So You’ve Had a Radical Prostatectomy… Now What?
A radical prostatectomy can be life-saving, but it can bring some pelvic side effects that can affect quality of life… such as:
Urinary incontinence: Damage or temporary loss of control of the urinary sphincter and pelvic floor muscles can lead to leakage with coughing, sneezing, lifting, or with urgency. Incontinence ranges from small leaks to more significant loss of bladder control.
Erectile dysfunction: Nerve injury during surgery can interrupt the vascular and neural pathways required for erection. Recovery can be gradual and may require a combination of medical and rehabilitative approaches.
Post-micturition dribbling: Incomplete emptying or residual urine held in the bulbar urethra and perineal tissues can cause dribbling after voiding. This is common and often related to pelvic floor muscle dysfunction.
Early hernias: Incisional or inguinal hernias can appear in the weeks to months after surgery, sometimes related to changes in intra-abdominal pressure, coughing, or weakness in the abdominal wall from surgery and reduced activity.
The good news is we can address a lot of these with pelvic physical therapy and other pelvic disciplines like:
Pelvic floor muscle training (PFMT): Targeted strengthening and coordination of the pelvic floor is the foundation of rehab for incontinence and dribbling. A clinician-guided program teaches correct muscle identification (often using internal or external assessment), progressive strengthening, endurance work, and functional integration (timing contractions with coughs, lifts, and voiding).
Biofeedback: Surface sensors or internal probes provide visual or auditory feedback to help patients locate and contract the right muscles, improve timing, and reduce overactivity or inappropriate bearing-down.
Bladder retraining and behavioral strategies: Timed voiding, urge suppression techniques, fluid management, and strategies to reduce nocturia support continence recovery while pelvic muscles strengthen.
Neuromodulation and adjunctive devices: For persistent urinary urgency or overactive bladder symptoms, neuromodulation (when indicated) or external devices can be considered alongside rehab and urology care.
Pelvic pain and scar mobilization: Manual therapy and scar mobilization techniques address tenderness, restricted tissue mobility, and guarding that can contribute to pain, pelvic floor dysfunction, or impaired sexual recovery.
Erectile rehabilitation: Pelvic rehab is used alongside medical treatments (phosphodiesterase inhibitors, vacuum erection devices, intracavernosal injections) to restore blood flow, encourage tissue health, and optimize pelvic floor coordination that supports erectile function and ejaculation.
Postoperative abdominal and core rehab: Progressive core strengthening, breathing retraining, and guidance on safe lifting reduce strain on the surgical site and may decrease risk of early hernia formation.
Referral and multidisciplinary care: Coordination with urology for persistent or severe symptoms, surgical evaluation for hernia repair, and sexual health specialists ensures comprehensive management.
What to expect and when to seek help
Start conservative pelvic rehab early or even prior to surgery if medically cleared.
Improvement is often gradual; continence and sexual function can recover over months to a year. Persistent or severe symptoms warrant urology follow-up and possible advanced interventions.
If you notice bulges, new localized pain, or changes at the incision site, get evaluated for a hernia sooner rather than later.
At Southern Grit PT & Wellness we focus on practical, function-first pelvic rehab for older adults and adaptive athletes. Individualized assessment, hands-on techniques, and stepwise exercise programs help men recover urinary control, reduce dribbling, improve sexual function alongside medical care, and safely rebuild core strength after surgery. If you've had a radical prostatectomy and are experiencing these issues, a targeted pelvic rehab evaluation is a good next step.
