Urinary incontinence after radical prostatectomy is expected in the early period and improves for most men over the following months. But "most men" is not all men, and "improves" is not the same as "resolves" — a meaningful proportion still have troublesome leaking a year later.
Pelvic floor muscle training is the recommended conservative treatment for post-prostatectomy incontinence, and there is good reason to start it before surgery rather than after. Pre-operative training gives you time to learn the correct contraction while your anatomy is intact and while you are not sore, catheterised or anxious — which is a considerably easier learning environment than the week after an operation.
If you are already post-operative, that is fine too. Rehabilitation is effective started at any point, including months or years afterwards.
Why continence is affected
Continence in men depends on two mechanisms. The internal sphincter at the bladder neck works involuntarily, and the external sphincter below the prostate is under voluntary control and forms part of the pelvic floor.
Radical prostatectomy removes the prostate, and with it the internal sphincter mechanism at the bladder neck is disrupted. That leaves the external sphincter and the surrounding pelvic floor doing a job they previously shared — and doing it alone, without the training to match.
This is exactly why pelvic floor rehabilitation works here. You are not repairing what was removed; you are training the remaining mechanism to compensate for it. That is a realistic, achievable target, and it is why supervised training outperforms simply waiting.
Before surgery — prehabilitation
Ideally starting four to six weeks before your operation, though even one or two appointments is worthwhile.
Learn the correct contraction while it is easy
Establishing an accurate pelvic floor contraction takes most men a few sessions. Doing that beforehand — pain-free, catheter-free and unhurried — is far easier than attempting it in the first post-operative week, and it means you start recovery already knowing what you are doing.
Build baseline strength
Entering surgery with a stronger, better-coordinated pelvic floor gives you more to work with afterwards.
Biofeedback baseline
Objective pre-operative measurement gives a reference point for tracking recovery afterwards, rather than relying on impressions.
Know what to expect
Understanding the normal recovery trajectory — including that early leaking is expected and not a sign the surgery failed — makes the first weeks considerably less alarming.
Plan the early weeks
Which products to have ready, how to manage fluid, what activity is reasonable, and when to restart exercises after catheter removal.
After surgery — the recovery pathway
While the catheter is in
Do not perform pelvic floor contractions against an indwelling catheter — it causes irritation. Gentle breathing, mobility and general activity are appropriate. Your surgical team will advise on timing.
After catheter removal
Restart gentle pelvic floor training once the catheter is out and you are comfortable, usually guided by your surgical team. Early leaking at this stage is expected and is not a measure of your eventual outcome.
Weeks 2 to 12 — the main rehabilitation phase
Progressive strengthening with both endurance holds and quick contractions, advanced from lying to sitting to standing to during activity. This is where the majority of improvement happens, and where supervision produces the biggest difference.
The knack
Pre-contracting immediately before standing, coughing, sneezing or lifting. One of the most effective early interventions, and it works before any strength has been regained.
Biofeedback throughout
Altered sensation after surgery makes it genuinely hard to tell whether you are contracting the right muscle. Biofeedback resolves that uncertainty and tracks objective progress. See biofeedback therapy.
Beyond three months
Improvement continues for many men well past the first few months. Where leaking persists at twelve months despite proper conservative treatment, that is the point to discuss surgical options such as a sling or artificial sphincter with your urologist — and having completed rehabilitation strengthens that conversation.
Bladder retraining if urgency features
Urgency as well as stress leaking is common after prostatectomy, and it needs deferral training rather than more strengthening. See overactive bladder.
Erectile function and wider recovery
Erectile dysfunction after prostatectomy is common and is primarily a nerve and vascular issue, managed by your urologist through penile rehabilitation protocols, medication and other options.
The pelvic floor contributes to erectile function and to ejaculatory control, and pelvic floor training has an evidence base as part of the wider picture. It is a contributor rather than the main treatment, and it works alongside urological management rather than replacing it.
Climacturia — leaking urine at orgasm — is common after prostatectomy, rarely mentioned, and often distressing. It usually responds to targeted pelvic floor work and practical strategies, and it is worth raising even though almost nobody does.
Contact your surgical team promptly for: fever, worsening pain, inability to pass urine, heavy bleeding, or a wound that is red, hot or discharging.
Frequently Asked Questions
When should I start pelvic floor exercises for prostate surgery?
Ideally four to six weeks before the operation. Learning the correct contraction takes most men several sessions, and doing so beforehand — while you are comfortable and not catheterised — is considerably easier than attempting it during the first post-operative week. After surgery, training restarts once the catheter is removed and you are comfortable, guided by your surgical team.
How long does incontinence last after prostate removal?
Leaking is expected in the early weeks and improves for most men over the following months, with the greatest gains typically in the first three months and continued improvement beyond that. A meaningful proportion of men still have some leaking at a year, which is when surgical options such as a sling or artificial sphincter are usually discussed — after conservative treatment has been properly tried.
Can I do pelvic floor exercises with a catheter in?
No. Contracting against an indwelling catheter causes irritation and is not recommended. During that period, gentle breathing, general mobility and walking are appropriate. Pelvic floor training restarts after catheter removal, on your surgical team's advice.
Is it too late to start if my surgery was months or years ago?
No. Pelvic floor muscle training remains effective started at any point, including years after surgery. Men who were never given proper supervised rehabilitation frequently improve substantially once they receive it, because in many cases the muscle was never trained correctly in the first place.
Will physiotherapy help with erectile dysfunction after prostatectomy?
It can contribute. Erectile dysfunction after prostatectomy is primarily a nerve and vascular problem managed by your urologist, but the pelvic floor plays a role in erectile function and ejaculatory control, and pelvic floor training has an evidence base as part of the wider approach. It works alongside urological management rather than in place of it.
What is climacturia and can it be treated?
Climacturia is leakage of urine at orgasm, which is common after radical prostatectomy and rarely discussed. It usually responds well to targeted pelvic floor training combined with practical strategies such as emptying beforehand. It is well worth raising at your appointment — it will not be an unusual question.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
Book Before Your Operation If You Can
Learning the correct contraction beforehand is considerably easier — and it gives you a head start on recovery.
Book Your ConsultationOr contact us directly: 07999 996926 | info@zylohphysio.com