Prostate Surgery Rehabilitation: How Pelvic Health Physiotherapy Can Help

Prostate surgery can be a significant physical and emotional experience. Whether you are preparing for surgery or recovering afterwards, it is natural to have questions about what happens next — particularly when it comes to bladder control, pelvic-floor function, exercise and sexual health.

One part of recovery that is sometimes overlooked is pelvic health physiotherapy.

Pelvic health physiotherapists work with men before and after prostate surgery to help them understand how the pelvic floor works, prepare for surgery and support their recovery afterwards.

What happens to the pelvic floor during prostate surgery?

The prostate sits just below the bladder and surrounds part of the urethra. Close to it are important muscles, nerves and tissues involved in bladder control and sexual function.

Following prostate surgery, particularly prostatectomy, these structures can be affected. It is therefore common for men to experience changes in bladder control during the early stages of recovery.

Some men may experience:

• Urinary leakage, particularly when standing, coughing or exercising

• Increased urinary urgency or frequency

• Difficulty controlling urine

• Changes in sexual function

• Reduced confidence with returning to exercise and normal activities

For many men, these symptoms improve considerably during recovery. However, rehabilitation can help you understand what is happening and give you strategies to support that recovery.

Why is the pelvic floor important?

The pelvic floor is a group of muscles at the base of the pelvis. In men, these muscles help support the bladder and bowel and contribute to urinary and bowel control.

They also play an important role in sexual function.

When the pelvic-floor muscles contract, they help close the urethra and can therefore contribute to maintaining continence.

After prostate surgery, learning to correctly identify and use these muscles can be an important part of rehabilitation.

Pelvic-floor physiotherapy before prostate surgery

Ideally, pelvic-floor rehabilitation begins before surgery, where possible.

A pelvic health physiotherapist can teach you:

• Where your pelvic-floor muscles are

• How to correctly contract and relax them

• How to avoid accidentally using your abdominal, buttock or thigh muscles instead

• How to coordinate your pelvic floor with breathing

• How to use the muscles functionally when coughing, sneezing or changing position

• What to expect during the early stages of recovery

Having already learned these skills before surgery can make it easier to put them into practice afterwards.

It is important to remember that more squeezing is not necessarily better. Good pelvic-floor rehabilitation involves being able to contract the muscles appropriately, but also being able to relax them fully.

What happens after surgery?

Your rehabilitation will depend on the type of surgery you have had, your symptoms and your stage of recovery.

Initially, your physiotherapist may focus on helping you understand changes in bladder control and establishing a gentle pelvic-floor exercise programme.

As your recovery progresses, rehabilitation may include:

Pelvic-floor strengthening

Specific pelvic-floor exercises can help improve the muscles' ability to support continence.

The emphasis should be on quality rather than simply doing large numbers of repetitions.

Coordination

Your pelvic floor needs to work as part of a wider system.

You may be taught how to coordinate your pelvic floor with breathing and everyday movements such as standing, lifting and coughing.

Returning to exercise

Being diagnosed with prostate cancer or having prostate surgery does not mean that you need to stop being active permanently.

A gradual return to walking, strength work, Pilates or other exercise can be an important part of recovery.

Your physiotherapist can help you determine how and when to progress activity safely, taking into account your surgery and your individual recovery.

Managing urinary symptoms

Some men experience leakage for a period of time after surgery. Your physiotherapist can help you understand your symptoms and develop strategies for managing them.

If leakage persists or is significantly affecting your quality of life, it is worth seeking professional advice rather than simply putting up with it.

What about sexual function?

Sexual function can be affected by prostate surgery, and this can be a difficult subject to talk about.

Changes may include difficulties achieving or maintaining an erection, altered sensation or changes in ejaculation.

Recovery varies considerably between individuals and can depend on factors including the type of surgery, the condition being treated and the structures affected during surgery.

Pelvic health physiotherapy can form one part of a wider rehabilitation programme. Your healthcare team may also discuss medical treatments and other options where appropriate.

There is no need to feel embarrassed about raising these issues. They are a legitimate part of your recovery.

Does pelvic-floor physiotherapy really make a difference?

Research supports the use of pelvic-floor muscle training following prostatectomy for improving urinary continence, although recovery varies between individuals.

Importantly, pelvic-floor rehabilitation isn't simply about being given a list of exercises.

A physiotherapist can assess how you are using your pelvic-floor muscles, check that you are performing the exercises correctly and help you progress them as your symptoms change.

When should you see a pelvic health physiotherapist?

If you are having prostate surgery, it can be useful to ask about pelvic-floor physiotherapy before your operation, rather than waiting until problems develop.

You should also consider seeking advice if, after surgery, you are experiencing:

• Persistent urinary leakage

• Difficulty controlling your bladder

• Urinary urgency or frequency

• Difficulty returning to exercise

• Concerns about your pelvic-floor exercises

• Changes in sexual function

• Anxiety or uncertainty about your recovery

There is no particular reason to feel that you should simply "put up with it".

Recovery takes time

It is important to remember that recovery following prostate surgery is not always linear.

Some men improve quickly, while others take considerably longer. Having a period of urinary leakage after surgery does not mean that you will necessarily have a permanent problem.

Your rehabilitation should be individualised to you, your surgery and your symptoms.

At BodyRight Physiotherapy

At BodyRight Physiotherapy in Drogheda, our pelvic health physiotherapists work with men experiencing a range of pelvic-floor and bladder symptoms.

We understand that discussing bladder or sexual health can initially feel uncomfortable. Our approach is professional, confidential and centred around helping you understand what is happening and what you can do to support your recovery.

If you are preparing for prostate surgery, or are recovering afterwards and would like advice about pelvic-floor rehabilitation, you don't have to navigate it alone.

Contact BodyRight Physiotherapy Drogheda to arrange an assessment with one of our pelvic health physiotherapists.