Pelvic Floor Training for Male Incontinence After Surgery

Urinary incontinence after prostate surgery is common, expected, and - in most cases - treatable with pelvic floor exercises. If you're dealing with leaking after a prostatectomy or other pelvic procedure, you're not alone, and there's strong clinical evidence that structured pelvic floor training can significantly improve or resolve the problem.

Why Incontinence Happens After Prostate Surgery

During a prostatectomy (removal of the prostate gland), the internal urethral sphincter - one of two muscles that control urine flow - is often disrupted. The remaining muscle, the external urethral sphincter, becomes the primary line of defense. This muscle is part of the pelvic floor.

If the pelvic floor is weak or the man hasn't trained conscious control of this muscle, leaking occurs - during coughing, sneezing, lifting, or physical activity (stress incontinence), or as a persistent dribble.

The good news: the external sphincter can be strengthened. Pelvic floor muscle training (PFMT) is the first-line, non-surgical treatment recommended by urological guidelines.

The Evidence

A systematic review by Myers and Smith (2019, published in Physiotherapy) analyzed 10 clinical trials and found consistent evidence supporting pelvic floor exercises for male urinary incontinence.

Dorey et al. (2005) found that in their study of 55 men with erectile dysfunction, 65.5% also had post-micturition dribble (leaking after urination). Pelvic floor exercises significantly cured this condition (p<0.001) as a secondary benefit of the training.

Standard clinical practice for post-prostatectomy incontinence includes starting pelvic floor exercises before surgery (pre-habilitation) and resuming them as soon as the catheter is removed after surgery.

The Exercise Program

Finding the Right Muscles

Use the evidence-based technique cues from Ben Ami et al. (2022):

• Best cue: "Squeeze as if you're preventing gas from escaping" (91%+ correct activation)
• Confirmation: You should feel a slight lift of your scrotum during the squeeze
• Avoid: "Draw in your belly" (only 25% correct activation)
• Check: Place a hand on your abdomen - it should stay relaxed during the squeeze

The Exercises

Standard holds are the primary exercise for incontinence:

1. Squeeze the pelvic floor muscles with strong effort
2. Hold for 3-5 seconds initially, building toward 10 seconds
3. Release completely for 10 seconds
4. Repeat 10 times
5. Do 2-3 sessions per day

Quick flicks train the rapid contraction needed during coughing, sneezing, or sudden movement:

1. Contract quickly and firmly
2. Release immediately
3. Repeat 10-15 times
4. Rest 10 seconds between sets

The "Knack" technique - contract the pelvic floor BEFORE a cough, sneeze, or lift. This preemptive contraction supports the urethra before the pressure spike hits. Once you've built some baseline strength, practice timing your contraction to just before a cough or before picking something up.

Post-urination squeeze (from Dorey's protocol): After finishing at the toilet, while still standing or sitting, perform a strong pelvic floor contraction to expel any remaining urine from the urethra. This directly addresses post-micturition dribble.

Progression

• Weeks 1-4: Focus on correct identification and gentle activation. If you're recovering from surgery, be gentle - the tissues are healing.
• Weeks 5-8: Gradually increase hold duration and contraction effort.
• Weeks 9-12: Build toward maximum-effort contractions with 10-second holds.
• Ongoing: Most men see significant improvement by 3-6 months post-surgery. Some continue improving up to 12 months.

Important Notes for Post-Surgical Recovery

• Start before surgery if possible. Men who begin pelvic floor exercises before prostatectomy typically recover continence faster than those who start after.
• Be gentle in the first weeks after catheter removal. The tissues need time to heal. Light contractions initially, increasing effort gradually.
• Consistency matters more than intensity. Three gentle daily sessions beat one intense session.
• Talk to your surgical team. They can provide specific guidance based on your procedure and recovery timeline.

Frequently Asked Questions

Guided Training for Recovery

Kegel King includes a bladder control training program with exercise parameters appropriate for incontinence recovery - gentler starting points, emphasis on standard holds and quick contractions, and progressive difficulty that adapts as your muscles recover. Haptic cues guide each exercise hands-free. For help choosing the right tool, see our guide to the best kegel app for bladder control.