In This Article

  1. Why pelvic floor exercises matter after prostatectomy
  2. What the surgery actually does to your pelvic floor
  3. When to start — timing matters more than you think
  4. The right way to do Kegels for men
  5. 5 mistakes that slow your recovery
  6. A structured 10-week program

Why Pelvic Floor Exercises Matter After Prostatectomy

If you've had a prostatectomy — robotic, laparoscopic, or open — urinary incontinence is the most common side effect in the first weeks and months. Studies show that up to 80% of men experience some level of leakage immediately after catheter removal, and many are not given any real guidance beyond a single-page handout.

The good news is that this is highly treatable. Pelvic floor physical therapy — specifically targeted exercises — has been shown in multiple randomized controlled trials to significantly shorten the time to regaining continence compared to men who do nothing or follow generic advice.

87%of men regain full continence within 12 months
40%faster recovery with guided PT vs no PT
6–8weeks average to see major improvement with proper rehab

What the Surgery Actually Does to Your Pelvic Floor

The prostate sits between the bladder and the urethra. When it's removed, the sphincter — the muscle that controls urine flow — loses the structural support the prostate previously provided. In robotic surgery, the surgeon must carefully dissect around the nerves and muscles in this area, which inevitably causes some trauma and temporary dysfunction.

Think of it like this: the scaffolding that your sphincter relied on has been removed. The muscles aren't gone, but they've been stretched, compressed, and temporarily weakened. Your job in recovery is to rebuild strength and coordination in those muscles so they can do the job the prostate used to help with.

Key InsightThe pelvic floor has two jobs: contraction (squeezing to stop urine) and relaxation (releasing to allow normal flow). Most men only focus on squeezing — but learning to fully relax is equally important and often overlooked.

When to Start — Timing Matters More Than You Think

The question we hear most is: "When should I start pelvic floor exercises after prostatectomy?"

The answer from the research is clear: before surgery if at all possible, and immediately after catheter removal if not.

Before Surgery (Ideal)

Men who begin pelvic floor training 4–8 weeks before surgery consistently show faster return to continence. The muscles are stronger going in, you've already learned proper technique, and the neuromuscular pathways are established. This is the single most impactful thing you can do if surgery is scheduled and you have time.

After Catheter Removal

Once the catheter is out — typically 1–2 weeks after surgery — gentle pelvic floor activation can begin. The goal in the first two weeks is not strength, it's reconnection. Many men find the muscles feel completely numb or unresponsive at first. This is normal and temporary.

Do not push through pain. If you feel discomfort during exercises in the first two weeks, reduce intensity and consult your surgical team.

The Right Way to Do Kegels for Men

Kegel exercises for men are different from what most people imagine. Here's a step-by-step breakdown of proper technique:

Finding the Right Muscles

The muscles you want are the ones you use to stop the flow of urine mid-stream, or to prevent passing gas. They are deep, internal muscles — you should feel a lifting and inward squeeze, not a tightening of your buttocks, thighs, or abdomen. If those are moving, you're compensating with the wrong muscles.

  1. Lie on your back with knees bent and feet flat on the floor
  2. Breathe in normally through the nose
  3. As you breathe out, gently lift and squeeze the pelvic floor — as if you're picking up a marble with those muscles
  4. Hold for 3–5 seconds without holding your breath
  5. Completely release and rest for 5–10 seconds
  6. Repeat 10 times

Common MistakeHolding your breath during the squeeze. Your pelvic floor works in coordination with your breath. Holding the breath creates downward pressure that counteracts the exercise. Always breathe normally throughout.

Progressing Over Time

As the weeks progress, you'll advance from short holds to longer contractions (10 seconds), then to functional positions like sitting, standing, and eventually walking. The goal is to make these muscles work automatically in real-life situations — not just lying in bed.

5 Mistakes That Slow Your Recovery

  1. Doing too many repetitions too soon. More is not better. Fatigued pelvic floor muscles cannot coordinate properly and can actually increase leakage. Start with 10 reps, 3 times a day.
  2. Never fully relaxing between contractions. The release phase is as important as the squeeze. A muscle that never relaxes can develop tension and trigger points that cause their own problems.
  3. Substituting with abs, glutes, or thighs. These are compensation patterns — the brain's way of finding an easier shortcut. They don't strengthen the right muscles and create imbalances over time.
  4. Expecting linear progress. Recovery is not a straight line. You may have good days and then a setback. Increased leakage after a more active day is normal and doesn't mean you're going backward.
  5. Stopping when things feel better. Most men stop their program when they reach 80–90% improvement. The final phase — return to exercise, intimacy, and full activity — requires continued work to consolidate gains.

A Structured 10-Week Program

Here's the general progression we use with our online class participants:

Get Guided Recovery — Not a Handout

Our live online classes give you expert instruction at every phase of recovery — with a DPT who specializes in exactly this. Small groups, real feedback, real results.

Book a Post-Surgery Class Pre-Surgery Prep Class