This “urge suppression” technique can work in many cases once trained.

Public leaks can create anxiety that worsens symptoms. Have a plan: wear appropriate protection, keep a small change kit (protection, wipes, small bag), identify toilets, and practise quick relaxation. Being prepared reduces anxiety dramatically. Remember: temporary incontinence affects 7 out of 10 men after prostatectomy.

When can you expect to stop using protection?

Average timelines vary: 20% stop at 1 month, 45% at 2 months, 65% at 3 months, 80% at 6 months, and 90% at 12 months. Helpful factors include age under 65, perfect pre-op continence, nerve-sparing surgery, and early rehabilitation. Factors that can slow recovery include diabetes, obesity, additional radiotherapy, and larger prostate size.

Gradual weaning is safest: stop night-time protection first (night leaks often improve earliest), then go without protection at home during the day, then remove it for short outings. Keep a backup protection option for 3 months after stopping completely for higher-risk situations. Stopping too abruptly can lead to setbacks and loss of confidence.

Conclusion: patience and consistency always pay off

Pelvic floor rehabilitation after prostatectomy is a true therapeutic marathon where every stage matters. The data is clear: with structured and consistent training, 90% of men regain satisfactory continence within a year, compared to only 70% without rehabilitation. That 20% difference represents thousands of men who regain quality of life, confidence and freedom.

The month-by-month protocol we covered is not a miracle cure, but a proven method supported by decades of clinical practice and rigorous scientific research. Starting before surgery can double your chances of a faster recovery. Every exercise, every contraction, every pelvic brace moves you closer to your goal.

Remember that throughout this process, you are not alone. Specialised pelvic floor physiotherapists can guide you. Modern protective options, including washable leakproof boxer briefs, allow you to maintain daily life discreetly. Support groups and patient associations can also provide understanding and shared experience.

The key to success is consistency rather than intensity, technique rather than brute force, and patience rather than rushing. Your pelvic floor needs time to adapt to its new role, and the time you invest today shapes your quality of life tomorrow. With persistence and the right exercises, regaining bladder control after prostatectomy is no longer a hope, but a statistically reliable outcome.

Keep going, progress at your pace, and celebrate every win, even the small ones. In a few months, you will look back with real satisfaction at how far you have come and the pride of taking back control. Your bladder will thank you, and your life will return to normal.